Validation of the Edinburgh Postnatal Depression Scale as a screening tool for depression in late pregnancy among Nigerian women

This study aimed to examine the validity of the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool for depression in late pregnancy among Nigerian women. A total of 182 women in late pregnancy (32–36 weeks) completed either the English or the translated Yoruba language version of the EPDS and a proportion of them were then assessed for the presence of DSM-IV major and minor depressive disorders using the MINI International Neuropsychiatric Interview. A cut-off score of 10 on the EPDS was found to be the best for screening for both major and minor depression (sensitivity = 0.867, specificity = 0.915, Diagnostic Likelihood Ratio for a positive result = 10.200). When screening for major depression only, a cut-off of 12 was found to the most appropriate (sensitivity = 1.000, specificity = 0.961, Diagnostic Likelihood Ratio for a positive result = 25.641). The EPDS is a valid and useful instrument in screening for depression in late pregnancy among Nigerian women.     

Predictive validity of the Postpartum Depression Predictors Inventory-Revised (PDPI-R): A longitudinal study with Portuguese women

ObjectiveThis study examined the predictive validity of the prenatal and postnatal versions of the Postpartum Depression Predictors Inventory-Revised (PDPI-R) in European Portuguese women, considering two gold standards to determine postpartum depression (PPD).DesignProspective longitudinal study conducted between November 2015 and September 2017.SettingOne public referral maternity hospital in the central region of Portugal.ParticipantsA total of 140 Portuguese women participated in the study.MeasurementsParticipants completed the PDPI-R during the second trimester of pregnancy (T1) and at 6 weeks postpartum (T2). At T2, participants also answered the Edinburgh Postnatal Depression Scale (EPDS). During the fourth month postpartum (T3), women were interviewed with the Structured Clinical Interview for DSM-IV Disorders, and between 6 and 9 months postpartum (T4), they completed the EPDS.FindingsRates of clinically significant depressive symptoms (EPDS ≥ 10) were 16.4% (23/140) at T2 and 23.2% (23/99) at T4. Six (4.3%) women met the criteria for a clinical diagnosis of PPD (major depressive episode) at T3. Overall, the postnatal version of the PDPI-R performed better than did the prenatal version (average area under the curve = 82% vs. 71%), but both versions accurately predicted women who developed a clinical diagnosis of PPD, at a cut-off score of 4.5 for the prenatal version (sensitivity = 83.3%; specificity = 85.8%) and 9.5 for the postnatal version (sensitivity = 83.3%; specificity = 94.8%).Key conclusions and implications for practiceDespite the low prevalence of PPD (albeit consistent with prior estimates of major depression at three months postpartum), this clinical condition has very serious consequences for the mother, the baby and the whole family when present. The PDPI-R is a valid screening tool to estimate the psychosocial risk for developing PPD among Portuguese women and can be used in research (e.g., for cross-cultural comparisons) and clinical practice. The recommended cut-off scores could assist health professionals (namely, midwives) in identifying the women who would benefit from appropriate referrals and/or closer monitoring to prevent them from developing PPD.     

Validation of the Edinburgh Postnatal Depression Scale as a screening tool for depression in late pregnancy among Nigerian women

This study aimed to examine the validity of the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool for depression in late pregnancy among Nigerian women. A total of 182 women in late pregnancy (32-36 weeks) completed either the English or the translated Yoruba language version of the EPDS and a proportion of them were then assessed for the presence of DSM-IV major and minor depressive disorders using the MINI International Neuropsychiatric Interview. A cut-off score of 10 on the EPDS was found to be the best for screening for both major and minor depression (sensitivity = 0.867, specificity = 0.915, Diagnostic Likelihood Ratio for a positive result = 10.200). When screening for major depression only, a cut-off of 12 was found to the most appropriate (sensitivity = 1.000, specificity = 0.961, Diagnostic Likelihood Ratio for a positive result = 25.641). The EPDS is a valid and useful instrument in screening for depression in late pregnancy among Nigerian women.     

