Edinburgh Postnatal Depression Scale Total Score Research Articles

The relationship between personality traits and individual factors with perinatal depressive symptoms: a cross-sectional study

BackgroundPregnancy is a crucial transition moment exposing women to potential mental health problems, especially depressive disturbances. Sociodemographic, pregnancy-related, and psychological factors have been related to depressive symptoms in the perinatal period. This study aims at (1) exploring personality and individual factors related with perinatal depressive symptoms, and (2) testing the mediating role of personality in the relation between characteristics of the woman’s family of origin and depressive symptoms.MethodsWomen in the perinatal period admitted to the gynecology unit for motherhood-related routine assessments (n = 241) were included in the study. A survey on individual sociodemographic, clinical, and pregnancy-related factors was administered, also including the Edinburgh Postnatal Depression Scale (EPDS) and the BIG-5 personality test.ResultsCouple conflict and neuroticism were independent and directly correlated with EPDS total score (respectively: B = 2.337; p = .017; B = 0.303; p < .001). Neuroticism was a significant mediator of the relation between the presence of a psychiatric disorder diagnosis in participant’s parents and the EPDS total score (indirect b = 0.969; BCCI95%=0.366—1.607).ConclusionsCouple relation and neuroticism traits are individual factors related to depressive symptoms in the perinatal period. The family of origin also plays an indirect role on perinatal depressive symptoms. Screening of these factors could lead to early recognition and more tailored treatments, ultimately leading to better outcome for the entire family.

Prenatal attachment in women with twin versus singleton pregnancy: Socio-demographic, mental health and pregnancy-related predictors

BackgroundWhile twin pregnancy (TP) is associated with increased maternal physical and psychological risks, little is known about how this context interferes with prenatal attachment. AimsTo compare the level of prenatal attachment between women with TP and singleton pregnancy (SP), and to investigate socio-demographic, maternal mental health and pregnancy-related predictors. Study designCase-control study in a university hospital. Subjects119 women with TP during their last trimester of pregnancy versus 103 women with SP. Outcome measuresThe Prenatal Attachment Inventory (PAI), the Edinburgh Postnatal Depression Scale (EPDS), in addition to the collection of general socio-demographic and medical data. ResultsThe mean PAI total score did not significantly differ between the two groups. In the group of women with TP, low but statistically significant correlations were found between the PAI total score and the EPDS total score (r = −0.21) and with maternal age (r = −0.20). ConclusionsNo major difference in prenatal attachment was found in women TP compared to those with SP. A higher level of depressive symptoms is worth considering to explore the risk of suboptimal attachment in this population. Questions were raised about the applicability of usual measures of prenatal attachment in this context.

Association of Postpartum Pain Sensitivity and Postpartum Depression: A Prospective Observational Study.

