Abstract
BackgroundAnxiety in the ante- and postnatal period is prevalent, often co-occurs with depression, and can have adverse consequences for the infant. Therefore, perinatal mental health screening programs should not only focus on depression but also on detecting anxiety. However, in many already implemented perinatal screening programs, adding extra screening instruments is not feasible. We examine the utility of a subscale of the Edinburgh Postnatal Depression Scale (EPDS) consisting of items 3, 4, and 5 (EPDS-3A) for detecting anxiety in new mothers.MethodsWe used confirmatory factor analysis (CFA) to confirm the presence of the EPDS-3A found in a previous study (n = 320) where exploratory factor analysis (EFA) was used. For the CFA we used a sample of new mothers (n = 442) with children aged 2–11 months recruited from the same population from which mothers for the previous study was recruited. Three models were tested and compared. Receiver operating characteristics of the EPDS-3A were investigated in relation to anxiety caseness status on the combined sample (N = 762). Sample weighing was used to match the dataset to the target population. Cross tabulation was used to investigate the proportion of anxiety cases identified by the EPDS-3A above those identified with the total EPDS.ResultsThe presence of the EPDS-3A was confirmed. An EFA-driven, two-dimensional 7-item model showed the best data fit with one factor representing the anxiety subscale consisting of items 3, 4, and 5. An EPDS-3A score of ≥ 5 was the most optimal for identifying cases of anxiety (sensitivity: 70.9; specificity: 92.2; AUC: 0.926). Further, we found that the EPDS-3A identifies an additional 2.5% of anxiety cases that would not have been identified with the total EPDS.ConclusionsThe EPDS-3A can be used as a time-efficient screening for possible anxiety in ante- and postnatal mothers. However, adding the EPDS-3A to routine screening with the total EPDS does not lead to a substantial increase in the number of women identified. In line with previous studies, this study confirms that the EPDS identifies anxiety in addition to depression. Therefore, assessment and treatment adjusted to the specific emotional difficulties is imperative.
Highlights
Anxiety in the ante- and postnatal period is prevalent, often co-occurs with depression, and can have adverse consequences for the infant
In the current study, we investigate the utility of using a subscale of the Edinburgh Postnatal Depression Scale (EPDS: [12]) to screen for anxiety in postpartum mothers
Be confirmed in a new sample of postnatal mothers recruited from the same population from which participants were recruited for the Dansih validation of the EPDS [15]?; and (2) can the EPDS-3A be used as an acceptable screening instrument in the detection of anxiety cases? We addressed this question by (a) evaluating Receiver Operating Characteristics (ROCs) of the EPDS-3A in relation to anxiety caseness status, and (b) investigating whether the EPDS-3A increases identification of women in need for further assessment and treatment above those identified by the total EPDS score
Summary
Anxiety in the ante- and postnatal period is prevalent, often co-occurs with depression, and can have adverse consequences for the infant. A populationbased study of postnatal women (N = 522) found that 52% of those, who reported depressive symptoms, presented with high levels of anxiety [10], another study (N = 4451) found a prevalence of postnatal anxiety of 18% out of which 35% reported symptoms of depression [5], and a recent meta-analysis shows that the prevalence of co-morbid depression and anxiety disorder is 8.2% during the first 24 weeks postnatal [3] Based on such results, it may be argued that perinatal screening programs should include the detection of women with high levels of anxiety [3, 11]. In the current study, we investigate the utility of using a subscale of the Edinburgh Postnatal Depression Scale (EPDS: [12]) to screen for anxiety in postpartum mothers
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