Screening for postnatal depression in a population-based Swedish sample

This study surveyed the prevalence of postnatal depression and demographic factors associated with it in a Swedish population. A community sample of 1584 women was screened at 8 and 12 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). The point prevalence of depression, using a threshold of 11/12 on the EPDS, was 12.5% at 8 weeks and 8.3% at 12 weeks postpartum. The period prevalence for 8 to 12 weeks postpartum was 4.5%. A significantly increased risk of postnatal depression was found for single women. Parity, maternal age and occupational status were not found to be related to postnatal depression. The findings suggest that screening for postnatal depression is feasible at the time of postnatal checks on the baby, and that it can aid in the identification of women at risk for depression. A two-stage screening procedure will identify women at risk for more persistent postnatal depression.     

Affective (depressive) morbidity in puerperal Nigerian women: validation of the Edinburgh Postnatal Depression Scale

OBJECTIVE: To determine the rate of depression in a group of postpartum Nigerian women and to validate the Edinburgh Postnatal Depression Scale (EPDS) in this group. METHOD: Between April and August 2000, all postpartum women who remained in the maternity ward for up to 7 days, and those who attended the postnatal clinics of Nnamdi Azikiwe University Teaching Hospital were recruited. Translated local language versions of the EPDS and the Zung Self-Rating Depression Scale were used to screen the subjects. A structured interview schedule was adapted from the depression section of the Composite International Diagnostic Interview and affective module of the ICD-10 Symptom Check List to assess screened subjects. RESULTS: The total rejection rate was 23%, with 225 women participating in the study. Twenty-four subjects (10.7%) had depression. At the optimal cut-off score of 9, the EPDS had a sensitivity of 0.75, and specificity of 0.97. CONCLUSION: The EPDS clearly distinguished between depressed and non-depressed postpartum mothers (t = 7.63, P < 0.001, df = 222). Because of its brevity and acceptability, it is recommended that the EPDS be used in routine postnatal screening.     

Death and suicide among former child and adolescent psychiatric patients

Background

Postnatal depression has received considerable research and clinical attention, however anxiety and stress in the postpartum has been relatively ignored. Along with the widespread use of the Edinburgh Postnatal Depression Scale (EPDS), depression has become the marker for postnatal maladjustment. Symptoms of anxiety tend to be subsumed within diagnoses of depression, which can result in anxiety being minimized or overlooked in the absence of depression. Some researchers have identified the need to distinguish between postnatal depression and anxiety, and to discern cases where depression and anxiety co-exist. The aim of this study was to assess the prevalence of postnatal distress using the EPDS and the Depression Anxiety Stress Scales (DASS-21).

Method

As part of a larger cross-sectional study, the EPDS and DASS-21 were administered to a convenience sample of 325 primiparous mothers, who ranged in age from 18 to 44 years (M = 32 years). Recruited through mother's groups and health centres in Melbourne Australia, inclusion was limited to mothers whose babies were aged between 6 weeks and 6 months. Analyses included comparisons between the classifications of women according to the EPDS and the DASS-21, and an exploration of the extent to which the EPDS identified anxious-depressed women.

Results

The EPDS identified 80 women (25%) as possibly depressed (using a cut-off of over 9), of which the DASS-21 corroborated 58%. In the total sample, 61 women (19%) were classified by the DASS-21 to be depressed. Using broader criteria for distress, it was revealed by the DASS-21 that a further 33 women (10%) showed symptoms of anxiety and stress without depression. A total of 41 women (13%) had symptoms of anxiety either in isolation or in combination with depression. The DASS-21 identified 7% of the sample as being both anxious and depressed. This at-risk sub-group had higher mean EPDS and DASS-depression scores than their depressed-only counterparts.

Conclusion

The prevalence of anxiety and stress in the present study points to the importance of assessing postnatal women for broader indicators of psychological morbidity than that of depression alone. The DASS-21 appears to be a useful instrument for this purpose.     