IntroductionPostpartum depression (PPD) is a severe psychiatric disorder that negatively affects postnatal mothers worldwide. The aim of the study is to investigate the association between postpartum pain sensitivity and PPD as well as to identify the other potential risk factors for PPD and their interconnections.MethodsThe current study was a prospective observational clinical study that enrolled 210 singleton pregnant women in a tertiary referral hospital from January to December 2020. Postpartum pain sensitivity was assessed by the Mandarin Chinese version of the Pain Sensitivity Questionnaire (PSQ), and PSQ-C-total and PSQ-C-minor scores were collected. PPD was screened by self-reporting Edinburgh Postnatal Depression Scale (EPDS), and EPDS total score was recorded. The association between postpartum pain sensitivity and PPD, as well as the risk factors and their interconnections, was analyzed by using a combination of stratified, bivariate, correlation, receiver-operating characteristic (ROC) curve, multivariate logistic regression, and path analysis.ResultsOverall, 87 of 210 mothers (41.4%) screened positive for PPD. A positive correlation between PSQ-C-total (r = 0.67) or PSQ-C-minor (r = 0.62) and EPDS scores was identified. PSQ-C-total [area under curve (AUC) 0.89, 95% CI 0.84–0.93; P < 0.0001] showed significantly higher diagnostic accuracy compared with PSQ-C-minor (AUC 0.85, 95% CI 0.80–0.90; P < 0.0001) in predicting EPDS scores ≥ 10 points. Multivariate logistic regression indicated that a high PSQ-C-total score [adjusted odds ratio (OR) 1.12, 95% CI 1.08–1.51; P < 0.001] and gestational diabetes (adjusted OR 2.68, 95% CI 0.96–7.47; P = 0.045) were independent risk factors, while breastfeeding (adjusted OR: 0.34, 95% CI 0.15–0.78; P = 0.007) and normal birth weight (adjusted OR 0.17, 95% CI 0.05–0.61; P = 0.0047) were independently associated with decreasing adjusted ORs for EPDS scores ≥ 10 points. The path analysis model indicated that PSQ-C-total scores and gestational diabetes showed bidirectional effects, while birth weight and breastfeeding only had a direct impact on EPDS scores ≥ 10 points.ConclusionIncreased postpartum pain sensitivity was closely associated with EPDS scores ≥ 10 points, and PSQ-C scores could be a reliable predictor. Moreover, gestational diabetes, low occurrence of breastfeeding, and low birth weight were the risk factors for EPDS scores ≥ 10 points.Trial RegistrationChiCTR.org.cn identifier, ChiCTR-2000033091.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-021-00325-1.

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

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.

Maternal and Paternal Depression During Pregnancy in China: Prevalence, Correlates, and Network Analysis

BackgroundDepression is a commonly seen mental health concern for mothers and fathers during their transition to parenthood. This study aims to provide new insights into the prevalence of maternal and paternal depression, its demographic and clinical correlates, and its symptom network among Chinese pregnant women and their partners.MethodsIn this multicenter, cross-sectional study, 769 pregnant women and their partners were assessed by Edinburgh Postnatal Depression Scale (EPDS) from June 15th to Sep 15th, 2020 in southern China. Convenient sampling method was used. Univariate analyses, multivariate logistic regression, and network analyses were conducted. Networks of maternal and paternal depression were compared.ResultsIn total, 60 (EPDS total score ≥13, 7.80%, 95% CI: 5.90–9.70%) women and 23 (2.99%, 95% CI: 1.78–4.20%) of these women’s partners reported depression. Physical comorbidities (OR=2.664, P=0.003) was the only factor that was found to significantly correlate with maternal depression. Network analyses showed that the resulting networks were well connected and that there was significant difference of network structure between maternal and paternal depression (M=0.330, P<0.001). Centrality plot indicated that “sad or miserable” (strength=1.097) was the most central symptom in the maternal depression network, while “scared or panicky” (strength=1.091) was the most central node in the paternal network. The edge between “things have been getting on top of me” – “able to laugh and see the funny side of things” (difference: 0.153, P=0.020), and “scared or panicky” – “the thought of harming myself” (difference: 0.084, P<0.001) was significantly stronger in women’s partners than that in pregnant women.ConclusionMaternal and paternal depression during pregnancy could result in significant negative consequences. Symptoms like “sad or miserable” and “scared or panicky” are critical and might be potential targets for further interventions. Evidence-based treatments, such as pharmacology, psychotherapy, community reinforcement and family training, might be beneficial for parents with depression during and after the pregnancy.

Postpartum bonding: the impact of stressful life events during pregnancy

Objective We aimed to determine if and to what extent a woman’s exposure to stressful life events were associated with impaired maternal bonding by using a sample of high-income Italian women. Methods In the second day postpartum, 425 healthy puerperae responded to Life Experiences Survey (LES), Mother-to-Infant Bonding Scale (MBS), and to the Edinburgh Postnatal Depression Scale (EPDS). Results Analysis revealed that the stressful life events scored by LES were a significantly predictor of impaired bonding as measured by MIBS (β = 0.04; t = 3.45; p < .001) and of postpartum depression symptoms as measured by EPDS total score (β = 0.32; t = 4.86; p < .001) as well as its subscales Anhedonia (β = 0.059; t = 4.99; p < .001), Anxiety (β = 0.03; t = 5.72; p < .001), and Depression (β = 0.05; t = 6.53; p < .001). Moreover, the partial correlation between EPDS total score and MIBS accounting for LES positive and negative scores was statistically significant (r = 0.208; n = 332; p < .001). Conclusion The findings emphasize the importance of identifying mothers with negative experiences toward pregnancy and delivery to address possible interventions beyond hospital-based antenatal care to improve bonding and maternal mental outcomes.

