Further validation of the Postpartum Depression Screening Scale

BACKGROUND: Up to 50% of all cases of postpartum depression go undetected. The Edinburgh Postnatal Depression Scale (EPDS) has been the only instrument available that was specifically designed to screen for this mood disorder. None of the items on the EPDS, however, are written in the context of new motherhood. OBJECTIVE: The purpose of this study was to further assess the construct validity of the newly designed Postpartum Depression Screening Scale (PDSS) along with its sensitivity, specificity, and predictive values. METHOD: A total sample of 150 mothers within 12 weeks postpartum participated in the study. Each mother completed in random order three questionnaires: The PDSS, EPDS, and The Beck Depression Inventory-II (BDI-II). Immediately after completing these three questionnaires, each woman was interviewed by a nurse psychotherapist using the Structural Clinical Interview for DSM-IV Axis 1 Disorders. RESULTS: Twelve percent (n = 18) of the mothers were diagnosed with major postpartum depression, 19% (n = 28) with minor postpartum depression, and 69% (n = 104) with no depression. The PDSS was strongly correlated with both the BDI-II (r = 0.81) and the EPDS (r = 0.79). The ability of the PDSS to explain variance in diagnostic classification of postpartum depression above that explained by the BDI-II and EPDS (i.e., incremental validity) was assessed using hierarchical regression. After explaining variance in group classification by the other two depression instruments, the PDSS explained an additional 9% of the variance in depression diagnosis. Using receiver operating characteristic (ROC) curves, a PDSS cut-off score of 80 (sensitivity 94% and specificity 98%) is recommended for major postpartum depression and a cut-off score of 60 (sensitivity 91% and specificity 72%) for major or minor depression. CONCLUSION: Based on the results of this psychometric testing, the PDSS is considered ready for use in routine screening of mothers.     

两种筛查量表早期发现产后抑郁的效果对比

目的比较产后抑郁筛查量表（PDSS）和爱丁堡产后抑郁量表（EPDS）在产后抑郁筛查中的应用价值。方法采用PDSS、EPDS及美国精神障碍诊断与统计手册第4版轴Ⅰ障碍定式临床检查患者版（SCID—I／P）同时对445名产后6周的妇女进行评定,以SCID—I／P作为产后抑郁诊断金标准。结果两种量表的临界值分别为74分和10分。PDSS的灵敏度（93．33％）和特异度（94．75％）的组合较好。PDSS与EPDS的ROC曲线下面积分别为0．978和0．872,差异均有统计学意义（P均〈0．05）。结论与EPDS相比,PDSS具有较好的筛检价值,是早期发现产后抑郁患者的简单、快速、准确的筛查工具。     

Validation of two postpartum depression screening scales with a sample of First Nations and Métis women.

The purposes of this study were to determine the prevalence of postpartum depression (PPD) and to examine the utility of the Postpartum Depression Screening Scale (PDSS) and the Edinburgh Postnatal Depression Scale (EPDS) in First Nations and Métis women in the Canadian province of Saskatchewan. A total of 103 women who had given birth in the preceding 1 to 12 months were recruited from the city of Regina and from First Nations health centres in Saskatchewan. Self-report screening instruments assessing PPD were administered along with a structured clinical interview for DSM-IV Axis I disorders (SCID) to confirm the diagnosis of PPD. Of the 103 women, 17% were diagnosed with PPD. The findings support the validity of the PDSS and the EPDS as measures of PPD in First Nations and Métis women. The author discusses the need for primary health care professionals, including nurses, to offer postnatal screening for women who may be at risk for PPD.     

Postpartum depression as profiled through the depression screening scale

PURPOSE: To describe in greater depth the profiles of the dimensions of the Postpartum Depression Screening Scale (PDSS), with a focus on those women identified with postpartum depression (PPD), and to provide a discussion of the implications for early detection in the community. METHOD AND DESIGN: Subanalysis of data from 150 new mothers who completed the PDSS and had a DSM-IV diagnostic interview conducted by a nurse psychotherapist. Data analysis focused on exploring the profiles of women who were diagnosed with PPD as well as those who were not. RESULTS: The respondents within the major PPD group averaged scores twice as high as those in the nondepressed group, and described more profound emotional responses to their maternal role transitions. CLINICAL IMPLICATIONS: PPD should be conceptualized as occurring in a continuum, with symptoms worsening over time for some women. Nurses working across healthcare settings can use the PDSS for identifying women with PPD. All healthcare providers who are in contact with postpartum women should be open to discussing these women's emotional needs, and should assess women on an ongoing basis. Using all opportunities to listen to women's unique stories that unfold during the postpartum period can help identify women who require treatment for this curable illness.     

