Screening accuracy and psychometric properties of the whooley questions, Edinburgh postnatal depression scale, and patient health questionnaire-9 among pregnant women.

OBJECTIVE: To compare the psychometric properties and diagnostic interview-validated screening accuracy of the Whooley Questions (WQ), Edinburgh Postnatal Depression Scale (EPDS), and Patient Health Questionnaire-9 (PHQ-9) among pregnant women in routine obstetric care. METHODS: This diagnostic accuracy study was conducted in a tertiary obstetric outpatient clinic in China from January to February 2025. A total of 557 consecutive pregnant women completed the WQ, EPDS, and PHQ-9, and 215 also completed a DSM-IV-based structured diagnostic interview as the reference standard. Internal consistency, structural validity, and diagnostic accuracy were evaluated. RESULTS: In this sample, the EPDS showed the highest discriminative accuracy and the clearest latent structure, whereas the PHQ-9 showed weaker structural validity. The WQ and PHQ-9 showed higher specificity and lower screen-positive rates than the EPDS, suggesting potential utility as brief triage tools when rapid screening or reduced follow-up burden is prioritized. However, because few depression cases were confirmed by diagnostic interview, comparative accuracy estimates should be interpreted cautiously. CONCLUSIONS: In this Chinese antenatal sample, the three instruments showed different psychometric and diagnostic performance profiles. The EPDS may be useful when sensitivity is prioritized, whereas the WQ and PHQ-9 may support brief triage or supplementary risk stratification in time-limited settings. These findings support context-adapted tool selection rather than reliance on a single optimal instrument for all antenatal screening purposes.