Detection of antenatal depression in rural HIV-affected populations with short and ultrashort versions of the Edinburgh Postnatal Depression Scale (EPDS)

Risk of antenatal depression has been shown to be elevated in Southern Africa and can impact maternal and child outcomes, especially in the context of the Human Immunodeficiency Virus (HIV). Brief screening methods may optimize access to care during pregnancy, particularly where resources are scarce. This research evaluated shorter versions of the Edinburgh Postnatal Depression Scale (EPDS) to detect antenatal depression. This cross-sectional study at a large primary health care (PHC) facility recruited a consecutive series of 109 antenatal attendees in rural South Africa. Women were in the second half of pregnancy and completed the EPDS and Structured Clinical Interview for Depression (SCID). The recommended EPDS cutoff (≥13) was used to determine probable depression. Four versions, including the 10-item scale, seven-item depression, and novel three- and five-item versions developed through regression analysis, were evaluated using receiver operating characteristic (ROC) analysis. High numbers of women 51/109 (47 %) were depressed, most depression was chronic, and nearly half of the women were HIV positive 49/109 (45 %). The novel three-item version had improved positive predictive value (PPV) over the 10-item version and equivalent specificity to the seven-item depression subscale; the novel five-item provided the best overall performance in terms of ROC and Cronbach's reliability statistics and had improved specificity. The brevity, sensitivity, and reliability of the short and ultrashort versions could facilitate widespread community screening. The usefulness of the novel three- and five-item versions are underscored by the fact that sensitivity is important at first screening, while specificity becomes more important at higher levels of care. Replication in larger samples is required.     

Validation of the Edinburgh Postnatal Depression Scale (EPDS) in Spanish mothers

BACKGROUND: The EPDS is a 10-items self-report scale designed as a specific instrument to detect postnatal depression. It was validated in the UK and in other countries, but not in Spain. METHOD: We report data from all women (n=1201) attending in a routine postnatal check-up at 6 weeks postpartum during 1 year. A two-stage method was used: for the first stage, all individuals selected completed the EPDS; in the second one, 'probable cases' (n=261) with EPDS score >/=9, and a randomised sample of 10% with EPDS score less than 9 (n=126) were interviewed by a psychiatrist using the Structured Clinical Interview for DSM-IV, non-patient (SCID-NP), to establish psychiatric diagnosis of major and minor depression. RESULTS: The best cut-off of the Spanish validation of the EPDS was 10/11 for combined major and minor depression, the sensitivity was 79%, and specificity was 95.5%, with a positive predictive value of 63.2% and a negative predictive value of 97.7%. At this cut-off all cases of major depression were detected. The area under the ROC curve was 0.976 (P<0.0001) with an asymptotic interval of confidence of 95% between 0.968 and 0.984. CONCLUSIONS: Our data confirm the validity of the EPDS to identify postnatal depression in its Spanish version. The cut-off 10/11 for major and minor combined depression is useful to screen for a posterior psychiatric evaluation in Spanish sample.     

Perinatal Mental Health: a guide to the Edinburgh Postnatal Depression Scale (EPDS)

Archives of Women's Mental Health -     

Calculating clinically significant change in postnatal depression studies using the Edinburgh Postnatal Depression Scale