The clinical application of three screening tools for recognizing post-partum depression

Postnatal depression is a major health issue for childbearing women world-wide, as it is not always identified early. This study aimed to evaluate the clinical application of three screening instruments for the early recognition of post-partum depression, the Postpartum Depression Prediction Inventory, the Postpartum Depression Screening Scale and the Edinburgh Postnatal Depression Scale, and to examine nurse interventions following use of the instruments. Data were collected at two points, at 28 weeks prenatal (107 women) and eight weeks postnatal (84 women). Results showed that 17% of the women scored significant symptoms of post-partum depression and 10-15% had a positive screen for major postnatal depression. There was a statistically significant correlation between the total score on the Postpartum Depression Screening Scale and the Edinburgh Postnatal Depression Scale. Of those eight women identified as being at risk, seven had received anticipatory guidance and five had received counselling by the nurses. The Postpartum Depression Prediction Inventory enabled nurses to identify women at risk of post-partum depression and offer interventions.     

Postpartum Depression Screening Scale: development and psychometric testing

BACKGROUND: Approximately 400,000 mothers in the United States experience postpartum depression each year. However, only a small proportion of these women are identified as depressed by health care professionals. OBJECTIVES: To improve detection of this postpartum mood disorder, the purpose of this study was to assess the psychometric properties of a newly devised instrument, the Postpartum Depression Screening Scale (PDSS), a 35-item Likert-type self-report instrument. METHODS: Content validity was supported through the literature and the judgments rendered by a panel of five content experts and a focus group. The PDSS was administered to 525 new mothers. RESULTS: Confirmatory factor analysis provided empirical support for the existence of the hypothesized seven dimensions. A Tucker-Lewis goodness-of-fit index of 0.87 and a root mean square residual of 0.05 were judged supportive of model fit. Item response theory techniques provided further construct validity support for finer interpretations of the respective seven dimensions. Analysis of the Likert 5-point response categories further supported meaningful score interpretations. Alpha internal consistency reliabilities ranged from 0.83 (sleeping/eating disturbances) to 0.94 (loss of self). CONCLUSIONS: Empirically, all of the reliability and validity analyses supported the score interpretations posited for the PDSS. Currently, the sensitivity, specificity, and positive predictive value of the PDSS are being determined.     

Postpartum depression screening scale: Spanish version

BACKGROUND: Postpartum depression is a global phenomenon. OBJECTIVE: The purpose of this study was to develop and psychometrically evaluate the Spanish version of the Postpartum Depression Screening Scale (PDSS). METHODS: Eight translators representing the predominant Hispanic groups in the United States translated the PDSS into a Spanish version. A total of 377 Hispanic mothers completed the PDSS-Spanish Version within 12 weeks postpartum at two sites: Connecticut and Texas. Confirmatory factor analysis and item response theory analysis were conducted to assess construct validity. RESULTS: For the total sample of 377 Hispanic women, the alpha reliability for the total PDSS was.95; dimension-level alphas ranged from.76 to.90. The total PDSS alphas by group were as follows: .94 (Mexican), .96 (Puerto Rican), and .93 (Other). Confirmatory factor analysis provided empirical support for the existence of the hypothesized constructs assessed by the PDSS. Item response theory analysis supported the adequacy of the construct definitions and confirmed that the response options for the Likert categories were an "ordered" attitude continuum in which higher responses corresponded to higher levels of "agreement" with the depressive symptomatology items. CONCLUSIONS: When compared to the original English PDSS, the reliability and validity psychometrics for the Spanish version were slightly lower, but still within the acceptable range.     

