Development of a Prenatal Psychosocial Screening Tool for Post-Partum Depression and Anxiety (original) (raw)
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BMC Pregnancy and Childbirth
Background It is worthwhile to identify women at risk of developing postpartum depression during pregnancy. This study aimed to determine the optimal time and cutoff score for antenatal screening for prediction of postpartum depressive symptoms (PDS) using the Edinburgh Postnatal Depression Scale (EPDS) and to identify risk factors for PDS. Methods The target population was healthy pregnant women receiving antenatal care at a university hospital in Tokyo, Japan. During the first, second, and third trimesters, 3–4 days postpartum, and one month postpartum, they were asked to take the Japanese version of the EPDS questionnaire. The primary outcome of the study was PDS, defined as an EPDS score ≥ 9 at one month postpartum. The area under the receiver operating characteristics curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of EPDS scores at each antenatal screening time were calculated. Results From 139 pregnant women, 129 wer...
Journal of Affective Disorders, 2004
Background: Postpartum depression is a major health issue for many women around the world with well-documented negative health consequences for the mother, child and family. While research has demonstrated the amenability of postpartum depression to treatment, there is preliminary evidence suggesting maternal mood in the immediate postpartum period may be predictive of postpartum depression such that secondary preventive interventions may be implemented. Methods: A populationbased sample of 594 mothers completed the Edinburgh Postnatal Depression Scale (EPDS) at 1, 4 and 8 weeks postpartum. The sensitivity, specificity and predictive power of the 1-week EPDS in relation to identifying mothers with elevated EPDS scores at 4 and 8 weeks was determined. The predictive power of the 1-week EPDS was further assessed using odds ratios and receiver operator characteristic (ROC) curves. Results: At 1 week postpartum, 29.5% of mothers scored >9 on the EPDS, decreasing to 23% at 4 weeks and 20.5% at 8 weeks. Using the cutoff score of 9/10, the 1-week EPDS accurately classified 85.4% mothers at 4 weeks and 82.5% mothers at 8 weeks with or without postpartum depression symptomatology. The 1-week EPDS was significantly correlated to the 4-week (r = 0.72, P < 0.001) and 8-week (r = 0.65, P < 0.001) EPDS. Mothers with a 1-week EPDS score >9 were 30.3 times more likely at 4 weeks (95% CI = 17.5-42.3) and 19.1 times more likely at 8 weeks (95% CI = 11.0-32.9) to exhibit postpartum depression symptomatology. Limitations: Psychiatric interviews were not completed in collaboration with the EPDS. Conclusion: The EPDS administered in the 1st week postpartum was predictive of maternal mood at 4 and 8 weeks postpartum. To identify mothers at high risk for postpartum depression, health care professionals could consider screening all new mothers in the immediate postpartum period such that secondary preventive interventions may be implemented.
Promoting Population Mental Health and Well-Being, 2019
Background: The Edinburgh Postnatal Depression Scale (EPDS) is a set of 10 screening questions that indicate whether a parent has symptoms that are common in women with depression and anxiety during pregnancy and in the year following the birth of a child. This study aimed to review systematically the validity of EPDS as a screening test for postpartum depression. Subjects and Method: A systematic review was used for this study. The subjects of this study were post-partum women. This study was conducted by searching eligible articles from 3 databases: ProQuest, PubMed, and Scopus, obtained from 2008 to 2018. The keywords used for this study were Edinburgh Postnatal Depression Scale (EPDS) AND validation AND validating AND validity. The inclusion criteria were post-partum women (1 year), used EPDS as screening instrument. EPDS was compared with gold standard diagnostic test. Data of sensitivity, specificity, and positive predictive value must be included. The data on methodology and main findings were then extracted, compiled, and analyzed. Results: Out of 104 articles, 5 articles were selected for this study. Sensitivity and specificity throughout the studies showed heterogeneity. Sensitivity varied from 71% to 100%. Specificity varied from 79% to 98.7%. Positive predictive value varied widely from 33.3% to 78%. Conclusion: EPDS shows a variety of sensitivity and specificity, ranging from fair to good validity. EPDS shows too wide range of positive predictive values.
Development of a new antenatal measure to predict postpartum depression
PsycEXTRA Dataset, 2000
Postpartum depression is 1 of the most common pregnancy complications, yet many women feel too ashamed to get help. It is important to study postpartum depression so that it can more easily be detected, more quickly treated, and that the stigma around this illness can be reduced. Early detection is vital to prevent complications for the infant, mother, and beyond. The first hypothesis of this study was that some identified antenatal factors would be more predictive of postpartum depression than other factors. Those factors were then used to construct the Measurement of Motherhood Stress-Second Edition (MOMS-II). The second hypothesis was that as the number of risk factors increase, then the score on the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9) would rise. Statements were created using risk factors identified in the literature and were added to a Likert-type scale to create the 33 item screener, Measurement of Motherhood Stress (MOMS; Jenkins, DePierre, Wilson, & Thurston, 2011). The MOMS, the EPDS, and the PHQ-9 were given to 160 pregnant women. Following the birth of the child, the EPDS and PHQ-9 were re-administered to 86 participants Postpartum Depression Predictors iv and results were collected. Item analysis was then performed on the MOMS. Thirteen items were stronger predictors of postpartum depression and were used to create a 10-item revised MOMS scale. Additionally, as predicted, the more stressors endorsed on the MOMS, the higher the depression scores on the EPDS and the PHQ-9. This study highlights the utility of an antenatal screener for postpartum depression as an important piece in the early detection and treatment of postpartum depression.