Perinatal Mood and Anxiety Disorders in Women Undergoing Medically Assisted Reproduction

Background: Women taking advantage of medically assisted reproduction (MAR) techniques may differ from spontaneously conceiving women (nonMAR) in risk of depression and/or anxiety. We aimed to investigate possible differences between MAR and nonMAR through the use of the Edinburgh Postnatal Depression Scale in a sample of Italian-speaking women at their third trimester of pregnancy. Methods: We administered the Edinburgh Postnatal Depression Scale (EPDS) to two groups of pregnant women, MAR and nonMAR, at the third trimester of pregnancy (T0), one month after delivery (T1), and three months after delivery (T2) from February 2013 to December 2019. EPDS total scores cutoffs were ≥9 for risk of depression, 9–11 mild depression, ≥12 major depression, and the EPDS-3A cluster ≥4 was a proxy for anxiety. Results: Included were 1303 nonMAR women and 92 MAR, an expected disproportion. NonMAR and MAR women did not differ on depression or anxiety at any assessment timepoint. MAR women were older than nonMAR, consumed more alcohol and medical drugs, and displayed more complications during pregnancy. Scoring over the threshold on depression risk was associated with foreign nationality, unemployment, psychiatric history of the patient, family or partner, psychiatric problems in past pregnancies, hyperemesis, premenstrual syndrome (PMS), and stressful life events in the last year at baseline, and, for some of them, at other timepoints. In contrast, MAR past or current was associated with having suprathreshold depression at the first-month postpartum follow-up. Conclusions: Taken together, our data show that women opting for MAR do not differ from spontaneously conceiving women regarding psychiatric outcomes but do differ on some sociodemographic and clinical variables.

Maternal prenatal stress and postnatal depressive symptoms: discrepancy between mother and teacher reports of toddler psychological problems

Maternal prenatal stress and postnatal depression are reported to increase the risk for early offspring psychological problems. We examined whether these two stressors predicted toddler emotional or behavioral problems based on the mother and teacher reports, respectively. A longitudinal study within the Odense Child Cohort (OCC). Prenatal stress was assessed (gestation week 28) using Cohen's Perceived Stress Scale (PSS). Depressive symptoms were assessed (3months after birth) using the Edinburgh Postnatal Depression Scale (EPDS). Behavioral and emotional problems were assessed by mothers using the preschool version of Child Behaviour Checklist (CBCL) and by teachers using the caregiver-teacher report form (CTR-F). N = 1302 mother-child dyads were included. CBCL (N = 1302) was collected at 29months (SD 5.3) and C-TRF (N = 989) at 32.6months (SD 6.9). N = 70 mothers (5.4%) were at high risk for postnatal depression (EPDS score > 12). Generalized additive models showed that prenatal stress (increase of + 1 on PSS-10 total score) predicted an increase in CBCL (+ 0.011) and C-TRF (+ 0.015) total scores. Postnatal depressive symptoms (increase of + 1 on EPDS total score) only predicted an increase in CBCL total score (+ 0.026). Prenatal maternal stress was a significant predictor of both mother and teacher reported toddler emotional and behavioral problems, although effect sizes were small. Postnatal depressive symptoms were associated with increased maternal (but not teacher) reporting of toddler problems. Mothers reported more toddler psychological problems than teachers, and the mother-teacher discrepancy was positively correlated to maternal postnatal depressive symptoms.

The Risk Factors Predicting Suicidal Ideation Among Perinatal Women in Japan.

