Comprehensive Community-Based PPD Screening

Abstract

Background: Despite growing recognition of postpartum depression (PPD) as a global childbirth-related problem, until recently the importance of detecting and treating postpartum depression has been largely been ignored.Purpose: To test a community-based postpartum depression (PPD) screening plan, and compare the EPDS-3 to the EPDS-10.Methodology: Nurses at two Boston Hospitals provided study information to eligible women CARE study nurses then asked women to complete the Permission to Be Contacted Form (PCF). Research nurses contacted women who completed the PCF by telephone and by mail at 4 weeks postpartum to administer the EPDS, and invited women with EPDS scores ≥ 10 to participate in Phase 2. A CARE advanced practice psychiatric nurse (APRN) arranged a home visit to obtain informed consent and administer the SCID diagnostic interview.Findings: Study nurses received permission from 7,212 mothers to be contacted and screened 5,169 mothers aged 14-49 using the EPDS-10. Of this group 674 (13%) women met criteria with EPDS scores ≥10. Elevated PPD scores were associated with race/ethnicities other than Caucasian, and less than high school education, but not with age or parity. The EPDS -10 had better internal consistency than the EPDS- 3 and detected PPD risk at 13% The EPDS-3 identified 40% of women with PPD risk, rendering it ineffective as a screening measure. Conditional probabilities indicated positive predictive validity and low specificity for the EPDS-3 in relation to EPDS-10 and SCID criteria.Summary Concluding Statement: The success of our approach supports adaptation for systematic community-based PPD screening in research and testing in practice. Our results support continued use of the EPDS- 10 with diagnostic confirmation over use of the EPDS-3. Background: Despite growing recognition of postpartum depression (PPD) as a global childbirth-related problem, until recently the importance of detecting and treating postpartum depression has been largely been ignored. Purpose: To test a community-based postpartum depression (PPD) screening plan, and compare the EPDS-3 to the EPDS-10. Methodology: Nurses at two Boston Hospitals provided study information to eligible women CARE study nurses then asked women to complete the Permission to Be Contacted Form (PCF). Research nurses contacted women who completed the PCF by telephone and by mail at 4 weeks postpartum to administer the EPDS, and invited women with EPDS scores ≥ 10 to participate in Phase 2. A CARE advanced practice psychiatric nurse (APRN) arranged a home visit to obtain informed consent and administer the SCID diagnostic interview. Findings: Study nurses received permission from 7,212 mothers to be contacted and screened 5,169 mothers aged 14-49 using the EPDS-10. Of this group 674 (13%) women met criteria with EPDS scores ≥10. Elevated PPD scores were associated with race/ethnicities other than Caucasian, and less than high school education, but not with age or parity. The EPDS -10 had better internal consistency than the EPDS- 3 and detected PPD risk at 13% The EPDS-3 identified 40% of women with PPD risk, rendering it ineffective as a screening measure. Conditional probabilities indicated positive predictive validity and low specificity for the EPDS-3 in relation to EPDS-10 and SCID criteria. Summary Concluding Statement: The success of our approach supports adaptation for systematic community-based PPD screening in research and testing in practice. Our results support continued use of the EPDS- 10 with diagnostic confirmation over use of the EPDS-3.