Application of Beck's Depression Inventory for screening post-miscarriage psychiatric morbidity

Miscarriage is the most common complication of pregnancy and it could be associated with significant psychological consequences. This study aimed to evaluate the 21-item Beck's Depression Inventory (BDI) in screening psychiatric morbidity after miscarriage. This was a prospective cohort study carried out at a university teaching hospital. Consecutive patients admitted for miscarriage were recruited. Six weeks after miscarriage, the patients were asked to fill out the BDI. Psychiatric “case” or “non-case” was diagnosed by a psychiatrist using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-R. A receiver operating characteristic (ROC) curve was constructed for BDI. Of the 337 patients recruited, 222 (66%) returned for SCID and 27 patients (12.2%) were found to be psychiatric cases. The mean BDI scores were significantly higher for the cases (19.8±7.1 vs. 6.5±7.5, P<0.001). An ROC with area under curve (AUC) of 0.93 (95% CI 0.87-0.99, P<0.001) was constructed. At the best BDI cutoff score (≥12) identified from the ROC, a sensitivity of 91.7%, specificity of 88%, positive predictive value (PPV) of 48.9%, and negative predictive value (NPV) of 98% were obtained. In conclusion, BDI is an effective tool in screening psychiatric morbidity after miscarriage. However, given a PPV of 48.9%, it should not be employed for diagnostic purpose.