产后自杀高危因素的相关性分析

目的探讨产后自杀发生的高危因素。方法对绵阳市精神卫生中心诊断为产后抑郁并伴有自杀行为和意念的40例住院患者用爱丁堡产后抑郁量表(EPDS)、生活事件量表(LES)和社会支持量表(SSRS)等进行问卷调查和评定,并与健康产妇进行比较,而后用多元逐步回归分析探讨其相关高危因素。结果产后自杀与既往抑郁史、半年内负性生活事件、缺乏社会支持、母婴疾病、夫妻关系等明显相关。结论产前防范和产后危机干预有利于降低产后自杀。     

Screening for depression among pregnant and postpartum women

The purpose of this study was to examine the screening of depression among pregnant and postpartum participants in a community-based program. This cross-sectional study used archival data from 98 women participating in a community-based visiting nurse program in a midwestern U.S. city. Depression screening was accomplished using the Center for Epidemiologic Studies Depression scale (CES-D) and Edinburgh Postnatal Depression scale (EPDS); both instruments ask respondents to answer questions regarding their mood during the past week. The CES-D identified more pregnant and postpartum women as depressed than did the EPDS. A standard regression analysis using previous pregnancies, history of depression, married versus nonmarried, presence of support, and breast-feeding as predictor variables did not produce statistically significant findings for predicting depression among the pregnant and postpartum women in this study. This finding underscores the value of brief depression screening instruments for nurses working with pregnant and postpartum women.     

综合干预措施对产妇抑郁的影响评价

目的探讨产妇抑郁的发生及其影响因素,观察综合干预措施对降低产后抑郁发生率的作用。方法将1210例孕妇随机分为干预组(实施干预措施)和对照组,每组各605例,采用医院焦虑-抑郁自评量表、艾迪产后抑郁量表进行产前产后跟踪调查至,并进行对比分析。结果两组产前医院焦虑-抑郁情绪自评量表评定焦虑抑郁发生率无显著性差异(P>0.05);有焦虑情绪者产后抑郁发生率为54.10%,有抑郁情绪者产后抑郁发生率为56.36%,有焦虑-抑郁情绪者产后抑郁发生率成倍增加;干预组产后抑郁发生率为5.12%,对照组产后抑郁发生率为14.22%,两组差异有极显著性(P<0.01)。结论孕期焦虑-抑郁情绪是发生产后抑郁的最主要因素,综合干预措施能够显著降低产后抑郁的发生率。提示,加强对孕产妇及其家属进行产前、产时、产后宣教,能有效预防产后抑郁的发生。     

Comparing validity of Edinburgh scale and SRQ20 in screening for post-partum depression

The Edinburgh Postnatal Depression Scale (EPDS) is the instrument most used worldwide for screening of Post-Partum Depression (PPD). The SRQ20 questionnaire has been largely used for screening of minor psychiatric disorders. This study aimed to compare the accuracy of the two instruments in screening for PPD. At the third-month follow-up home visit to infants of the 2004 Pelotas Birth Cohort, Southern Brazil, a sub-sample of 378 mothers was selected. Among other questions, EPDS and SRQ20 were applied by trained fieldworkers. Up to 15 days later, a mental health professional re-interviewed the mother (the gold standard interview). Sensitivity and specificity of each cutoff point were calculated for EPDS and SRQ20 and the results were plotted at a ROC curve. The areas under both curves were compared. Highest sensitivity and specificity cutoff were observed for EPDS ≥ 10 (sensitivity 82.7%, 95%CI 74.0 – 89.4; specificity 65.3%, 95%CI 59.4 – 71.0) and for SRQ20 ≥ 6 (sensitivity 70.5%, 95%CI 60.8 – 79.0%; specificity 75.5%, 95%CI 70.0 – 80.5%). Shape of ROC curves and areas under both curves were virtually identical (respectively, 0.8401 ± 0.02 for EPDS and 0.8402 ± 0.02 for SRQ20; p = 0.9). In conclusion SRQ20 showed to be as valid as EPDS as a screening tool for PPD at third month after delivery.     

Postpartum depression: the reliability of telephone screening

PURPOSE: This study evaluated the reliability of screening women for symptoms of postpartum depression by a telephone assessment after hospital discharge. STUDY DESIGN: Correlational design with a convenience sample of women from a Midwestern community hospital. METHODS: One hundred and twenty-six women agreed to participate prior to hospital discharge and 106 women were in the final sample (response rate 84%). Telephone contact was made 8 weeks after discharge, when the Postpartum Depression Screening Scale was administered. RESULTS: Twenty-seven percent of the women screened had scores indicating moderate-to-severe depression (score range 60-128). Reliability coefficients were calculated on the data for the short and long forms of the PDSS, as well as for all seven subscales (alpha coefficients were .72 and .94, respectively, for the short- and long-form totals). Subscale scores for the 35-item form were as follows: sleeping/eating disturbances .80, anxiety/insecurity .77, emotional lability .82, mental confusion .80, loss of self .87, guilt/shame .82, and contemplating harming oneself.90. The correlation between the short-form total and the long-form total was r = .91 (p = < 01.) Studies using the PDSS as an in-person instrument were compared with scores for telephone screening, and the overall mean scores were similar. CONCLUSION: Telephone screening is a reliable method to screen for postpartum symptomatology that may occur later than the 6-week office visit. Women who are at risk, especially those who have a history of treatment for depression, current treatment for depression or increased anxiety, should be screened for postpartum depression symptomatology.     