Prevalence and risk factors for a high level of postnatal depression symptomatology in Italian women: A sample drawn from ante-natal classes

BackgroundDepression after childbirth is a major problem affecting 10–22% of all mothers. In Italy, postnatal depression has not yet been systematically studied.MethodsIn this retrospective study we have sought to identify risk factors, assessed during pregnancy, and their importance for postnatal depression symptoms in a sample of 297 Italian women attending ante-natal classes organised by the local Consultorio Familiare Unit of the National Health Service, Italy. The Postpartum Depression Predictors Inventory – revised form (PDPI-Revised), was used to identify risk factors, 8–9 month of pregnancy. A double-test strategy using the Edinburgh Postnatal Depression Scale (EPDS) and 12-item General Health Questionnaire (GHQ12), was administered to screen women with a higher occurrence of symptoms of postnatal depression six–eight weeks after delivery. Women with high EPDS (<8) and high GHQ12 (<3) scores were compared with those who had scored below the EPDS and/or GHQ12 threshold scores.ResultsWe found that 13% of the women studied showed high postnatal depressive symptomatology, which is very similar to rates of prevalence of postnatal depression in the first year after the birth of the child reported in other Western World studies. Feeling anxious during pregnancy is a strong predictor of high symptoms of depression at 6–8 weeks after delivery. However, University education and friends' support appear to be important protective factors.ConclusionThese findings could be useful both for Italian health professionals and for researchers interested in the transcultural aspects of postnatal depression.     

Does antenatal screening for psychosocial risk factors predict postnatal depression? A follow-up study of 154 women in Adelaide, South Australia

OBJECTIVE: This study investigated the effectiveness of antenatal screening for psychosocial risk factors in predicting postnatal depression, in women living in a socioeconomically deprived area. METHOD: 154 women completed the Antenatal Psychosocial Questionnaire (APQ) and the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression analysis was used to identify antenatal psychosocial risk factors predictive of EPDS caseness, with an EPDS score of 10 or more being taken to indicate depression. RESULTS: Antenatal depression was more common than postnatal depression. 44 women (30%) met criteria for antenatal depression and 33 women (22.6%) met criteria for postnatal depression. 21 women (14.4%) were depressed both before and after delivery of their baby, and women who had antenatal depression were significantly more likely to be depressed postnatally. Whilst there were high rates of endorsement of antenatal psychosocial risk factors, the only item from the APQ that predicted postnatal depression was emotional abuse as a child. CONCLUSION: Antenatal screening for psychosocial risk factors was useful in identifying problems during the antenatal period, but was not useful as a predictor of postnatal depression.     

Detecting women at risk for postnatal depression using the Edinburgh Postnatal Depression Scale at 2 to 3 days postpartum.

OBJECTIVE: This study evaluates the capacity of the Edinburgh Postnatal Depression Scale (EPDS) implemented in the first days postpartum to detect women who will suffer from postnatal depression. METHOD: A sample of 1154 women completed the EPDS at 2 to 3 days postpartum and again at 4 to 6 weeks postpartum. RESULTS: There was a highly significant positive correlation between EPDS scores on both occasions (Spearman rank correlation: r = 0.59, P < 0.0001). The cut-off scores of 10 and 11 for EPDS administered at 2 to 3 days obtained good specificity, sensitivity, and positive predictive values for the cut off scores proposed for the diagnosis of postnatal depression at 4 to 6 weeks postpartum. CONCLUSION: The EPDS completed at 2 to 3 days postpartum is a useful means of detecting women at risk of postnatal depression.     

Risk factors for depression in the first postnatal year

BACKGROUND: The aim of the study was to identify risk factors for depression and to estimate its prevalence in postnatal mothers. METHODS: This cross-sectional and multi-centre study was carried out on 1,350 Turkish women in their first postnatal year. Measures included a structured questionnaire and the Turkish version of the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Of the women, 31.1% had a score of 13 or higher on the EPDS. The mean score and standard deviation was 9.8+/-5.7. In the multivariate analysis, EPDS scores were significantly associated with economic status, access to support from family members and close friends, emotional distress at the pregnancy, whether the pregnancy was planned, health problems during pregnancy, the perceived standard of baby care after delivery, and mental disorder before and during pregnancy. CONCLUSION: The prevalence of EPDS-based depression among Turkish women in postnatal the period was high, and was associated with several social, economic and demographical factors.     