Positive screening and risk factors for postpartum depression
European Psychiatry, 2017
The birth of a child may lead to the onset of psychopathological symptoms in the mother that vary in frequency and intensity [1,2], and to short/long-term effects on the mother's and/or child's health [3-7]. These symptoms usually regard some form of anxiety and depression which may cause little alarm but in some cases indicate serious problems. These include the condition defined as baby blues, which is short lasting, and characterized by mild symptoms and a minimal impact on functioning [8]. Postpartum psychosis [9,10] is definitely a more serious disorder, with a prevalence that can range between 0.1 to 0.2% [11], and an increased risk of suicide and infanticide [12]. From a clinical and statistical point of view, postpartum depression (PPD) is the most important psychological complication related to childbirth. Research studies have demonstrated that approximately 10-15% of women who give birth are affected by PPD, with some variability in prevalence across different geographical locations and population groups [13-17]. There is also a substantial percentage of women who suffer postpartum anxiety, many of whom experience comorbid depressive symptoms. Literature regarding perinatal anxiety disorders reports a prenatal prevalence of 9-22%, and a postpartum prevalence of 11-21% [18]. The key risk factors linked with poorer postpartum mental health are well documented [19-22] and include: a past history of depression and/or anxiety [23-25], relationship problems with European Psychiatry xxx (2016) xxx-xxx
Acta Psychiatrica Scandinavica, 2005
To assess the predictive value of an antenatal index of risk for postnatal depression (PND). Participants returned the Pregnancy Risk Questionnaire (PRQ; 18 antenatal items) and the Edinburgh Depression Scale (EDS) at a mean of 32 weeks gestation; the EDS was then mailed out at 2 and 4 months postpartum to ascertain those women who were screened positive (score>2), i.e. probable cases of depression. Only those returning the EDS at 2 and/or 4 months were included in the study (n=1296). Women who screened positive (n=322; 24.8%) were contacted and of these, 245 completed the Auto-Composite International Diagnostic Interview (CIDI) and form the basis of our primary analyses. A CIDI diagnosis of major depression was found in 5.3% women at either 2 or 4 months. In this population, the optimal PRQ cut-off was >or=46 at which point sensitivity was 44% and specificity 92%. At this cut-off 9.9% tested positive (for risk of PND) on the PRQ with a positive predictive value (PPV) of 23.5%. Of 1079 women who scored below 46 on the PRQ, 3.2% were cases of CIDI depression while of those 119 scoring 46 or above, 23.5% were CIDI cases at 2 or 4 months postpartum, yielding an odds ratio of 9.18. Using a cut-off of >or=46, the PRQ is better than previously reported tools in the antenatal prediction of PND with respect to sensitivity and specificity, while like other studies PPV remains limited. The PRQ allows identification of high and low risk groups and thus has applicability in both the research and clinical settings.
Journal of Affective Disorders
Background: Early identification of postnatal depression is important in order to minimize adverse outcomes. The Edinburgh Postnatal Depression Scale (EPDS) is commonly used as a screening tool but a single, direct question on depression may offer an alternative means of identifying women in need of support. This study examines the agreement between these methods and characteristics of women who self-identify as depressed and those with EPDS ≥ 13. Methods: Secondary analysis of two national maternity surveys conducted in England and Northern Ireland. Agreement between the direct question and EPDS scores was assessed using Cohen's kappa. Logistic regression was used to identify characteristics of women in each group. Results: 6752 women were included. At three months postpartum, 6.1% of women self-identified as having depression, 9.1% scored EPDS ≥ 13, 2.8% were positive on both. Agreement between the two methods was minimal (Cohen's kappa < 0.3). Women who self-identified as having depression had higher odds of being aged > 40 years (OR 1.8; 95% CI 1.2-2.8). EPDS ≥ 13 was associated with < 16 years of education (OR 1.4; 95% CI 1.1-1.8), minority ethnicity (OR 1.4; 95% CI 1.1-1.9), living without a partner (OR 1.7; 95% CI 1.3-2.2), and a less than happy reaction to the pregnancy (OR 1.7; 95% CI 1.4-2.1). Limitations: Low survey response limits the representativeness of findings. The absence of a diagnostic interview limits conclusions on accuracy or internal validity of the measures. Conclusions: A direct question about postnatal depression may offer a valuable addition to screening tools to identify women in need of support.