The association between depressive symptoms and social support in Taiwanese women during the month

The purpose of the study was to explore the association between depressive symptoms and social support in Taiwanese women doing the month. A correlational survey design using the Postpartum Social Support Questionnaire (PSSQ) and the Edinburgh Postnatal Depression Scale (EPDS) to measure social support and postnatal depressive symptomatology was employed. Two hundred and forty postpartum women receiving care in two teaching hospitals in Taipei, Taiwan, aged between 20 and 35, with no peri-natal complications or previous psychiatric history, experiencing a normal spontaneous delivery of one full term healthy baby, were selected. Each was mailed the PSSQ and the EPDS as well as a short, semi-structured self-report questionnaire requesting demographic details and subjective data relating to the experience of doing the month and depressive symptoms during the fourth week following birth. One hundred and eighty six women (78%) returned questionnaires. Taiwanese postpartum women were less depressed when they stayed in their parents' home and had their own mothers take care of them. It was found that the greater the level of postpartum social support received by the women doing the month, the lower the risk of postnatal depressive symptoms experienced. Almost a quarter (24%) of the variance of the symptoms was attributed to dissatisfaction with parents' instrumental support and unwanted emotional support from parents-in-law. It is concluded that the ritual of doing the month provides valuable social support and may help to prevent postnatal depression in Taiwanese women.     

Effectiveness of informational support in reducing the severity of postnatal depression in Taiwan

AIM: The aim of the study was to investigate the effectiveness of informational support in reducing the Edinburgh Postnatal Depression Scale (EPDS) scores in Taiwan. METHODS: Five hundred Taiwanese women were screened during the fourth week after giving birth and those with a score of over 10 on the EPDS were considered to be at risk of postnatal depression. Seventy postpartum women were randomly allocated to the experimental or control group. Only those in the experimental group received informational support about postnatal depression during the sixth week postpartum. Two groups were assessed by the EPDS at 3 months postpartum to explore their depressive status. RESULTS: Taiwanese women who received informational support about postnatal depression 6 weeks after giving birth experienced lower EPDS scores at 3 months postpartum than those who did not receive this information. CONCLUSIONS: The findings suggest that informational support about postnatal depression given to women in the postnatal period may contribute to psychological well-being.     

Validation of the Edinburgh postpartum depression scale in a population of puerperal women in Mexico

Background

The Edinburgh postnatal depression scale (EPDS) has been validated and used successfully in detecting postnatal depression in several language versions in a number of countries. However, there is not any Mexican version of the EPDS that had been validated. Therefore, we sought to validate a Spanish translated Mexican version of the EPDS in a population of puerperal Mexican women.

Methods

One hundred puerperal women within their three month postpartum period attending routine postnatal consultations in a public hospital in Durango City, Mexico participated in the study. The participants were divided into two groups: one group included 49 women with less than 4 weeks of postpartum, and the other group included 51 women within 4 to 13 weeks of postpartum. All participants submitted a Spanish translated Mexican version of the EPDS and were interviewed by a psychiatrist to assess major and minor depression by using DSM-IV criteria.

Results

Out of the 49 women with less than 4 weeks of postpartum, 4 were found as suffering from major depression and none from minor depression by using the DSM-IV criteria. In this group of women we found that the best EPDS score for screening depression was 11/12. This threshold showed a sensitivity of 75% (95% CI: 63.8–86.2), a specificity of 93% (95% CI: 84.6–100), a positive predictive value of 50%, a negative predictive value of 97.6%, and an area under the curve of 0.84. While in the 51 women within 4 to 13 weeks of postpartum, 7 were found as suffering from major depression and 1 from minor depression by using the DSM-IV criteria. In this group we found that the best EPDS score for screening depression was 7/8. This threshold showed a sensitivity of 75% (95% CI: 66.1–83.9), a specificity of 84% (95% CI: 76.1–91.9), a positive predictive value of 46.2%, a negative predictive value of 94.7% and an area under the curve of 0.80.