BACKGROUND: Statistical significance between test scores can sometimes be obtained even when the actual difference between the scores is very small. Because of this researchers have recommended that clinical significance also be calculated when reporting results of interventions. The calculation of clinical significance between scores on a particular test takes into account the reliability of the test, as well as normative data from clinical and non-clinical samples. Jacobson and Truax (1991) describe the calculation of the Reliable Change Index (RCI) as a method of calculating this clinical significance. RESULT: The RCI for the Edinburgh Postnatal Depression Scale (EPDS) is calculated to be four points. This is the size of difference between two scores which is needed for a clinician to be 95% confident that this change reflects a real change in the individual's mood, and is not likely to be due to measurement error. Using the accepted EPDS cut-off score of 12/13 for major depression (English-speaking women), examples are given of the clinical significance classification of individual's pre-post EPDS scores. A further example of reporting both statistical significance and clinical significance on the EPDS scores of 23 women is given, highlighting the improved information that is obtained when this clinical significance is calculated. CLINICAL IMPLICATIONS: Statistical significance allows the interpretation of whether women 'on average' improve more in one condition than another. Clinical significance allows the further interpretation of how many women show improvement in each condition. This improvement can be categorised into those who recover, those who improve but are still in the distressed range, those who show no reliable change in their EPDS score, and those who deteriorate. Calculating clinical significance, using the reliable change index and cut-off classification, therefore adds to our understanding of the impact of postnatal depression treatment studies.     

Partner report of paternal depression using the Edinburgh Postnatal Depression Scale-Partner

Similar to maternal depression, paternal depression may have adverse effects on the family environment (e.g., partner mental health, child behavior). Detection of paternal depression is rare because the maternal-child health care system usually only screens for maternal depression. The scarcity of paternal depression screening and detection is due to fathers not usually being involved in the maternal-child health care system and, therefore, unavailable for depression screening. The purpose of this study was to assess the psychometric characteristics of the Edinburgh Postnatal Depression Scale-Partner Version (EPDS-P) in detecting paternal depression through maternal report. The EPDS-P, rated by the mother, was found to be a reliable and valid measure of paternal depression when compared to other well-validated measures of depression. The EPDS-P has clinical utility in the maternal-child health care system by making it possible to screen for paternal depression without the father being present. Proxy screening for paternal depression can be beneficial for early detection and treatment of paternal depression both in the perinatal period and through a child's early life. Detection and treatment of paternal depression reduces the risk of long-term depression in fathers.     

The Edinburgh Postnatal Depression Scale (EPDS) and the detection of major depressive disorders in early postpartum: some concerns about false negatives

This paper presents a phenomenological study of three false negative cases according to the Edinburgh Postnatal Depression Scale (EPDS) of major depressive disorder identified by a semi-structured clinical interview. In a study of 87 unselected women with 23 of them suffering from a major depressive disorder (according to the Research Diagnostic Criteria), three cases of major depressive disorders were not identified as potential cases by the EPDS. The symptomatology of these three false negative cases was also assessed by a semi-structured interview (Present State Examination). Comparisons between EPDS scores and the scores of two other self report questionnaires (the General Health Questionnaire-28 and the Center for Epidemiologic Studies-Depression Scale) suggest that EPDS is better at identifying depressed postnatal women with anhedonic and anxious symptomatology rather than those whose depression presents mainly with psychomotor retardation.     

Replicability of structural models of the Edinburgh Postnatal Depression Scale (EPDS) in a community sample of postpartum African American women with low socioeconomic status

The Edinburgh Postnatal Depression Scale (EPDS) is increasingly used in public health and social service programs serving postpartum women of racially, ethnically, and socioeconomically diverse backgrounds at risk for depression. However, we know little about its factor structure across groups of women with implications for measuring symptom levels in research. This study evaluated the underlying structure of the EPDS using a confirmatory factor analyses model comparison approach of five factor models from the literature in a purposive community sample of 169 postpartum African American women of low socioeconomic status. Participants were identified through an exhaustive review of local health department program files dated August 2006 to August 2010 in a Midwestern state of USA. Tuohy and McVey’s (Br J Clin Psychol 47:153–169, 2008) three-factor model (depression, anxiety, and anhedonia) demonstrated the best fit to the data with a nonsignificant Satora–Bentler scaled chi-square value (21.70, df = 24, p = 0.60) and the lowest root mean square error of approximation (0.00) and standardized root mean square residual (0.05) values. The results call for further study of the factor structure of the EPDS in other racial and ethnic groups and cautious use of the EPDS among perinatal women of racially, ethnically, and socioeconomically diverse backgrounds until its factorial invariance is better understood.     