Screening for postnatal depression in Bengali women: Preliminary observations from using a translated version of the Edinburgh Postnatal Depression Scale (EPDS)

Postnatal depression carries a significant health burden for mothers and their offspring. However, the majority of screening or treatment studies for postnatal depression have been carried out on white or European populations and clinicians have been appropriately cautious about applying these findings to different cultural groups. This study describes the development and use of a Bengali version of the Edinburgh Postnatal Depression Scale (EPDS). Forty-eight Bangladeshi postnatal women in both Bangladesh and England were interviewed by a Syhletti/Bengali-speaking psychologist. The translated version of the EPDS was presented in the usual way, along with a standardized interview about the degree of social support and a translated version of the General Health Questionnaire (GHQ). Although one item of the EPDS presented some translation difficulties, the majority of items obtained reasonable semantic equivalence and were successfully rated by the women in the study. Preliminary examination of the psychometric properties of the scale suggested adequate reliability for the scale. Higher EPDS scores had both a significant positive association with less social support and higher scores on the GHQ. While this is not a screening validation study of the Bengali version of the EPDS, the findings do provide preliminary evidence that postnatal depression screening programmes may be an appropriate and inexpensive method of identifying postnatal distress in Bangladeshi women.     

Translation and validation of the Perinatal Grief Scale in a sample of Greek women with perinatal loss during the 1st and 2nd trimester of pregnancy

Objective: To translate and validate the Perinatal Grief Scale (PGS) (short version) in a sample of Greek women with perinatal loss during the first and second trimester of pregnancy.

Methods: One hundred seventy-six women were approached a few hours after the loss. Along with the PGS, three more questionnaires were completed: the Edinburgh Postnatal Depression Scale (EPDS), the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI), in order to assess the convergent validity of the PGS.

Results: Total sample mean age was 34.1 years (SD?=?5.2). Mean values and Cronbach’s alpha coefficients for PGS subscales exceeded the minimum reliability standard of 0.70. Mean score for “Active grief” was 31.47 (SD?=?9.31), for “Difficulty Coping” was 23.13 (SD?=?7.54) and for “Despair” was 21.07 (SD?=?7.07). By applying Pearson’s correlation coefficients, PGS subscales positively correlated with scores on EPDS, STAI and HADS.

Conclusions: The PGS Greek version is a reliable instrument in terms of internal consistency and the Cronbach’s alpha coefficients are high. The Greek version of PGS can be a useful instrument for the detection of the psychological impact after a perinatal loss and it has implications for both scientific research and clinical routine.     

The factor structure of the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS)

The psychometric properties of the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS) were evaluated at the six‐week postnatal period. A shorter version, the EPDS‐6, was found to offer an optimal fit to our data and provides a sound psychometric basis for the development of an abbreviated version of the tool which may offer enhanced screening and predictive utility.     

Prevalence of antenatal depression in women enrolled in an outreach program in Canada

OBJECTIVE: To determine the prevalence of depression and its correlates in pregnancy and to establish the appropriateness of using the Edinburgh Postnatal Depression Scale with inner-city, high-risk pregnant women. DESIGN: Convenience sample of women enrolled in a prenatal outreach program. Women were recruited and the Edinburgh Postnatal Depression Scale was administered during home visits. PARTICIPANTS: 39 women, most of whom were Aboriginal, participating in a prenatal outreach program. MAIN OUTCOME MEASURE: Edinburgh Postnatal Depression Scale score of >or=10 suggests minor depressive symptoms and >or=13 suggests probable major depression. RESULTS: 27% of women reported symptoms consistent with major depression. The Aboriginal women had higher levels of depressive symptoms than the non-Aboriginal women. Women who had stopped using tobacco or alcohol during pregnancy had more depressive symptoms than those who had quit before pregnancy. Acceptability of the Edinburgh Postnatal Depression Scale for use with high-risk, Aboriginal, and non-Aboriginal pregnant women was supported. CONCLUSIONS: The prevalence of depressive symptoms and concurrent substance use within this population is a major public health problem. Nurses can incorporate the Edinburgh Postnatal Depression Scale into routine prenatal visits to identify women at risk for depression.     

Transient vs enduring distress in late pregnancy using the EPDS: a brief longitudinal exploratory study

ABSTRACT

Background and Objective: The Edinburgh Postnatal Depression Scale (EPDS) is widely used to detect perinatal distress in women by one single administration. Recently, research has shown that during early pregnancy around half of the women scoring as ‘possibly depressed’ on the EPDS only have transient distress, when re-tested after few weeks. This finding may not occur if women are screened later in pregnancy, as their worries then may be more enduring; therefore an exploratory study was conducted to further investigate this issue.

Methods: Pregnant women (N = 84) attending a public hospital in Italy completed the EPDS in their third trimester (x = 33 weeks) and again 8–42 days later (while still pregnant). They had not received professional mental health intervention in this time interval.

Results: Approximately half of the women who initially scored high on the EPDS in late pregnancy no longer scored high just a few weeks later.