Screening and intervention for depressive mothers of new-born infants]

BACKGROUND AND THE AIM OF THE STUDY: Postnatal depression is a key concept for mother-infant mental health. Evidence of its impact on mother-infant relationship has been increasingly demonstrated in recent years. Therefore optimal intervention is important for women and their babies' mental health. Identifying risk factors of postnatal depression and developing screening system are needed. Study I Hospital-based prospective study--onset and course of Postnatal depression and developing screening system. SAMPLING AND METHOD: One hundred and one consecutive admitted women on maternity ward in our university hospital were invited to the study and 88 mothers participated. Present psychiatric status was assessed by telephone interview at three weeks and three months postnatally, using the Schedule for Affective Disorders and Schizophrenia and diagnosis was made based on Research Diagnostic Criteria. The Maternity Blues Scale and Edinburgh Postnatal Depression Scale (EPDS) were also administered at the 5th day, one and three months postnatally. RESULTS AND DISCUSSION: At 3 weeks, 21 of the 88 mothers (24%) were categorized as having had Maternity blues, and twelve (14%) were diagnosed as depression cases. At 3 months postpartum overall 15 of 88 mothers (17%) were categorized as depression cases. Ten out of total 15 mothers had their onset of depression within the first week. There were no differences in age, parity, educational level, social class compared to non-depressed mothers. The scores of the Blues and the EPDS were always significantly higher in depressed mothers. The Blues scale score was significantly higher in the depressed mothers compared to the control mothers at any timing of investigation. Even at the fifth postnatal day, 11 of 15 mothers who subsequently became clinical depression had already scored 9 or more, which is indicative of postnatal depression, this means postnatal depression could be detected from the very early postpartum period. As for the validity test of the EPDS, having set a cut-off point being 9 or more, the sensitivity was 82% and the specificity were 95% respectively. This score is the same as Okano reported in Japan and lower than many studies in Western countries. Study II Multi-centre prospective study of early postpartum mood states. SAMPLING AND METHODS: Fourteen obstetric wards in teaching hospitals participated in the study, and there, recruitment in each ward continued until 20 post-natal women had agreed to participate. Two hundred twenty six patients (89.7%) completed the study. During the first 5 days Maternity blues scale, and the EPDS on the 5th postnatal day, and one month postnatally the EPDS again were given to the mothers. The EPDS score of 9 or more was regarded as a probable case of postnatal depression. RESULTS AND DISCUSSION: Seventy-nine out of the 226 patients (35%) had maternity blues. Forty six out of the 226 patients (20%) had postnatal depression (EPDS being 9 or more) at one month postnatally. There was a significant correlation between the EPDS scores on the 5th postnatal day and those at one month. Having maternity blues and higher than 9 or more of the EPDS score were significantly related to the EPDS scores of 9 or more at one month postnatally. (odds's ratio = 4.4 and 13 respectively). Dysphoria on 5 day was significantly related to history of pregnancy loss, Caesarean section, Maternal and neonatal complications and Maternity blues. Dysphoria on one month was only related to Maternal complication. CONCLUSIONS: The onset of postnatal depression can be within the first week after delivery. The use of the EPDS during the first week is a simple and useful screening for early onset case. Maternal complications and related medical factors might be the risk factors of mood disturbance during early postnatal period.     

Postnatal mental health of women giving birth in Australia 2002-2004: findings from the beyondblue National Postnatal Depression Program

OBJECTIVES: To describe the postnatal mental health status of women giving birth in Australia 2002-2004 at 6-8 weeks postpartum. METHOD: Women were recruited from 43 health services across Australia. Women completed a demographic questionnaire and an Edinburgh Postnatal Depression Scale (EPDS) in pregnancy; the latter was repeated at 6-8 weeks following childbirth. RESULTS: A total of 12 361 postnatal women (53.8% of all postnatal women surveyed) completed questionnaires as part of a depression screening programme; 15.5% of women screened had a postnatal EPDS>9 and 7.5% of women had an EPDS>12 at 6-8 weeks following childbirth. There was significant variation between States in the percentage of women scoring as being potentially depressed. The highest percentage of women scoring EPDS>12 were in Queensland and South Australia (both 10.2%) while Western Australia had the lowest point prevalence (5.6%). Women recruited from private health services in Western Australia had a significantly lower prevalence of elevated EPDS scores than those women recruited from the public health service (EPDS >12: 3.6% vs 6.4%, p=0.026); differences in the prevalence of elevated EPDS scores were not significant between public and private in Australian Capital Territory (EPDS>12: 7.6% vs 5.8%, p=0.48), where income and education was significantly higher than other States for both groups. CONCLUSIONS: Postnatal depressive symptoms affect a significant number of women giving birth in Australia, and the point prevalence on the EPDS may be higher for women in the public sector, associated with lower incomes and educational levels. Maternity services--particularly those serving women with these risk factors--need to consider how they identify and manage the emotional health needs of women in their care. Specific State-related issues, such as availability of specialist perinatal mental health services and liaison between treating health professionals, also need to be considered.     