Validation of the Edinburgh Postnatal Depression Scale in an Iranian sample

Summary Background: Considering the adverse effects of postpartum depression on both mother and infant, a screening instrument for early diagnosis seems to be of importance. Aims: To assess the psychometric properties of the Persian version of Edinburgh Postnatal Depression Scale (EPDS) on a sample of Iranian postpartum women. Method: The EPDS was translated and back-translated in the standard method. The questionnaire was completed by 600 postpartum women. Hundred cases with an EPDS score of ≥9 and 100 cases with an EPDS of <9 were randomly selected for interview. Sensitivity, specificity, positive likelihood ratio, and receiver operating characteristics were calculated by comparing the EPDS sum score against the DSM-IV diagnoses. The correlation coefficient of the EPDS score with GHQ-12 score was calculated. Principal component analysis and internal consistency were assessed. Results: The best cutoff scores for major depression were 12/13 with a sensitivity and specificity of 95.3% and 87.9%, respectively. The correlation coefficient of the total score of the Persian version of EPDS with the GHQ-12 total score was 0.76 (P < 0.001). A two-factor solution was selected as the most appropriate model based on both values and the score plot. The coefficient alpha for the whole scale was 0.83. Conclusion: The Persian version of EPDS is a reliable and valid measure for detecting postpartum depression. Furthermore, it seems acceptable to patients and a valid screening instrument for depression in postpartum women. Correspondence: Shahrzad Mazhari, M.D., Neuroscience Department, Research Center of Kerman University of Medical Sciences, Jomhoori Islamic Blvd, P.O. Box 67175-113, Kerman, Iran     

Validation of the Maltese version of the Edinburgh Postnatal Depression Scale

Summary This paper reports the validation of the Maltese translated Edinburgh Postnatal Depression Scale against Diagnostic Criteria for Research (DCR-10) diagnosis for severe, moderate and mild depression during pregnancy (antenatally) and at 8 weeks postnatally. A random sample of 239 pregnant women were interviewed at booking and at 8 weeks postnatally using a detailed sociodemographic history, the Revised Version of the Clinical Interview Schedule (CIS-R) and Maltese translation of the Edinburgh Postnatal Depression Scale (EPDS). The Maltese translated EPDS had good face validity and had satisfactory sensitivity and specificity for identifying depression both antenatally and postnatally. Cut-off scores of 13/14 antenatally and 11/12 postnatally are recommended when using the Maltese EPDS. Controversial issues surrounds the use of the EPDS in clinical practice. However, introducing the EPDS in pregnancy will help to identify women who are at high risk of depression so as to treat appropriately and early in the antenatal period.     

Validation of a computerised version of the 10-item (self-rating) Edinburgh Postnatal Depression Scale

Twenty-nine women were obtained from two community-based facilities and administered the 10-item Edinburgh Postnatal Depression Scale (EDPS) in a computerised and 'pencil and paper' form. A high correlation (r = 0.98) was found between the two test types. The computerised test was found to be acceptable to all women in the study. Our findings suggest that the computerised form of the EPDS may be of use in screening women in community settings and may also be valuable in antenatal or postnatal clinics.     

Validation of the Edinburgh Postnatal Depression Scale among women in a high HIV prevalence area in urban Zimbabwe