Conclusions: Approximately half of women who initially score high on the EPDS when screened in pregnancy only have transient distress in both the second and third trimester. To label these women as being ‘possibly depressed’, and mixing them with women who show enduring distress, represents a possible weakness in research studies, and may also overburden clinical services. We would therefore recommend, as research and clinical practice, a second administration of the EPDS if a woman initially scores in the distressed range at any stage in pregnancy.     

Antenatal depression among women hospitalized due to threatened preterm labor in a high-risk pregnancy unit in Greece

Purpose: Estimates for the prevalence of antenatal depression vary widely across different studies and especially concerning high-risk pregnancies. Threatened preterm labor is the most common indication for antenatal obstetric hospitalization. The aim of this study was to screen for depressive symptoms among pregnant women hospitalized in a high-risk pregnancy unit due to threatened preterm labor and also to investigate possible associated risk factors.

Materials and methods: A total of 103 pregnant women admitted at >24 and <36 gestational weeks were eligible to participate in the study. The Greek version of the Edinburgh Postnatal Depression Scale (EPDS) was used to detect depressive symptoms on admission. A cutoff score of >13 was considered as indicative of depression. Possible associated risk factors were also investigated.

Results: The prevalence of antenatal depression (score >13) was 24.3% (n?=?25). In the multivariate analysis, antenatal depression was significantly correlated with thoughts of abortion (OR: 6.208; 95% CI: 1.141–33.765).

Conclusions: About one quarter of the pregnant women hospitalized in the HRPU due to threatened preterm labor were depressed based on the EPDS. Thoughts of abortion were associated with a sixfold increase in the risk of depression, while no associations were found between antenatal depression and other sociodemographic and obstetric parameters.     

Effects of assisted reproductive technology and of women’s quality of life on depressive symptoms in the early postpartum period: a prospective case-control study

Abstract

This study explored the influence of both assisted reproductive technology (ART) and reduced quality of life (QoL) during pregnancy on postpartum blues (PPB). Sixty-three sub-fertile patients who conceived through ART and 72 women who naturally conceived were enrolled in this prospective study. At 22nd and 32nd gestational weeks, women completed the Edinburgh Postnatal Depression Scale (EPDS) and the Short-Form 36 (SF-36), to investigate depressive symptoms and QoL, respectively; EPDS was again used at 15 days after birth to assess PPB. At both time points, higher EPDS scores and lower mental well-being scores (SF-36) significantly predicted PPB. The number of previous ART cycles emerged as the strongest predictor, whereas no significant effect was observed for the conceiving method. The results suggest the usefulness of assessing QoL during pregnancy and considering previous ART failures in preventing PPB.     

Are Pregnant and Postpartum Women Moodier? Understanding Perinatal Mood Instability

ObjectiveTo better understand mood changes in pregnancy and postpartum, we studied mood instability in a group of perinatal women and in a group of normally menstruating non-pregnant women.MethodsPerinatal women (n = 45) completed the Edinburgh Postnatal Depression Scale at 16 weeks’ and 30 weeks’ gestation and again at four weeks postpartum. Immediately after completing the Edinburgh Postnatal Depression Scale, participants also completed mood diaries with separate visual analogue scales for depressed, irritable, anxious, and euphoric/activated moods. This was done twice daily for one week. A comparison group of 31 non-perinatal women without depression or premenstrual symptoms completed identical mood diaries for seven consecutive weeks. Mood instability was represented by the mean square successive difference statistic.ResultsPerinatal women showed higher mean levels of depressed, irritable, anxious, and high mood instability than the non-perinatal women. The findings held when pregnant women who were depressed were removed from the comparison, except that the difference in depressed mood instability was no longer significant.ConclusionsWider fluctuation in mood in pregnant and postnatal women is consistent with the common belief that perinatal women are moodier than non-perinatal women.     

Relationships Among Infant Sleep Patterns,Maternal Fatigue,and Development of Depressive Symptomatology