IntroductionThe aim of the present study was to elucidate the foreseeable risk factors for suicidal ideation among Japanese perinatal women.MethodsThis cohort study was conducted in Nagoya, Japan, from July 2012 to March 2018. The Edinburgh Postnatal Depression Scale (EPDS) questionnaire was conducted at four time points: early pregnancy, late pregnancy, 5 days postpartum, and 1 month postpartum. A total of 430 women completed the questionnaires. A logistic regression analysis was performed using the presence of suicidal ideation on the EPDS as an objective variable. The explanatory variables were age, presence of physical or mental disease, smoking and drinking habits, education, hospital types, EPDS total score in early pregnancy, bonding, and quality and amount of social support, as well as the history of major depressive disorder (MDD).ResultsThe rate of participants who were suspected of having suicidal ideation at any of the four time points was 11.6% (n=52), with the highest (n=25, 5.8%) at late pregnancy. For suicidal ideation, education level (OR: 1.19; 95% CI: 1.00–1.41; p=0.047), EPDS total points in the pregnancy period (OR: 1.25; 95% CI: 1.16–1.34; p < 0.000), a history of MDD (OR: 2.16; 95% CI: 1.00–4.79; p=0.049), and presence of mental disease (OR: 2.39; 95% CI: 1.00–5.70; p=0.049) were found to be risk factors for suicidal ideation. Age [odds ratio (OR): 0.88; 95% confidence interval (CI): 0.80–0.95; p=.002] and quality of social support (OR: 0.77; 95% CI: 0.60–0.99; p=.041) were found to be protective factors.ConclusionBased on these results, effective preventive interventions, such as increasing the quality of social support and confirming the history of depression, should be carried out in pregnant depressive women at the early stage of the perinatal period.

Effects of postpartum depression on the behaviour of children born to mothers with epilepsy

PurposePostpartum depression (PPD) is a non-psychotic depressive disorder that begins within 4 weeks of childbirth. This study aimed to evaluate the prevalence of PPD by screening mothers with the Edinburgh Postnatal Depression Scale (EPDS), to assess the behavioural outcome of children born to mothers with and without epilepsy and to investigate the relationship between PPD and children’s behavioural problems. MethodWe enrolled 80 pregnancies of women with epilepsy, who filled in EPDS after birth, and afterward we asked them to complete the Child Behavior Checklist (CBCL). Results23.8% of patients presented PPD. Children, when the CBCL were completed, had a mean age of 6.05 ± 3.07 years. The CBCL results indicate the occurrence of at least one behavioural issue in 25.0% (20/80) of children.CBCL scores revealed a higher prevalence of behavioural disturbances with regards to the CBCL Total (P = 0.016), internalizing (P = 0.014) and somatic problems (P = 0.048) in patients with PPD vs. patients without PPD.We found an association between mothers’ EPDS total score and children’s CBCL global score (P = 0.034), internalizing score (P = 0.021), anxiety problems (P = 0.05), affective problems (P = 0.027) and withdrawn/depressed (P = 0.05).We recorded a statistically higher malformation rate in patients with PPD (P = 0.005) compared to the general population. ConclusionsChildren born from mothers with epilepsy have an increased risk for emotional disorders. These findings highlight the importance of screening for emotional distress and providing adequate interventions to children born to women with epilepsy.

