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