Despite the significant burden of common mental disorders (CMD) among women in sub Saharan Africa, data on postnatal depression (PND) is very limited, especially in settings with a high HIV prevalence. The Edinburgh Postnatal Depression Scale (EPDS), a widely used screening test for PND has been validated in many countries, but not in Zimbabwe. We assessed the validity of the EPDS scale among postpartum women compared with Diagnostic Manual of Mental Disorders (DSM-IV) criteria for major depression. Six trained community counselors administered the Shona version of the EPDS to a random sample of 210 postpartum HIV-infected and uninfected women attending two primary care clinics in Chitungwiza. All women were subsequently subjected to mental status examination using DSM IV criteria for major depression by 2 psychiatrists, who were blinded to the subject’s EPDS scores. Data were analyzed using receiver operating characteristic (ROC) curve analysis. Of the 210 postpartum mothers enrolled, 64 (33%) met DSM IV criteria for depression. Using a cut-off score of 11/12 on the Shona version of the EPDS for depression, the sensitivity was 88%, and specificity was 87%, with a positive predictive value of 74%, a negative predictive value of 94%, and an area under the curve of 0.82. Cronbach's alpha coefficient for the whole scale was 0.87. Conclusion: The Shona version of the EPDS is a reliable and valid tool to screen for PND among HIV-infected and un-infected women in Zimbabwe. Screening for PND should be integrated into routine antenatal and postnatal care in areas with high HIV prevalence.     

A qualitative study of the acceptability of routine screening of postnatal women using the Edinburgh Postnatal Depression Scale.

BACKGROUND: Screening for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS) has been widely recommended and implemented in primary care, although little is known about how acceptable it is to women. AIM: To explore the acceptability to women of postnatal screening by health visitors with the EPDS. DESIGN OF STUDY: Qualitative interview study. SETTING: Postnatal patients from 22 general practices within the area of Oxford City Primary Care Group. METHOD: Thirty-nine postnatal women from a purposive sample were interviewed, chosen on the basis of different general practices, EPDS results at eight weeks and eight months postnatal, and whether 'listening visits' were received. The interviews were analysed using the constant comparative method. RESULTS: Just over half of the women interviewed found screening with the EPDS less than acceptable, whatever their postnatal emotional health. The main themes identified were problems with the process of screening and, in particular, the venue, the personal intrusion of screening and stigma. The women interviewed had a clear preference for talking about how they felt, rather than filling out a questionnaire. CONCLUSION: For this sample, routine screening with the EPDS was less than acceptable for the majority of women. This is of concern, as universal screening with the EPDS for the detection of postnatal depression is already recommended and widespread in primary care.     

The Edinburgh Postnatal Depression Scale detects but does not distinguish anxiety disorders from depression in mothers of infants

Specific screening tests to detect postpartum anxiety are as yet unavailable. The aim of this study was to test the ability of the Edinburgh Postnatal Depression Scale (EPDS) to detect anxiety disorders in women admitted to residential early parenting centres. Consecutive cohorts of English speaking women admitted with their infants to two centres in Melbourne, Australia completed the Composite International Diagnostic Interview and the Edinburgh Postnatal Depression Scale (EPDS). Anxiety and depression diagnoses were compared with EPDS scores. Of the 145 women (78% recruitment rate), 138 (95%) provided complete data of whom 35 (25%) had at least one anxiety disorder. EPDS scores over 12 correctly identified 28 women (44%) as having major depression, either alone or co-morbid with an anxiety disorder but 10 (16%) had only an anxiety disorder and were not depressed. All of the 26 (41%) women with EPDS scores over 12 with neither diagnosis met diagnostic criteria for minor depression or an adjustment disorder. EPDS scores were unable to distinguish between these diagnostic groups. The presumption that EPDS scores over 12 indicate only probable depression is an oversimplification. Current national initiatives recommend that EPDS scores over 12 warrant treatment for depression, which may lead to inappropriate labeling and therapy.     

Predictive validation study of the Edinburgh Postnatal Depression Scale in the first week after delivery and risk analysis for postnatal depression