Postnatal depressive symptoms display marked similarities across continents

BackgroundPostnatal depressive symptoms measured by the Edinburgh Postnatal Depression Scale (EPDS) are reported to display measurement variance regarding factor structure and the frequency of specific depressive symptoms. However, postnatal depressive symptoms measured by EPDS have not been compared between women representing three continents. MethodsA cross-sectional study including birth cohort samples from Denmark, Vietnam and Tanzania. Women were included during pregnancy at routine care sites. Depressive symptoms were self-reported 40–90 days postpartum using the EPDS. Exploratory and confirmatory factor analyses and generalized additive regression models were performed. ResultsA total of N = 4,516 participated in the study (Denmark N = 2,069, Vietnam N = 1,278, Tanzania N = 1,169). Factor analyses identified three factors (anhedonia, anxiety and depression) that were almost identical in the three study populations. The only variation between countries was that the item ‘self-harm’ loaded differently. Women from Tanzania and Denmark were more likely to have an EPDS total score above cut-off 12 (12.6% and 6.4%), compared to women from Vietnam (1.9%) (p<0.001). A low level of education was associated with significantly more depressive symptoms after adjusting for country (p<0.001). LimitationsEPDS data was collected at a later time point in the Danish sample. ConclusionsPostnatal depressive symptoms constitute a three-factor model across cultures including the factors anhedonia, anxiety and depression. The frequency of postnatal depressive symptoms differs between high-, medium-, and low-income countries. However, clinicians should bear in mind that low-educated women worldwide are more likely to experience postnatal depressive symptoms.

White matter integrity in medication-free women with peripartum depression: a tract-based spatial statistics study.

Diffusion tensor imaging (DTI) studies in depression show decreased structural connectivity in the left anterior limb of the internal capsule and the genu of the corpus callosum but no such studies exist in peripartum depression (PPD), which affects 1 in 8 women. We analyzed fractional anisotropy (FA) as a measure of white matter integrity of these two tracts using tract-based spatial statistics (TBSS). We then conducted an exploratory whole-brain analysis to identify additional regions implicated in PPD. Seventy-five pregnant, medication-free women were evaluated with the Edinburgh Postnatal Depression Scale (EPDS) and Structured Clinical Interview (SCID) for DSM-IV-TR in pregnancy and in the postpartum. Structural MRI and DTI sequences were acquired in forty-four women within 2-8 weeks postpartum. TBSS data were analyzed between healthy comparison postpartum women (HCW) and women who developed PPD to determine differences in white matter integrity within the left anterior limb of the internal capsule and the genu of the corpus callosum, then analyzed across participants to explore correlation between FA and the EPDS score. An exploratory whole-brain analysis was also conducted to identify other potential regions showing differences in white matter integrity between groups, as well as correlation between EPDS and FA across groups. All results were corrected for multiple comparisons and analyses conducted using FSL, p < 0.05, K > 10. In comparison to HCW, women with PPD had significantly lower FA in left anterior limb of the internal capsule (p = 0.010). FA was negatively correlated with EPDS scores in the left anterior limb of the internal capsule (p = 0.019). In the whole-brain analysis, FA in the right retrolenticular internal capsule (p = 0.03) and two clusters within the body of the corpus callosum (p = 0.044, p = 0.050) were negatively correlated with EPDS; there were no between-group differences in FA. Reduced FA in the left anterior limb of the internal capsule suggests disruption of fronto-subcortical circuits in PPD. A negative correlation between FA within the body of the corpus callosum and EPDS total score could additionally reflect disrupted interhemispheric structural connectivity in women with depressive symptoms.

Prevalence trends of pre- and postnatal depression in Japanese women: A population-based longitudinal study

BackgroundThis study aimed to describe the prevalence trends of pre- and postnatal depression, via measures of the Edinburgh Postnatal Depression Scale (EPDS) total and factor scores, from 20 weeks’ gestation to 3 months postpartum, stratified by parity, in a Japanese female population. MethodsA longitudinal, population-based study was conducted among perinatal women giving birth at maternity facilities in Setagaya area of Tokyo, Japan. Of the 1775 women who participated, 1311 women met the inclusion criteria of this analysis. All data, including EPDS, were collected via self-administrated questionnaires at 20 weeks’ gestation and at 5 time points postpartum, from the first few days to 3 months postpartum. We divided EPDS items into three factors: “anxiety,” “anhedonia,” and “depression,” according to factor analysis. ResultsThe prevalence of individuals exhibiting depressive symptoms, EPDS total score, and each factor score peaked at two weeks postpartum in primiparas (EPDS total = 5.58, anhedonia = 0.47, anxiety = 2.64, and depression = 1.23). In contrast, the EPDS total score and factor scores for “anxiety” and “depression” gradually decreased for multiparas, from the prenatal to postpartum period (EPDS total 3.33, 3.03, 3.03, 2.72, 2.76, and 2.37). LimitationsEach factor score was not weighted; instead, we simply added up the item scores ranging from 0 to 3 for each question. Additionally, the population representativeness of Japanese women was not high, although the sample was population-based and had a high follow-up rate. ConclusionsThis study shows that the trends of EPDS total and factor scores differ by parity throughout the pre- and postnatal periods among a Japanese female population.