Validation of the Thai Edinburgh Postnatal Depression Scale for screening postpartum depression

This study aimed to validate and determine an appropriate cut-off score on the Thai Edinburgh Postnatal Depression Scale (EPDS) as a screen for postpartum depression. A prospective cohort of postpartum women at 6-8 weeks were tested using the EPDS and clinically interviewed by psychiatrists to establish a DSM-IV diagnosis of major or minor depressions in a university hospital in Southern Thailand. Of 351 postpartum women interviewed, 38 postpartum women met the criteria for depressive disorders, major depression in four women (1%) and minor depressive disorder in 34 women (10%). The area under the curve was 0.84 (95% confidence interval 0.76-0.91). Using an EPDS cut-off sum score of 6/7, major and/or minor depression was detected with a sensitivity of 74%, specificity of 74%, positive predictive value of 26% and negative predictive value of 95%. When the cut-off score was higher, the sensitivity was lower but the specificity was higher. The Thai version of the EPDS is a valid self-report instrument and is useful in Thailand where no other screening instrument for postpartum depression is available.     

Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders

Screening for postnatal mood disorders in English-speaking women often uses the validated cut-off score of 13 or more on the Edinburgh Postnatal Depression Scale (EPDS) to detect probable major depression. Increasingly there is evidence that for many women, and men, anxiety disorders can occur postnatally in the absence of depression. This study therefore examined data on the three EPDS items frequently found to cluster together on an anxiety factor for women (items 3, 4, and 5: EPDS-3A), to determine the optimum cut-off score to screen for specified anxiety disorders. A sample of 238 women and 218 men were administered a diagnostic interview for anxiety and depressive disorders, and completed the EPDS, at 6 weeks postpartum. The receiver operating characteristics show that the optimum cut-off score on the EPDS-3A for women is 6 or more (possible range: 0-9), and for men it is 4 or more, though it appears that the factor structure for men is different than for women. The conclusion is that the EPDS can be used to screen for probable depression in women (using the validated total cut-off score of 13 or more) and also probable anxiety (using the EPDS-3A cut-off score of 6 or more). For men there is already a validated total cut-off score for both depression and anxiety (6 or more)--however, if services are not using this, they can use the EPDS-3A score of 4 or more to screen for probable anxiety disorders in fathers, though further work needs to be undertaken to clarify whether the anxiety factor structure for men is different to that found for women.     

Screening for postnatal depression in routine primary care: properties of the Edinburgh Postnatal Depression Scale in an Australian sample

OBJECTIVES: First, to explore the utility of the Edinburgh Postnatal Depression Scale (EPDS) in routine primary care through a large community screening program. Next, to compare administration of a second EPDS versus the Beck Depression Inventory (BDI) in identifying postnatal depression in the prescreened population. METHOD: Screening with the EPDS through Maternal and Child Health Centres at 4 months post-partum. Women scoring > or = 12 were assessed against DSM-IV criteria and completed a BDI and a second EPDS. These data were subjected to receiver operating characteristic (ROC) analyses. RESULTS: Of 4148 screened, 533 (12.8%) scored > or = 12. Of these, 344 were assessed against DSM-IV criteria: 193 (56%) - major depressive disorder; 67 (20%) - other diagnoses that incorporated depression. Positive predictive value at screening was therefore 76%. Another 45 (13%) had non-depressive disorders and 39 (11%) were psychiatric non-cases. The BDI was the better diagnostic instrument in the prescreened population, having a significantly higher efficiency as quantified by ROC curve analysis, though the absolute difference in efficiency was small (approximately 6%). CONCLUSIONS: Screening with the EPDS integrated well into routine primary care. Two-step screening offers one way of achieving acceptable balances of operational simplicity and diagnostic accuracy.     