Conclusion

The Mexican version of the EPDS can be considered for screening depression in puerperal Mexican women whenever cut-off scores of 11/12 and 7/8 in women with less than 4 weeks and within 4 to 13 weeks of postpartum are used, respectively.

     

Comparisons of different instruments to measure blues and to predict depressive symptoms 2 months postpartum: a study of new mothers and fathers

The aim of the study was to investigate 'blues' during the first week postpartum in new mothers and fathers and to compare different instruments for measuring blues, as well as their ability to predict depressive symptoms at 2 months. Parents were informed while at the maternity clinic about the study and asked to independently answer questions for 5 days during the first week on the Blues Questionnaire, a VAS questionnaire and on the Edinburgh Postnatal Depression Scale (EPDS) at 1 week and 2 months. Of the parents who initially agreed to participate in the study 171 (38%) of the mothers and 133 (31%) of the fathers returned all questionnaires completely filled-out after the first week, and of these, 155 mothers and 113 fathers also completed the EPDS at 2 months. The results showed that mothers experienced more blues than fathers, and that mothers' blues peaked on day 3, while fathers' peaked on day 1 after the delivery-day. The Blues Questionnaire and the VAS subscale 'depressed mood' identified more women as having blues (64% and 52%, respectively) during the first week over the EPDS (24%), but the EPDS identified women with the highest scores on the Blues Questionnaire. At 2 months, 19 (12%) of the mothers, and one father scored 10 or more on the EPDS. All these women, except for one, had experienced severe blues according to the Blues Questionnaire, the first week. Regression analyses showed that the Blues Questionnaire subscale 'depression' was the best predictor for a high EPDS score at 2 months in mothers, while the subscales 'primary blues', 'hypersensitivity' and 'despondency' best predicted depressive symptoms in fathers. Our results indicate that the EPDS could be a valuable instrument to measure 'blues', as EPDS seemed to indicate women with the highest risk for depressive symptoms.     

易感性人格类型量表预测产后抑郁症的效果研究

目的探讨易感性人格类型量表(VPSQ)对产后抑郁症的预测效果。方法选取349例健康初产妇在产前、产后分别应用VPSQ、爱丁堡产后抑郁量表测量样本人格类型和产后抑郁症的实际发生状况,并进行统计分析。结果VPSQ中忧虑性、强迫性、不稳定性、胆怯性、敏感性和应付性这6项人格维度与产后抑郁症的发生显著相关,以易感性分量表得分15分为界,可将产妇划分为易感性人格和非易感性人格,前者更易发生产后抑郁症。结论VPSQ作为一种筛查工具,可早期识别产后抑郁症的高危人群,以便有针对性地进行早期护理干预。     

Acculturation level and postpartum depression in Hispanic mothers

PURPOSE: Perinatal health outcomes for Hispanic women are associated with acculturation. The purpose of this study was to explore the relationship between acculturation levels and postpartum depressive symptomatology and diagnosed postpartum depression among Hispanic subgroups. STUDY DESIGN AND METHODS: The Postpartum Depression Screening Scale and the Short Acculturation Scale were used in the two phases of data collection. Phase 1 and 2 samples consisted of 377 and 150 Hispanic mothers, respectively. Puerto Rican mothers showed higher levels of acculturation than Mexican and other Hispanic women. A DSM-IV diagnostic interview (SCID) was used to establish a diagnosis of depression. Hierarchical regression analyses were used to study the unique relationships between ethnicity, depressive symptomatology, diagnosed depression, and acculturation. RESULTS: There was no consistent relationship between acculturation and postpartum depression. Significant predictors of elevated postpartum depressive symptoms in Hispanic mothers were Puerto Rican ethnicity and cesarean delivery. Single marital status was a significant risk factor for postpartum depression. A limitation of the study was use of language as the sole criterion measure for acculturation. Acculturation is a complex construct with problematic measurement that needs greater refinement to facilitate research in which it is used as a variable. CLINICAL IMPLICATIONS: Hispanic mothers are a heterogeneous group and should not be treated as a homogeneous group. Subgroups of Hispanic mothers may not have the same level of acculturation or the same level of postpartum depressive symptomatology.