BACKGROUND: Postnatal depression is a major public health problem. The aim of this study is to validate the use of the Edinburgh Postnatal Depression Scale (EPDS) in the early postpartum, and to identify the markers for risk of postnatal depression. METHODS: 815 women filled out an EPDS and general information questionnaire between the third and the fifth day postpartum. The women with an EPDS score of >8 and a randomized control group from those with scores of <8 were contacted 8 weeks postpartum. 363 women therefore had a structured diagnostic interview by telephone at 8 weeks postpartum (MINI-DSM-IV), without knowledge of their EPDS scores, to screen for a major or minor depressive episode. RESULTS: The sensitivity of EPDS was measured as 0.82 [0.78-0.86], with a positivity threshold of 9.5/30. For an estimated prevalence for all depressive episodes of 16.1%, the positive predictive value of EPDS was measured as 42.8% [39.1-46.5%]. Multivariate risk analysis using logistical regression identified the following as risk markers for postnatal depression: previous history of depression (postnatal or other), unemployment, premature delivery or stopping breast-feeding in the first month for non-medical reasons. CONCLUSION: The use of EPDS between the third and fifth day postpartum is valid. An EPDS score of >10 should be completed by a clinical assessment and suitable management. The risk markers identified here are clinical indices that can be used for first-line early screening by non-psychiatric health workers.     

Screening for postnatal depression. Validation of the Norwegian version of the Edinburgh Postnatal Depression Scale,and assessment of risk factors for postnatal depression

OBJECTIVE: The Edinburgh Postnatal Depression Scale (EPDS) is a self-rating scale developed to screen for postnatal depression. The aim of this study was to validate a Norwegian translation of the EPDS, study its psychometric properties, and identify risk factors for postnatal depression. METHOD: EPDS was filled in by 411 women at 6-12 weeks postpartum. Of these, 100 were interviewed using the Mini International Neuropsychiatric Interview for DSM-IV major and minor depressive disorders. RESULTS: When using a cut-off of 11 on the EPDS, 26 of 27 women with major depression were identified (sensitivity 96%, specificity 78%). An aggregate point prevalence of 10.0% of major and minor depression was found. A one-factor model accounted for 46.6% of the variance. Strongest risk factors for postpartum depression were previous depression, depression in current pregnancy, and current somatic illness. LIMITATIONS: Women screened using the EPDS who had a score above threshold, yet did not attend the diagnostic interview could cause the point prevalence of depression to be higher than indicated here. CONCLUSION: The Norwegian translation of EPDS functions equally well as other translations as a screening tool for postnatal depression. The risk factors that were found are compatible with other studies.     

Validation of the Edinburgh postnatal depression scale (EPDS) in a sample of women with high-risk pregnancies in France

Summary This research is intended to validate the Edinburgh Postnatal Depression Scale (EPDS) in a high-risk pregnant population.Method: Sixty women attending antenatal consultations for pregnancy complication in a major Parisian maternity facility were included. They completed the EPDS and were then interviewed according to a standardised psychiatric interview.Results: The study of its sensitivity, specificity and predictive values, with a DSM-IV diagnosis of major depression as the reference, found that 11.5 was the optimal cut-off score (Se 0.80; Sp 0.80). Its validity as an index of severity of depression was also good as well as internal consistency and reliability. Factor analysis showed that its internal structure is composed of two subscales (F2 depression and F1 with items reflecting depression and other disorders, including anxiety).Conclusion: The French version of the EPDS would be a valid instrument to identify pregnant women who are likely to have clinical major depression. The results may have to be confirmed on a community sample before clinical use.     

The development of the Brief Edinburgh Depression Scale (BEDS) to screen for depression in patients with advanced cancer

BACKGROUND: The development of a brief valid tool to screen for depression in patients with advanced cancer is important. This paper reports data on the psychometric properties of the Brief Edinburgh Depression Scale. METHOD: Two hundred and forty six patients who fulfilled the inclusion criteria completed the 10-item EDS and Present State Examination. RESULTS: Factor extraction revealed 6 items from the ten item EDS. The most valid cut off for defining a case, using the PSE diagnosis as the "gold-standard", was a score of 6 out of 18 on the Brief Edinburgh Depression Scale which gave a sensitivity of 72% and specificity of 83% with a PPV of 65.1% and NPV of 87.1%. CONCLUSIONS: The six item EDS is a brief and sensitive method of screening for depression in advanced cancer patients--this novel use of the Edinburgh depression scale may have a significant impact on the assessment and thus management of this distressing symptom.