Cortisol response to the Trier Social Stress Test in pregnant women at risk for postpartum depression.

Antepartum depression and anxiety are risk factors for postpartum depression (PPD). Postpartum abnormalities in hypothalamic-pituitary-adrenal (HPA) reactivity are associated with PPD. It is not known if antepartum HPA abnormalities exist in women at risk for PPD (AR-PPD). We measured salivary cortisol response to the Trier Social Stress Test (TSST) in 44 (24 AR-PPD, 20 healthy comparison) pregnant women. Depression and anxiety were measured using the Edinburgh Postnatal Depression Scale (EPDS) and Spielberger State-Trait Anxiety Inventory-State (STAI-S). We analyzed longitudinal changes in cortisol using generalized estimating equation methods to control for the correlation within subjects at the six TSST time points. Group differences in area under the curve (AUC) were examined. A majority (70.8%) of the AR-PPD had prior depression. EPDS total score was higher in AR-PPD vs. comparison women (mean EPDS = 9.8 ± 4.9 vs. mean EPDS = 2.4 ± 2.0 respectively, p < 0.001). Mean STAI-S total score was higher in AR-PPD vs. comparison women at all TSST time points and over time (z = 2.71, df = 1, p = 0.007). There was no significant difference in cortisol concentration over time between groups. We observed no detectable difference in cortisol response to psychosocial stress induced by the TSST despite clinically significant between-group differences in current/past depression and current symptomatology.

Association between Postpartum Depression and Gnβ3 C825T Polymorphism

Background: Postpartum depression (PPD), affecting mother’s and baby’s health and wellbeing, is a subtype of major depression with onset within 4 weeks after childbirth. G-protein β3 subunit gene C825T polymorphism has been shown to be associated with major adult depression. This study aims to investigate whether PPD is associated with GNβ3 C825T polymorphism in Chinese Han women. Methods: This was a case control study, nested to a cohort that was established in three hospitals in Changsha, Hunan, China between February and September 2007. PPD was measured using the Chinese version of Edinburgh Postnatal Depression Scale (EPDS) at two weeks postpartum with a score of 13 or higher as the cut-off. GNB3 gene Rs5443 (C/T) was determined with ligase detection reaction (LDR). Genotype and allele frequency of GNB3 gene Rs5443 polymorphism were compared between women with PPD and hospital and age-matched controls. Results: A total of 43 PPD cases and 86 matched controls were included in the final analysis. GNβ3 Rs5443SNP genotypes were CC = 23.30%, C/T = 51.2%, TT = 25.6%, C = 48.84%, and T = 51.16%, respectively, in PPD cases, and corresponding figures were CC = 30.20%, C/T = 39.50%, TT = 30.20%, C = 50.00%, and T = 50.00%, respectively, in matched controls (P>0.05). For PPD subjects, the genotypes were not associated with the clinical phenotype: EPDS total score and/or subunit scores (P>0.05). Conclusion: No association between GNβ3 rs5443SNP polymorphism and PPD is observed in the pilot data from a small sample of Chinese Han women. Replications of our finding from a large sample are needed.

