Screening for depression in the postpartum using the Beck Depression Inventory II: What logistic regression reveals

Abstract

Objective: To identify items on the Beck Depression Inventory-II (BDI-II) that best discriminate between clinically depressed and nondepressed postpartum women. Background: Postpartum depression is a serious and widespread health burden, and the BDI-II is commonly used to detect depression in the postpartum. Yet certain depressive symptoms are ‘normative’ sequelae of childbirth, calling into question the discriminative utility of the BDI-II. Methods: We examined the prospective contribution of BDI-II items to identify items that have the strongest relation with clinical postpartum depression. Women with BDI-II scores >12 were invited to participate in a structured clinical interview. A logistic regression was conducted to determine which BDI-II items discriminated between women who were later diagnosed as Depressed (n = 75) and Nondepressed (n = 78). Results: Of the 11 BDI-II items that differed between the two groups, eight represented cognitive/affective symptoms. Results from the logistic regression indicated that four BDI-II symptoms were significant predictors of Depression status: sadness, pessimism, loss of interest, and changes in appetite. Conclusion: The BDI-II should be used in the postpartum with caution. Professionals who screen for postpartum depression should pay particular attention to cognitive/affective symptoms, as they appear more robust to normative physical and emotional changes that occur in the postpartum.