The usage of the Hospital Anxiety and Depression Scale during third trimester to predict the possibility of postpartum depression

Abstract

Objective To explore the possibility of predicting postnatal depression based on Hospital Anxiety and Depression (HAD) scale for women during the third trimester of pregnancy. Methods 1 230 pregnant women were evaluated during their third trimester of pregnancy using HAD scale deriving from common questionnaire and self-related questionnaire, and again 4 weeks postnatal using Edinburgh Postnatal Depression Scale (EPDS). Results (1) The incidences for depression and anxiety during the third trimester of pregnancy were 5.20% (64 /1 230) and 4.07% (50 /1 230）, respectively. The incidence of postnatal depression was 9.98% (121 /1 213). (2) According to the two step screening diagnosis for severe postnatal depression, the 1 230 cases were categorized into patient group (121 cases) and normal group (1 092 cases). There were statistically significant differences between the two groups in age, the relationship of the couple, work and study pressure, knowledge of childbirth, parenting and postnatal depression, maternal gender discrimination, group HAD score and EPDS score (χ2= 6.54, 6.92, 8.07, 23.82, 21.88, 10.24, 9.26, 6.63, 5.66, P<0.05 for all). There were no significant differences between the two groups in marital status, personality, level of education, occupation, history of abnormal delivery, complications of pregnancy, gender discrimination from the husband and/or family. (3) In ROC curve the optimal critical value of the HAD during postnatal depression was 9 symptoms. For the cases who got an A or D in the HAD scale, the sensitivity and specificity of predicting postnatal depression were 86.21%/87.64%, 95.43%/94.72%, respectively. (4) For the cases who got an A or D in the HAD scale, the area under the ROC curve were 0.941 and 0.914, respectively. (5) The optimal critical value of HAD was related to the scores of EPDS after delivery (r=0.852, 0.846, both P<0.01). (6) For the cases with HAD ≥ 9 points, the probability for the risk of postnatal depression will be increased by 15.891 and 18.264 times, respectively. Conclusion HAD scale can be used as a routine screening method for women in late stage pregnancy. Women with HAD≥9 points should be comprehensively evaluated for the risk of postnatal depression. Key words: Depression，postpartum; Late pregnancy; Hospital Anxiety and Depression Scale; Forecasting