A Simplified Predictive Index for the Detection of Women at Risk for Postnatal Depression

Background: Many women who suffer from postnatal depression are never diagnosed or treated. The objective of this study was to develop an index for use in maternity settings that identifies women who may be at risk for postnatal depression. Methods: Women (n = 1762) attending the ‘‘booking‐in’’ clinic were screened for antenatal risk factors for postnatal depression. On the third postnatal day eligible women were screened for postnatal risk factors. The Edinburgh Postnatal Depression Scale was mailed to participants16 weeks after the birth. A predictive index was developed, based on the mean Edinburgh Postnatal Depression Scale scores for each risk factor. The sensitivity, specificity, positive predictive value, and negative predictive value were used to assess the diagnostic value of the index. Results: Seven hundred and twenty‐three (50.1%) of the eligible women completed all phases of the study. Of this group, 93 (12.2%) women scored higher than 12 on the Edinburgh Postnatal Depression Scale. At a cutoff of 6, the index had positive predictive value of 39.8 percent for postnatal depression, a threefold improvement over the base rate. Conclusion: The Brisbane Postnatal Depression Index provides a clinically useful method for identifying women at risk for developing postnatal depression. It has applications for early intervention or to identify high‐risk groups for research purposes. (BIRTH 30:2 June 2003)     

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.     

Evaluation of Antenatal and Postnatal Support to Overcome Postnatal Depression: A Randomized,Controlled Trial

ABSTRACT: This randomized, controlled trial tested the hypothesis that women identified as more vulnerable to developing postnatal depression who attended two specific antenatal groups and one postnatal group have a reduced frequency of postnatal depression from 37 to 15 percent at 6 weeks, 12 weeks, and 6 months postpartum. A modified antenatal screening questionnaire was completed, and women identified as more vulnerable to postnatal depression were stratified by parity and randomly allocated to receive extra support groups or to a control group. The Edinburgh Postnatal Depression Scale (EPDS) was used to detect postnatal depression. Attendance at the support groups was low, 31 percent overall. At six weeks, in the intervention group, 8 (13%) of 64 women scored high (>12) on the EPDS, compared with 11 (17%) controls. Similarly, at 12 weeks 7 (11%) of 63 versus 10 (15%) of 65 women scored higher than 12, and at 6 months, 9 (15%) of 60 versus 6 (10%) of 64 women scored higher than 12, indicating that the intervention did not reduce postnatal depression. It is possible that the method of applying the intervention, using groups separate from the standard antenatal classes, may have affected attendance. More research is required into ways of reaching and supporting women who may become depressed.     

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.     

Maternal health after childbirth: results of an Australian population based survey

Objective To describe the prevalence of maternal physical and emotional health problems six to seven months after birth.
Design Statewide postal survey, incorporating the Edinburgh Postnatal Depression Scale, distributed to women six to seven months after childbirth.
Participants All women who gave birth in a two-week period in Victoria, Australia in September 1993 except those who had a stillbirth or known neonatal death.
Results The response rate was 62.5% (   n = 1336  ). Respondents were representative of the total sample in terms of mode of delivery, parity and infant birthweight; young women, single women and women of nonEnglish speaking background were under-represented. One or more health problems in the first six postnatal months were reported by 94% of the women; a quarter had not talked to a health professional about their own health since the birth. Of women reporting health problems, 49% would have liked more help or advice. The most common health problems were tiredness (69%), backache (435%), sexual problems (26.%), haemorrhoids (24.%) and perineal pain (21%); 16.% of women scored as depressed. Compared with spontaneous vaginal births, women having forceps or ventouse extraction had increased odds for perineal pain (OR 4.9 [95% CI 3.–6.]), sexual problems (OR 2.6 [95% CI 1.–3.]), and urinary incontinence (OR 1.81 [95% CI 1.–2.1). These differences remained significant after adjusting for infant birthweight, length of labour and degree of perineal trauma.
Conclusion Physical and emotional health problems are common after childbirth, and are frequently not reported to health professionals despite the fact that many women would like more advice and assistance in dealing with them.     

Depressive mood in early pregnancy and postpartum: prevalence and women at risk in a national Swedish sample

We investigated the prevalence of postnatal depressive mood in a national Swedish sample, together with factors associated with depressed mood postpartum only as opposed to having depressed mood both in early pregnancy and postpartum. Swedish‐speaking women booked for antenatal care during a chosen period of three recruitment weeks were invited and 3293 (72%) agreed to participate in the study. Of these women, 2674 (81%) completed two questionnaires, one in early pregnancy and another 2 months postpartum. Depressive mood was assessed by the Edinburgh Postnatal Depression Scale (EPDS) and the validated Swedish cut‐off of 11/12 was used. In all, 12.3% scored above the threshold postpartum depressed mood, that being 6.5% postpartum only (‘post’ group) and 5.8% both in pregnancy and postpartum (‘ante and post’ group). Unemployment, lack of support, and physical health problems were the most important factors associated with a postpartum depressed mood in both groups. Women in the ‘ante and post’ group were more socially disadvantaged with increased relative risks in most of the factors that were investigated. Postnatal problems such as dissatisfaction with support from relatives and factors related to the infant were only associated with a depressed mood in the ‘post’ group. Obtaining a psychosocial history in early pregnancy, including factors associated with a depressed mood, may be the first step towards identifying and providing individualized care for women at risk of sustained or recurrent depressive mood during pregnancy and the postpartum period.     