ABSTRACT: Background: Postpartum depression is a serious condition for women after childbirth. Although its etiology is unclear, one potentially important predictive variable that has received little attention is maternal sleep deprivation. The objective of this study was to examine relationships among infant sleep patterns, maternal fatigue, and the development of postpartum depression in women with no major depressive symptomatology at 1 week postpartum. Methods: As part of a population‐based postpartum depression study, 505 women who had an Edinburgh Postnatal Depression Scale (EPDS) score < 13 at 1 week postpartum completed questionnaires at 4 and 8 weeks postpartum. Results: Mothers exhibiting major depressive symptomatology (EPDS > 12) at 4 and 8 weeks were significantly more likely to report that their baby cried often, be woken up 3 times or more between 10 pm and 6 am , have received less than 6 hours of sleep in a 24‐hour period over the past week, indicate that their baby did not sleep well, and think that their baby's sleep pattern did not allow them to get a reasonable amount of sleep. Consistent with these findings, mothers with an EPDS score > 12 were significantly more likely to respond that they often felt tired. Conclusions: These results suggest that infant sleep patterns and maternal fatigue are strongly associated with a new onset of depressive symptoms in the postpartum period, and provide support for the development of postpartum depression preventive interventions designed to reduce sleep deprivation in the early weeks postpartum.     

Relationship between a high Edinburgh Postnatal Depression Scale score and premenstrual syndrome: A prospective,observational study

ObjectiveThis study aimed to evaluate whether the Edinburgh Postnatal Depression Scale (EPDS) score predicts the occurrence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) after delivery.Materials and methodsThe women in this study were registered at 35–36 weeks of pregnancy at Mie University Hospital from 2013 to 2015. We prospectively divided the puerperants into those with an EPDS score ≥9 (the high-EPDS group) and those with an EPDS score <9 (the low-EPDS group) at 1 month postpartum. We compared the incidence rate of severe PMS and PMDD between both groups at 1 year after delivery.ResultsOf 200 registered cases, 178 (89.0%) did not experience severe PMS or PMDD before pregnancy. Among them, 21 were in the high-EPDS group, and 89 in the low-EPDS group. Four of the 21 women (19.0%) in the high-EPDS group and five of the 89 (5.6%) in the low-EPDS group had severe PMS or PMDD at 1 year after delivery. The incidence rate of severe PMS or PMDD in the high-EPDS group was higher than that in the low-EPDS group (p = 0.07).ConclusionsThe novel finding of this study is that the EPDS may predict the occurrence of severe PMS/PMDD after delivery. The EPDS will contribute to the early detection of these diseases and to improving the quality of life of the patients by allowing treatment initiation at an early stage.     

Effectiveness of an Exercise Support Program in Reducing the Severity of Postnatal Depression in Taiwanese Women

ABSTRACT: Background: Depression during the perinatal period should be identified as early as possible to avoid negative effects on the new family. The purpose of this study was to examine the effectiveness of an exercise support program on reducing psychological morbidity after childbirth. Methods: A controlled trial was conducted in a regional hospital in Taipei, Taiwan. Eighty primiparas with an Edinburgh Postnatal Depression Scale (EPDS) score above 10 at 4 weeks postpartum agreed to participate. They were allocated alternately to an intervention (to receive exercise support) and control group (to receive standard care) at 6 weeks postpartum. The exercise support consisted of 1 hour per week at the hospital and two sessions at home for 3 months. Sixty‐three primiparas finished the exercise support program. The main outcome measure was the EPDS score at 5 months postpartum. Results: Women who received the exercise support program were less likely to have high depression scores after childbirth when compared with the control group. Conclusions: The exercise support program given to postpartum women appeared to benefit their psychological well‐being. This promising finding should be tested in a well‐designed randomized controlled trial. (BIRTH 35:1 March 2008)     

Validation of the Bangla version of the Edinburgh Postnatal Depression Scale for a Bangladeshi sample

In developing countries, postnatal depression (PND) is estimated to affect a high proportion of women following childbirth. There are no reliable estimates for the magnitude of the problem in Bangladesh, a country of 140 million people. The lack of a validated Bangla version of screening scale such as the Edinburgh Postnatal Depression Scale (EPDS) has hindered attempts to quantify and address the problem in the country. This study was carried out among Bangladeshi women to validate the Bangla version of the EPDS with the help of a multi‐disciplinary research consultative group. A research assistant administered the Bangla EPDS to a convenience sample of 100 mothers at 6–8 weeks postpartum attending an urban childhood immunization clinic. A psychiatrist examined all women using the Structured Clinical Interview (SCID) for DSM‐IV diagnosis of depression. Nine (9%) women were found to have depression. Internal consistency was tested using Cronbach's alpha coefficient (0.84). The optimal Receiver Operating Characteristic (ROC) cut‐off score of Bangla EPDS was 10 with a sensitivity of 89%, specificity of 87 %, positive predictive value of 40%, and negative predictive value of 99%. The Bangla EPDS is thus a valid and reliable screening scale for identifying PND in Bangladesh.     