Combined use of the postpartum depression screening scale (PDSS) and Edinburgh postnatal depression scale (EPDS) to identify antenatal depression among Chinese pregnant women with obstetric complications

The purpose of the present study was to evaluate antenatal depression screening employing two scales: the Postpartum Depression Screening Scale (PDSS) and Edinburgh Postnatal Depression Scale (EPDS) for the population of Chinese pregnant women with obstetric complications. A convenience sample of 842 Chinese pregnant women with complications participated in this study. The PDSS total score correlated strongly with the EPDS total score (r=0.652, p=0.000). Each tool performed extremely well for detecting major and major/minor depressions with PDSS resulting in a better psychometric performance than EPDS (p<0.01). If combined use, the recommended EPDS cut-off score was 8/9 for major depression, at which the sensitivity (71.6%) and specificity (87.6%) were the best, and the recommended PDSS cut-off score was 79/80 for major depression, along with its best sensitivity (86.4%) and specificity (100%). The study concluded that EPDS and PDSS appear to be reliable assessments for major and minor depression among the Chinese pregnant women with obstetric complications. Combined use of these tools should consider lower cutoff scores to reduce the misdiagnosis and improve the screening validity.

The prevalence of suicidal ideation identified by the Edinburgh Postnatal Depression Scale in postpartum women in primary care: findings from the RESPOND trial

1 1.1 BackgroundSuicide is a leading cause of perinatal maternal deaths in industrialised countries but there has been little research to investigate prevalence or correlates of postpartum suicidality. The Edinburgh Postnatal Depression Scale is widely used in primary and maternity services to screen for perinatal depressive disorders, and includes a question on suicidal ideation (question 10). We aimed to investigate the prevalence, persistence and correlates of suicidal thoughts in postpartum women in the context of a randomised controlled trial of treatments for postnatal depression.1.2 MethodsWomen in primary care were sent postal questionnaires at 6 weeks postpartum to screen for postnatal depression before recruitment into an RCT. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for postnatal depression and in those with high levels of symptoms, a home visit with a standardised psychiatric interview was carried out using the Clinical Interview Schedule-Revised version (CIS-R). Other socio-demographic and clinical variables were measured, including functioning (SF12) and quality of the marital relationship (GRIMS). Women who entered the trial were followed up for 18 weeks.1.3 Results9% of 4,150 women who completed the EPDS question relating to suicidal ideation reported some suicidal ideation (including hardly ever); 4% reported that the thought of harming themselves had occurred to them sometimes or quite often. In women who entered the randomised trial and completed the EPDS question relating to suicidal ideation (n = 253), suicidal ideation was associated with younger age, higher parity and higher levels of depressive symptoms in the multivariate analysis. Endorsement of 'yes, quite often' to question 10 on the EPDS was associated with affirming at least two CIS-R items on suicidality. We found no association between suicidal ideation and SF-12 physical or mental health or the EPDS total score at 18 weeks.1.4 ConclusionsHealthcare professionals using the EPDS should be aware of the significant suicidality that is likely to be present in women endorsing 'yes, quite often' to question 10 of the EPDS. However, suicidal ideation does not appear to predict poor outcomes in women being treated for postnatal depression.Trial registrationCurrent Controlled Trials ISRCTN16479417.

Relation between Edinburgh Postnatal Depression Scale scores at 2-3 days and 4-6 weeks postpartum

A sample of 299 women completed the Edinburgh Postnatal Depression Scale (EPDS) at 2-3 days and 4-6 weeks postpartum. There was a highly significant positive correlation between EPDS scores at both occasions (Spearman rank correlation: r=0.61, p<0.0001). Exploratory factorial analyses extracted three factors which were called 'anxiety', 'depressive mood', and 'anhedonia'. A multiple regression analysis entering factor scores at 2-3 days showed that the 'anxiety' factor was the main significant predictor of 4-6 weeks EPDS scores. The correlation between the 'anxiety' factor scores derived from 2-3 days EPDS and 4-6 weeks EPDS total scores was very strong (Spearman rank correlation: r=0.84, p<0.0001). The 'anxiety' factor was the only significant predictor of the clinical diagnosis of postnatal depression. These results suggest that the EPDS completed at 2-3 days postpartum is a useful means of screening for women at risk of postnatal depression.