IDentify, Educate and Alert (IDEA) trial: an intervention to reduce postnatal depression

Objective To test the effectiveness of a prenatal intervention in reducing the incidence of postnatal depression.
Design A randomized controlled trial.
Setting A large metropolitan obstetric hospital.
Population or sample Pregnant women with risk factors for postnatal depression.
Methods Women attending their first prenatal visit at the Royal Women's Hospital, Brisbane, were screened for risk factors for postnatal depression ( ID entify). Positively screened women were randomly allocated to the intervention group or the control group. The intervention consisted of a booklet about postnatal depression, which included contact numbers; prenatal screening using the Edinburgh Postnatal Depression Scale; a discussion with the woman about her risk of developing postnatal depression ( E ducate); and a letter to the woman's referring general practitioner and local Child Health Nurse, alerting them of the woman's risk for postnatal depression ( A lert).
Main outcome measure Edinburgh Postnatal Depression Scale Score> 12 at 16 weeks postpartum.
Results Of the 509 women who were sent a follow up questionnaire, 371 (72.9%) responded. The proportion of women who reported an Edinburgh Postnatal Depression Scale score of>12 was 26%. There were no significant differences between intervention (46/192, 24%) and control groups (50/177, 28.2%) on this primary outcome measure (OR 0.80; 95% CI 0.50–1.28).
Conclusion Over one-quarter of women with risk factors will develop postnatal depression. It is a treatable disorder but under-diagnosis is common. Efforts to reduce postnatal depression by implementing interventions in the prenatal period have been unsuccessful.     

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.     

The North Staffordshire Maternity Hospital prospective study of pregnancy-associated depression

The objective of the study was to establish the frequency of depression during pregnancy and the puerperium, and its relationship to marital disharmony and sociodemographic variables. A prospective longitudinal study was carried out in a district general hospital in the West Midlands, UK. The cohort consisted of 417 women booked for confinement at the hospital. Depression was measured as a proportion of high scores (> 14) on the Edinburgh Postnatal Depression Scale (EPDS) and marital disharmony was determined by the Spanier Dyadic Adjustment Scale. Using recommended cut-offs, 41/417 (9.8%) of the women were depressed during pregnancy and 31/417 (7.4%) were depressed at 3 months postpartum. There was a significant association between antenatal and postnatal depression, seven of the 31 women who were depressed postpartum had also been depressed in the antenatal period. Only five of the 41 women with antenatal depression and eight of the 31 women with postnatal depression were identified by their general practitioners as depressed. Marital disharmony was sequentially associated with depression before and after delivery. We conclude that antenatal depression is more common than generally thought, and that both antenatal and postnatal depression are frequently missed during routine consultation. Pregnancy-associated depression is more common where marital disharmony exists. More widespread use of the EPDS during pregnancy may help to highlight these often unidentified mental health problems.     

Postpartum depression: a comparison of screening and routine clinical evaluation

OBJECTIVE: This study compared the efficacy of routine clinical evaluation with that of screening with the Edinburgh Postnatal Depression Scale for the detection of postpartum depression in a residency training program practice.Study Design: Three hundred ninety-one patients during a period of 1 year were assigned according to delivery date to screening for postpartum depression with the Edinburgh Postnatal Depression Scale or to a control group who had only spontaneous detection during routine clinical evaluation. The incidences of postpartum depression detection and demographic characteristics were compared between 79 patients in the Edinburgh Postnatal Depression Scale group and 96 patients in the clinical evaluation group by means of chi(2) analyses. RESULTS: The incidence of postpartum depression detection with the Edinburgh Postnatal Depression Scale was significantly higher than the incidence of spontaneous detection during routine clinical evaluation (35.4% and 6.3%, respectively; P =.001). CONCLUSIONS: The Edinburgh Postnatal Depression Scale is an effective adjunct to clinical interview for diagnosis of postpartum depression and should be considered in residency training.     

The relationship between sexual functioning and depressive symptomatology in postpartum women: a pilot study

IntroductionPrevious research on postpartum sexuality has primarily focused on the impact of physical factors on the resumption and frequency of sexual intercourse; fewer studies have focused on the impact of psychological factors on women's sexual functioning.AimThe aim of this study is to assess current sexual functioning and sexual behavior in women with and without symptoms of postpartum depression using validated measures of postpartum depression and sexual functioning.MethodsWomen attending postpartum appointments were consecutively recruited over a 12‐month period and completed questionnaires assessing sexual functioning, current sexual behavior, and mental health.Main Outcome MeasuresThe Female Sexual Function Index (FSFI), the Edinburgh Postnatal Depression Scale (EPDS), and items assessing current sexual behaviors.ResultsA total of 77 women returned completed questionnaire packages (mean postpartum weeks: 13, range 3–24). Of these, 57 women (74%) had engaged in sexual activity with a partner in the 4 weeks prior to completing the questionnaire. The mean FSFI score was 23.0 (range 6–34), with 37 women (65%) scoring in the range associated with clinical sexual dysfunction. Women with elevated EPDS scores had significantly lower total FSFI, arousal, orgasm, and satisfaction FSFI subscale scores (all P values <0.005) than nondepressed women, suggesting more problematic sexual functioning. Desire, lubrication, and pain FSFI subscale scores were not significantly associated with depression status.ConclusionsA substantial proportion of women experience sexual problems in the postpartum period; these problems are particularly pronounced among women with symptoms of postpartum depression. Longitudinal research is needed to better understand the relationship between sexual dysfunction and depression among postpartum women, and to identify implications for prevention and treatment of both conditions. Chivers ML, Pittini R, