Postnatal Depression Test Pro medical app, review of a postpartum depression screening medical app

Purpose of App Review

  • to evaluate the usability of the app
  • to evaluate the questions utilized compared to Edinburgh Postnatal Depression Scale

Introduction

Depression affects 4 in 10 Americans. Postpartum depression affects up to 25% of postpartum women.

Screening for postpartum depression is different than screening for major depressive disorder.

The Edinburgh Postnatal Depression Scale (EPDS) provides a sensitive and specific screening tool for postpartum depression and until recently, the tool was usually given in paper form.

The Postnatal Depression Test Pro app provides an electronic version of the EDPS for perinatal care providers and their patients.

User Interface

Upon initial use of the app, the configuration page allows you to personalize the header with your practice’s settings as well as to set digital signature preferences.

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The home page of the app allows you to conduct a Quick Test, see Existing Patients, or to Register a new patient.

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Choosing New Patient allows you to create/input a unique identifier before proceeding to the test.

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Regardless of choosing New Patient or Quick Test, you will be taken to the intro screen for the EDPS.

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At this point, the app can be given to the patient, who chooses to begin the test. The provider can also ask the patient the questions or assist them in answering the questions. They can then choose their answer for each of 10 questions in the EDPS.

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After answering the ten questions, the patient can add a comment to the comments section.

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After comments are entered or the section is skipped, you are taken to the score page. Below the numerical score, a line suggests if the patient is a candidate for therapy.

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The Score page also gives you several options: Your Report, Your Patient’s, and View Guidelines. The Your Report and Your Patient’s radio button allows you to see the questions, answers, and score; I have not been able to decipher a difference in the two types of reports.

2013-09-11 20.42.23 2013-09-11 20.42.48From either of these screens, you can email or print the report. If you have entered the patient as a New Patient, you can also save the report, which then is available in iTunes as a HTML file (as far as I can tell, other than your iTunes password, the data is not otherwise protected or encrypted).

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Also from the Score page, you can access the EDPS guidelines via the View Guidelines. This screen tells you how the questions are to be scored, what the maximum score of the test is, reminds you to look carefully at question 10, and states whether depression is possible in scores of 10 or more. The Existing Patients screen brings you to a screen of previously entered patients. By choosing a patient from this menu, you can begin a new test, but not review previous tests.

To look at previous tests for patients, select the View Existing radio button from the home screen. You are brought to a list of patients.

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You can also select the patient and look at the score screen and reports for each test. This can be helpful in documenting how patient’s scores change over their pregnancy and postpartum periods, which may help to identify needing additional counseling or therapy.

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Evidence and literature to support use

  • The app states that it is based on the EDPS and provides the original reference. The link provided by the developers goes to wikipedia description, but not the original article.
  • The Edinburgh Postnatal Depression Scale is a validated screening tool. The EDPS was developed in the 1980s. The first study describing it was published in 1987 by Cox et al, in the British Journal of Psychiatry. Several validation studies have been published on the EDPS and include a variety of patient populations. It was first described for postpartum/postnatal depression screening, but has been used by some for antepartum baseline setting and antepartum depression identification.
  • All of the questions are the same as the EDPS, except for Question 3 in the report (but not in the actual patient questionnaire portion). EDPS’s Question #3 is I have blamed myself unnecessarily when things went wrong, whereas this app’s report portion Question #3 is Trouble falling asleep, staying asleep, or sleeping too much.

Price

  • $1.99

Likes

  • ability to email and print report for both providers and for patients
  • comments section available
  • header and signature personalization available
  • exact replication of the EPDS
  • includes guide to scoring/interpretation of screening tool

Dislikes

  • only available in English (the paper version is available in 12 languages)
  • does not list references
  • the Scores page does not flag undesirable answers in question 10, which solicits if the patient endorses suicidal ideation
  • claim that a score greater than or equal to 10 signifies needing treatment (12.5 was the original cutoff used by Cox.  Jardri et al uses a score greater than 8 as their cutoff. In a brief report, Guedeney et al  lists the cutoff values for several validation studies. A commonly used cutoff is 12 or 13 points, although there is controversy to scores between 7 and 12-13)
  • inability to passcode protect app or app data
  • change in question three from question on blaming to question on sleeping (**only in the report section)

Healthcare providers that would benefit from the app

  • For healthcare providers caring for women who are pregnant or who are recently postpartum

Patients that may benefit from app

  • Women who are pregnant or who have just recently delivered

Conclusion

  • The Postnatal Depression Test Pro app provides a portable and exact replication of the EPDS. The Pro version of the app allows you to save individual patients, as well as their individual tests – without password protection/encryption, this version violates HIPAA laws.
  • The app additionally provides a general guideline as to whether the patient may need treatment for possible depression, although this should be interpreted only by those trained to interpret EPDS scores.
  • This app is currently not available on the Android platform.

iTunes Link

Rating: 4.25/5
1. User Interface – 4.  Easy to use. Configuration screen routinely pops up if not previously addressed
2. Multimedia usage – 4.  Utilizes split screen and clean transitions.
3. Price – 4. $1.99.
4. Real world applicability – 5. Could be used on a daily basis depending on how often one sees postpartum patients

App version: 1.0
Compatibility: Compatible with iPhone, iPad, and iPod touch. Optimized for iPhone 5.
Requires: iOS 4.3 or later
Tested on: iPhone 4S

References

Disclaimer:
This post does not establish, nor is it intended to establish, a patient physician relationship with anyone. It does not substitute for professional advice, and does not substitute for an in-person evaluation with your healthcare provider. It does not provide the definitive statement on the subject addressed. Before using these apps please consult with your own physician or healthcare provider as to the apps validity and accuracy as this post is not intended to affirm the validity or accuracy of the apps in question. The app(s) mentioned in this post should not be used without discussing the app first with your healthcare provider.

Author:

Kelli Barbour MD
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