The factor structure of the Edinburgh Postnatal Depression Scale among perinatal high-risk and community samples in London

Alexandra Lautarescu,Michael C Craig,Serena J Counsell,A David Edwards,Alex Lau-Zhu,Suresh Victor

doi:10.1007/s00737-021-01153-0

Abstract

Timely and accurate detection of perinatal mental health problems is essential for the wellbeing of both mother and child. Growing evidence has suggested that the Edinburgh Postnatal Depression Scale (EPDS) is not a unidimensional measure of perinatal depression, but can be used to screen for anxiety disorders. We aimed to assess the factor structure of the EPDS in 3 different groups of women: n = 266 pregnant women at high-risk of depression (“Perinatal Stress Study”), n = 471 pregnant women from a community sample, and n = 637 early postnatal women from a community sample (“developing Human Connectome Project”). Exploratory factor analysis (40% of each sample) and confirmatory factor analysis (60% of each sample) were performed. The relationship between EPDS scores and history of mental health concerns was investigated. Results suggested that a 3-factor model (depression, anxiety, and anhedonia) is the most appropriate across groups. The anxiety subscale (EPDS-3A) emerged consistently and was related to maternal history of anxiety disorders in the prenatal sample (W = 6861, p < 0.001). EPDS total score was related to history of mental health problems in both the prenatal (W = 12,185, p < 0.001) and postnatal samples (W = 30,044, p < 0.001). In both high-risk and community samples in the perinatal period, the EPDS appears to consist of depression, anxiety, and anhedonia subscales. A better understanding of the multifactorial structure of the EPDS can inform diagnosis and management of women in the prenatal and postnatal period. Further research is required to validate the EPDS-3A as a screening tool for anxiety.

Highlights

Mood and anxiety disorders in the perinatal period affect up to a quarter of women (Howard and Khalifeh 2020)
In addition to the models suggested by the exploratory factor analysis (EFA), a number of models chosen to reflect the wide variety of solutions from the literature were examined using confirmatory factor analysis (CFA): 1-factor model (Cox et al 1987; Lydsdottir et al 2019); bifactorial model containing depression and anxiety (Phillips et al 2009; Matthey 2008); bifactorial model containing depression and anhedonia (Zhong et al 2014); a 3-factor model containing depression, anxiety, and self-harm (Brouwers et al 2001); and three 3-factor models containing anhedonia, anxiety, and depression (Lau et al 2010; Kubota et al 2014; Tuohy and McVey 2008)
In the community postnatal sample, the Edinburgh Postnatal Depression Scale (EPDS) total score was higher in mothers of babies born extremely preterm, with a mean EPDS total score of 10.13 ± 5.36, than in mothers of babies born at term, with a mean EPDS total score of 5.22 ± 4.12

Summary

Introduction

Mood and anxiety disorders in the perinatal period affect up to a quarter of women (Howard and Khalifeh 2020). Screening strategies to date have focused predominantly on perinatal depression. This is a significant shortcoming, as exposure to prenatal maternal anxiety has detrimental behavioural and cognitive effects on the offspring Prenatal anxiety is associated with an increased risk for severe postnatal depression (Norhayati et al 2015). A recommendation to expand antenatal screening to include a tool to assess for anxiety may be impractical in the context of antenatal clinics that are already under significant pressure. An alternative would be to adapt our current screening tools to identify potential anxiety disorders

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Results

Conclusion