The Edinburgh Postpartum Depression Scale: Stable structure but subscale of limited value to detect anxiety.

Angarath I Van Der Zee-Van Den Berg,Magda M Boere-Boonekamp,Catharina G M Groothuis-Oudshoorn,Sijmen A Reijneveld,Angela Lupattelli

doi:10.1371/journal.pone.0221894

Angarath I Van Der Zee-Van Den Berg, Magda M Boere-Boonekamp + Show 3 more

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https://doi.org/10.1371/journal.pone.0221894

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Abstract

PurposeThe Edinburgh Postnatal Depression Scale (EPDS) aims at detecting postpartum depression. It has been hypothesized that a subscale (items 3, 4, 5) may detect anxiety. The aim of this study is to assess whether this EPDS anxiety subscale is present in a community-based dataset, and if so, to assess its validity and stability during the first six months postpartum.MethodsWe obtained EPDS data of a community sample of 1612 women at 1 month, with follow-up at 3 and 6 months, postpartum (Post-Up study). We performed an exploratory factor analysis on the EPDS forcing two- and three-factor solutions. We assessed the correlations of the extracted factor subscales and the total EPDS with the short-form of the STAI (STAI-6). We examined the stability of the identified factors by means of a confirmatory factor analysis (CFA), using the EPDS data collected at 3 and 6 months postpartum.ResultsBoth the two- and three-factor solutions contained a hypothesized anxiety subscale of items 3,4,5,10, and fitted well with the 3- and 6-months EPDS data, with CFI and TLI values >.99 and RMSEA and SRMR values < .035 and < .45. The subscale’s Pearson correlations with the STAI-6 were moderate: .516, compared to .643 for the total EPDS.ConclusionsThe factor structure of the EPDS is stable across the first six months postpartum, and includes the subscale assumed to represent anxiety. However, this subscale as well as the total EPDS correlate only moderately with anxiety criteria. Using the EPDS thus does not imply adequate screening for anxiety.

Highlights

In the postpartum period, both depression and anxiety frequently occur, with reported metaanalysis period prevalence rates of 19.2% for major and minor depression (0–3 months postpartum) [1], and 13.2% for anxiety (0–24 weeks postpartum) [2]
Using the Edinburg Postnatal Depression Scale (EPDS) does not imply adequate screening for anxiety
This hypothesized anxiety subscale, named the EPDS-3A by Matthey [13], might be of clinical interest when considering screening for anxiety along with postpartum depression (PPD)

Summary

Introduction

Both depression and anxiety frequently occur, with reported metaanalysis period prevalence rates of 19.2% for major and minor depression (0–3 months postpartum) [1], and 13.2% for anxiety (0–24 weeks postpartum) [2]. The majority of the factor solutions found contained a subscale formed by three items (3, 4 and 5), interpreted as being an anxiety subscale, even though evidence on the total number of factors and item allocation is inconclusive. This hypothesized anxiety subscale, named the EPDS-3A by Matthey [13], might be of clinical interest when considering screening for anxiety along with PPD. The aim of this study is to assess whether the hypothesized EPDS anxiety subscale is present in EPDS data of a large community based sample, and if so, to assess whether this subscale enables measurement of anxiety in addition to depression, and is stable across the first six months postpartum. Correlations between the factors in the factor models can be found in S1 and S2 Figs

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