Postnatal psychiatric morbidity: a validation study of the GHQ-12 and the EPDS as screening tools

OBJECTIVE: To assess the validity of the 12-Item General Health Questionnaire (GHQ-12) and the Edinburgh Postnatal Depression Scale (EPDS) in screening for the most common postnatal psychiatric morbidities (mood, anxiety and adjustment disorders). METHOD: A two-phase cross-sectional study was designed. First, a sample of 1453 women visiting at 6 weeks postpartum completed the GHQ-12 and the EPDS questionnaires. Second, based upon EPDS outcomes, participants were stratified and randomly selected within each stratum for clinical evaluation [Structured Clinical Interview for DSM-IV (SCID)]. Receiver operating characteristic (ROC) analysis was used. RESULTS: The concurrent validity was satisfactory (0.80). At optimum cut-off scores, both GHQ-12 and EPDS yielded very good sensitivity (80; 85.5) and specificity (80.4; 85.3), respectively. ROC curves showed that the performance of the EPDS (AUC=0.933) is slightly superior to that of GHQ-12 (AUC=0.904). CONCLUSION: Both GHQ-12 and EPDS are valid instruments to detect postnatal depression as well as postnatal anxiety and adjustment disorders.     

Postnatal depressive symptoms go largely untreated

Background Prior studies providing estimates of the prevalence of postnatal depressive symptoms (PNDS) in New Zealand have been hampered by methodological shortcomings. Aims of this study were to derive an accurate estimate of PNDS prevalence and treatment frequency in an urban population of a major city in New Zealand. Method This was a one-wave postal survey of a probability, community sample of all women in Auckland who were 4 months postpartum. PNDS was assessed with the Edinburgh Postnatal Depression Scale (EPDS). Results There were 225 usable responses (78% response-rate): 36 women (16.0%) scored above the threshold for depressive symptomatology, and nine of them were in treatment. A further 31 women (13.8%) scored just below the threshold region for depressive symptomatology, and none were in treatment. Conclusion The prevalence rate of PNDS in urban New Zealand is slightly higher than the world-wide average, and goes largely untreated in the community. Health care providers should remain vigilant to the finding that almost one in three mothers with infants is suffering with symptoms of depression and may need strong encouragement to admit they need help.     

Single motherhood versus poor partner relationship: outcomes for antenatal mental health

OBJECTIVE: In the transition to parenthood, lack of social support significantly impacts on maternal mood. This paper compares the influence of single-mother status and level of partner support in a partnered relationship, on antenatal emotional health. METHODS: Antenatal demographic, psychosocial and mental health data, as determined by Edinburgh Postnatal Depression Scale (EPDS) score, were collected from 1578 women. The association between these variables, and marital status, was investigated using logistic regression. RESULTS: Sixty-two women (3.9%) were identified as single/unpartnered. Elevated EPDS scores (>12) were found in 15.2% (240/1578) of the total cohort and 25.8% (16/62) of the single/unpartnered women. EPDS scores were significantly lower for single/unpartnered women than for women with unsupportive partners (8.9+/-5.3 vs 11.9+/-6.5, p<0.001). Compared to the partnered cohort, single/unpartnered women were more likely to have experienced >or=2 weeks of depression before the current pregnancy (p<0.05), a previous psychopathology (p<0.001), emotional problems during the current pregnancy (p<0.01) and major life events in the last year (p<0.01). Binary logistic regression modelling to predict antenatal EPDS scores suggests that this is mediated by previous psychiatric history (p<0.001) and emotional problems during pregnancy (p=0.02). CONCLUSION: Women in a partnered-relationship with poor partner-derived support were at an increased risk of elevated antenatal EPDS scores compared to single/unpartnered women. A previous history of depression and current emotional problems, rather than single mother status, were significant risk factors for elevated EPDS scores. The present study reiterates the contribution of psychosocial risk factors as important mediators of antenatal emotional health.     