Validation of the Edinburgh Postnatal Depression Scale as a screening tool for postpartum depression in a clinical sample in Hungary

Background

the purpose of the study was to assess the validity of the 10-item Edinburgh Postnatal Depression Scale (EPDS) in screening for postnatal depression (PND) in Hungary.

Methods

between July 2010 and March 2011, a sample of 266 women attending a routine check-up at six weeks post partum completed the newly translated Hungarian version of the EPDS at the Department of Obstetrics and Gynecology, University of Szeged, Hungary, and underwent clinical assessments based on the Structured Clinical Interview for DSM-IV disorders (SCID-I).

Findings

eight (3.0%) of the mothers were diagnosed with major postnatal depression, and 36 (13.5%) with minor depression on the basis of the SCID. Internal consistency of the Hungarian version of the EPDS was satisfactory (Cronbach α coefficients ≥0.727). The best cut-off for major depression was 12/13, with a sensitivity of 100.0%, and a specificity of 97.7%. The area under the ROC curve was found significant for combined (major+minor) depression as well and at a cut-off of 7/8 indicated a sensitivity of 72.7% and a specificity of 86.0%. A factor analysis suggested multidimensionality with two factors (anxiety and depression).

Conclusions

the EPDS showed good validity in the postnatal period in a clinical sample in Hungary.     

Diagnosing postpartum depression: can we do better?

OBJECTIVE: The purpose of this study was to evaluate the efficacy of the Edinburgh Postnatal Depression Scale versus routine clinical evaluation to detect postpartum depression among a low-income inner-city population and to evaluate risk factors associated with a positive score on the Edinburgh Postnatal Depression Scale. STUDY DESIGN: On the basis of the day of the month, all English-speaking patients who were seen for their postpartum visit were assigned either to routine clinical evaluation for postpartum depression or routine clinical evaluation plus the use of the 10-question Edinburgh Postnatal Depression Scale. RESULTS: During the 7-week study period, 72 women participated in the study: 35 women in the routine evaluation group and 37 women in the Edinburgh Postnatal Depression Scale group. Women who completed the Edinburgh Postnatal Depression Scale were significantly more likely than those in the routine evaluation group to be identified as being at risk for depression: 11 of 37 women (30%) versus 0 of 35 women (P <.001). A failed attempt at breast-feeding was associated with an increased risk of a score of > or =10 on the Edinburgh Postnatal Depression Scale (relative risk, 3.78; 95% CI, 1.03-13.89). CONCLUSION: The Edinburgh Postnatal Depression Scale appears to be a valuable and efficient tool for the identification of patients who are at risk for postpartum depression.     

Improving antenatal recognition of women at risk for postnatal depression

The purpose of this study was to assess the effectiveness of a practical antenatal screen used at the Royal Women's Hospital, Brisbane, to identify women at risk for postnatal depression. It was a prospective, hospital-based, cohort study of 901 women (600 with and 301 without prenatal risk factors for postnatal depression). Depression was measured 16 weeks after the birth using the Edinburgh Postnatal Depression Scale. More of the women with a prenatal risk factor for depression (25.9%) scored above 12 on the Edinburgh Postnatal Depression Scale than those without any risk (10.9%) (p < or = 0.001). Low social support (p < or = 0.001), a personal history of mood disorder (p < or = 0.001) and a past history of postnatal depression ( p = 0.002) were all strongly associated with postnatal depression in this sample. Results indicate that an objective, psychosocial assessment during pregnancy improves recognition of women at risk for postnatal depression.     

Intergenerational transmission of postpartum depression

Objective: This study aimed to explore the hypothesis of an intergenerational transmission of postpartum depression. Mother’s postpartum depressive symptomatology was linked to former depression, postpartum depression of her mother as well as the quality of the mother–daughter relationship. Method: A sample of 65 women and their mothers completed questionnaires one month after delivery: the Edinburgh Postnatal Depression Scale (EPDS), dimension A of the International Mini Neuropsychiatric Interview (MINI) assessing a former depressive episode, the Mother and Adult Daughter Questionnaire (MAD) as well as the Inventory of Peer and Relative Attachment (IPPA). Their mothers completed the Bromley Postnatal Depression Scale (BPDS) in order to retrospectively diagnose a postpartum depression. Results: Women whose mother had suffered from a postnatal depression had significantly higher scores on the EPDS. Former depression symptoms and grandmother’s former postnatal depression were significant predictors of postpartum depression symptoms intensity. Conclusion: this study confirms the hypothesis of an intergenerational transmission of postpartum depression and highlights the need to provide an in‐depth examination of these issues.