Reproducibility of the Edinburgh Postnatal Depression Scale during the Postpartum Period

Abstract

Objective This study was aimed to evaluate the efficacy of the Edinburgh Postnatal Depression Scale (EPDS) in the immediate postpartum period, which we defined as between 3 and 24 hours postpartum for the purpose of this research. This is such that if it can predict scores obtained at the postpartum visit, it will be an opportunity to access psychiatric services for the patient that may otherwise be more difficult to access in the outpatient setting.

Study Design Longitudinal observational study, which included an analysis of 848 consecutive participants screened with the EPDS in the hospital and at the 6-week postpartum visit.

Results Receiver-operating characteristic (ROC) curve suggested >3 at delivery as a more optimal score to predict depression at the postpartum visit with sensitivity 76.5% and specificity 65.9%. The commonly accepted EPDS cut-off value of >9 was far less sensitive at 28.8% but reasonably specific at 93.2% for predicting elevated scores (>9) 6 weeks postpartum. In subgroup analysis, only a prior mental health disorder was found to be predictive of elevated scores at the postpartum visit (relative risk: 1.97, 95% confidence interval: 1.17–3.32, p = 0.01).

Conclusion The EPDS, originally designed to screen for postpartum depression (PPD) in the outpatient setting, does not predict the development of PPD, as determined by the EPDS (validated at the 6-week postpartum time interval) when administered during hospitalization shortly after delivery.

Key Points

• EPDS is a validated screening tool for PPD that is validated in the outpatient setting, but various guidelines are presently unclear on the exact timing for PPD screening.

• EPDS scores from 3 to 24 hours postpartum does not reliably predict elevated scores 6 weeks later.

• EPDS scores >3 from 3 to 24 hours postpartum may identify need to “rule out” PPD 6 weeks later.

Keywords

depression - Edinburgh Postnatal Depression Scale - mood - perinatal - postpartum - screening

Publikationsverlauf

Eingereicht: 03. August 2020

Angenommen: 02. März 2021

Artikel online veröffentlicht:
21. April 2021

• References

• 1 Brummelte S, Galea LA. Postpartum depression: etiology, treatment and consequences for maternal care. Horm Behav 2016; 77: 153-166
• 2 Bobo WV, Yawn BP. Concise review for physicians and other clinicians: postpartum depression. Mayo Clin Proc 2014; 89 (06) 835-844
• 3 Slomian J, Honvo G, Emonts P, Reginster JY, Bruyère O. Consequences of maternal postpartum depression: a systematic review of maternal and infant outcomes. Womens Health (Lond) 2019; 15: 1745506519844044
• 4 Netsi E, Pearson RM, Murray L, Cooper P, Craske MG, Stein A. Association of persistent and severe postnatal depression with child outcomes. JAMA Psychiatry 2018; 75 (03) 247-253
• 5 Rowan PJ, Duckett SA, Wang JE. State mandates regarding postpartum depression. Psychiatr Serv 2015; 66 (03) 324-328
• 6 O'Hara MW, Schlechte JA, Lewis DA, Wright EJ. Prospective study of postpartum blues. Biologic and psychosocial factors. Arch Gen Psychiatry 1991; 48 (09) 801-806
• 7 American Psychiatric Association, Depressive disorders, Diagnostic and Statistical Manual of Mental Disorders. 5th ed.. American Psychiatric Association. 2013
• 8 Fisher SD, Wisner KL, Clark CT, Sit DK, Luther JF, Wisniewski S. Factors associated with onset timing, symptoms, and severity of depression identified in the postpartum period. J Affect Disord 2016; 203: 111-120
• 9 Altemus M, Neeb CC, Davis A, Occhiogrosso M, Nguyen T, Bleiberg KL. Phenotypic differences between pregnancy-onset and postpartum-onset major depressive disorder. J Clin Psychiatry 2012; 73 (12) e1485-e1491
• 10 Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; 150: 782-786
• 11 Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium. Heterogeneity of postpartum depression: a latent class analysis. Lancet Psychiatry 2015; 2 (01) 59-67
• 12 Levis B, Negeri Z, Sun Y, Benedetti A, Thombs BD. DEPRESsion Screening Data (DEPRESSD) EPDS Group. Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data. BMJ 2020; 371: m4022
• 13 Gynecologists TACoOa. Screening for perinatal depression. ACOG Committee Opinion No. 757. Obstet Gynecol 2018; 132 (05) e208-e212
• 14 Texas Department of Health and Human Services. Policy No. 12370, Revision 19–0: Postpartum Depression Among Women Utilizing Medicaid. 2019 . Accessed February 1, 2020 at: https://hhs.texas.gov/sites/hhs/files/Postpartum-Depression-Among-Women-Utilizing-Texas-Medicaid.pdf
• 15 Texas Department of Health and Human Services. The Texas Clinician's Postpartum Depression Toolkit: A resource for screening, diagnosis and treatment of postpartum depression (Volume 2). Accessed February 1, 2020 at: https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/health/women/tx-clinicians-ppd-toolkit.pdf
• 16 Dennis CL. Can we identify mothers at risk for postpartum depression in the immediate postpartum period using the Edinburgh Postnatal Depression Scale?. J Affect Disord 2004; 78 (02) 163-169
• 17 El-Hachem C, Rohayem J, Bou Khalil R. et al. Early identification of women at risk of postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS) in a sample of Lebanese women. BMC Psychiatry 2014; 14: 242
• 18 Knights JE, Salvatore ML, Simpkins G, Hunter K, Khandelwal M. In search of best practice for postpartum depression screening: is once enough?. Eur J Obstet Gynecol Reprod Biol 2016; 206: 99-104
• 19 Burton A, Patel S, Kaminsky L. et al. Depression in pregnancy: time of screening and access to psychiatric care. J Matern Fetal Neonatal Med 2011; 24 (11) 1321-1324
• 20 Bryant AS, Haas JS, McElrath TF, McCormick MC. Predictors of compliance with the postpartum visit among women living in healthy start project areas. Matern Child Health J 2006; 10 (06) 511-516
• 21 McCarthy M, McMahon C. Acceptance and experience of treatment for postnatal depression in a community mental health setting. Health Care Women Int 2008; 29 (06) 618-637
• 22 Henderson V, Stumbras K, Caskey R, Haider S, Rankin K, Handler A. Understanding factors associated with postpartum visit attendance and contraception choices: listening to low-income postpartum women and health care providers. Matern Child Health J 2016; 20 (Suppl. 01) 132-143
• 23 Goyal D, Gay C, Lee KA. How much does low socioeconomic status increase the risk of prenatal and postpartum depressive symptoms in first-time mothers?. Womens Health Issues 2010; 20 (02) 96-104
• 24 Cox J. Use and misuse of the Edinburgh Postnatal Depression Scale (EPDS): a ten point ‘survival analysis’. Arch Women Ment Health 2017; 20 (06) 789-790
• 25 Iwata H, Mori E, Sakajo A, Aoki K, Maehara K, Tamakoshi K. Prevalence of postpartum depressive symptoms during the first 6 months postpartum: association with maternal age and parity. J Affect Disord 2016; 203: 227-232
• 26 Rowe HJ, Fisher JR, Loh WM. The Edinburgh Postnatal Depression Scale detects but does not distinguish anxiety disorders from depression in mothers of infants. Arch Women Ment Health 2008; 11 (02) 103-108