The role of self-report questionnaire in the screening of postnatal depression

Abstract.Background: Numerous studies have shown that health care professionals often experience difficulty in detecting postnatal depression. In Japan, where mental illness has traditionally been stigmatized, detection seems even more difficult. This study investigates the prevalence of postnatal depression in the community and its relation to screening methodology.Methods: The Edinburgh Postnatal Depression Scale (EPDS) was distributed at community health centers in a district in central Tokyo. The results from both non-identifiable questionnaires and identifiable questionnaires were compared. Screening by EPDS and clinical judgment by community nurses were compared.Results: Making the questionnaire identifiable did not change the score distribution pattern. Among mothers with 3- to 4-month-old babies in the community, 13.9% scored high (9 or above) on EPDS. In 51.1% of high scorers,nurses did not detect postnatal depression. Clinically, postnatal depression can be easily missed in the community health-check setting especially when there was hitherto no report of obstetric abnormality during pregnancy or delivery.Conclusion: The prevalence of high scorers is comparable to those reported in other countries. The use of the questionnaire was helpful in drawing the attention of mothers and health care professionals to issues of mental health.     

Postnatal depression and social supports in Vietnamese, Arabic and Anglo-Celtic mothers

The significance of a western woman's social supports to postnatal depression is well documented. We examine which deficits in components of their social support network are associated with postnatal depression in women from a non-English-speaking background. The social support network and postnatal mood of 105 Anglo-Celtic, 113 Vietnamese and 98 Arabic women were assessed at 6 weeks postpartum. The role of social supports in determining scores on the Edinburgh Postnatal Depression Scale (EPDS) was analysed using multiple regressions. For Anglo-Celtic women, low postnatal mood was associated with perceived need for more emotional support from partners and mothers. For Vietnamese women, low postnatal mood was associated with poor quality of relationship with the partner and a perceived need for more practical help from him. For Arabic women, low postnatal mood was associated with perceived need for more emotional support from partners. We conclude that cultural factors mediate the relation between social supports and postnatal depression. Accepted: 3 March 1998     

A study of the Edinburgh Postnatal Depression Scale (EPDS) on 859 mothers: detection of mothers at risk for postpartum depression

The postpartum is a high-risk period for the occurrence of anxious and depressive episodes. Indeed, during the first few days after delivery, mothers can present postpartum blues symptomatology: fatigue, anxiety, disordered sleeping and a changing mood. Postpartum depression is characterised by a changing mood, anxiety, irritability, depression, panic and obsessional phenomena. It occurs in approximately 10 to 20% mothers. The exact prevalence depending on the criteria used for detection. The first symptoms usually appear between the fourth and sixth week postpartum. However, postpartum depression can start from the moment of birth, or may result from depression evolving continuously since pregnancy. We can add that the intensity of postpartum blues is a risk factor that can perturb maternal development. So it is important for health professionals to dispose of predictive tools. This study is a validation of the French version of the EPDS. The aims of the study were to evaluate the postpartum depression predictive value at 3 days postpartum and to determine a cut-off score for major depression. Subjects participating in this study were met in 3 obstetrical clinics in, or in the vicinity of, Toulouse. Mothers with psychological problems, under treatment for psychological problems or mothers whose babies present serious health problems were excluded from the study. The EPDS was presented to 859 mothers (mean age=30.3; SD=4.5) met at one of the clinics at 3 days postpartum (period 1). They had an EPDS mean score of 6.4 (SD=4.6); 258 (30%) mothers had an EPDS score 9. 82.6% of these mothers experienced a natural childbirth and 17.3% a caesarean section; 51.5% gave birth to their first child, 36.2% to their second child and 12.3% to their third or more. All subjects were given a second EPDS with written instructions to complete the scale during the period 4 to 6 weeks postpartum and return it for analysis (period 2). Between the 4 to 6 weeks postpartum period, 722 mothers replied again to the EPDS. 131 mothers had an EPDS score 11 (mean age=30.3; SD=4.8). They had an EPDS mean score of 13.6 (SD=3.3). Mothers with probable depression were interviewed and assessed, using the Mini (Mini Neuropsychiatric Interview, Lecrubier et al. 1997), the SIGH-D (Structured Interview Guide for the Hamilton Depression Scale) and the BDI (Beck Depression Inventory) in order to diagnose a major depressive episode. They had a HDRS mean score of 13.7 (SD=5.1) and a BDI mean score of 13.6 (SD=5). At 3 days postpartum, we observed that 258 mothers (30%) had an EPDS scores 9 and 164 mothers (19%) had an EPDS scores 11. Between 4 and 6 weeks postpartum, we observed 18.1% of postpartum depression (EPDS 11) and 16.8% (EPDS 12) of major postpartum depression. The analysis of the sensitivity and the specificity at 3 days postpartum provides a cut-off score of 9 (Sensibility: 0.88) (Specificity: 0.50) as predictive of postpartum depression, for this cut-off score, the type I error is low (5.8%) but the type II error is more higher (18.9%). The analysis of the sensitivity and the specificity between 4 and 6 weeks postpartum provides a cut-off score of 12 (Sensibility: 0.91) (Sensibility: 0.74) for the detection of major postpartum depression. Factor analysis shows at 3 days postpartum that the internal structure of the scale is composed of two subscales. The first factor F1 "anxiety" accounts 28% of the variance and the second factor F2 "depression" accounts 20% of the variance. Between 4 and 6 weeks postpartum, factor analysis suggests an unidimensional model in the evaluation of postpartum depression which is better than a two factor model. This factor accounts 40% of the variance. The scale has a good predictive value, and we can observe a significant correlation with the EPDS periods 1 and 2 (r=0.56; p<0.05). This result shows that the depressive mothers mood intensity predicts a future depressive risk. Furthermore, correlations between EPDS and BDI (r=0.68; p<0.05) and EPDS and HDRS (r=0.67; p<0.05) show a good convergent validity. The reliability study confirms the good internal consistency of the EPDS, at 3 days postpartum and in the postpartum depression -symptomatology evaluation (Cronbach's Alpha>0.80). In conclusion, this scale demonstrates good validity and is fast and easy use in obstetrical services, allowing early detection of women who risk to develop postpartum depression and, in the first week of postpartum, of mothers who suffer from a major postpartum depression. The use of the EPDS for an early screening of the risk of postnatal depression which is essential considering the consequences that postnatal depression can have on the development of the infant, on the quality of the relationship within the couple and on other social relationships. Mothers at risk for postnatal depression should be controlled and surveyed by the health professionals in obstetrical clinics.     

Screening mixed depression and bipolarity in the postpartum period at a primary health care center

IntroductionMixed depression is a clinical condition accompanied by the symptoms of (hypo)mania and is considered to be a predictor for bipolar disorder. Compared to pure major depression, mixed depression is worse in progress. There are limited data on the prevalence of mixed depression since it is a relatively new entity. Therefore, the present study aimed to investigate the prevalence of mixed depression during the postpartum period which is risky for mood disorders.MethodsThe study included 63 postpartum women. The participants were administered Beck Depression Scale, Edinburgh Postnatal Depression Scale (EPDS), Mood Disorders Questionnaire (MDQ), and Modified Hypomania Symptom Checklist-32 (mHCL-32).ResultsThe MDQ scores of the women with expected depression according to the EPDS cut-off scores, were significantly higher than the women with lower EPDS scores (t = −4.968; p < 0.001). The modified hypomania scores were significantly higher in the women with higher depression scores compared to the women under EPDS cut-off scores (t = −4.713; p < 0.001). According to the EPDS and BDS results, 27 (42.9%) and 14 (22.2%) women needed additional clinical examination for depression, respectively. In addition, 3 (4.8%) women require additional clinical examination for bipolar disorder. The scores for the first item of MDQ were above the cut-off value in 11 (17.5%) women. According to the mHCL-32 results, 50 (79.4%) women had at least 1 symptom, 45 (71.4%) women had at least 3 symptoms, and 43 (68.3%) women had at least 5 symptoms of mixed depression.ConclusionPostpartum mixed depression should be promptly diagnosed by using appropriate diagnostic tools, particularly by primary health care physicians. Patients with mixed depression should be closely monitored to avoid manic switch.     

Sociodemographic risk factors of perinatal depression: a cohort study in the public health care system

ObjectiveTo assess the sociodemographic risk factors for the prevalence and incidence of relevant postpartum depressive symptoms.MethodWe studied a cohort of women in their perinatal period with the assistance of the public health system in the city of Pelotas-RS, Brazil. We assessed depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) in the prenatal and postnatal periods.ResultsWe interviewed 1,109 women. The prevalence of meaningful depressive symptoms during pregnancy was 20.5% and postpartum was 16.5%. Women with prenatal depression were at higher risk for postpartum depression.ConclusionThe mother's poverty level, psychiatric history, partner absence and stressful life events should be considered important risk factors for relevant postpartum depressive symptoms.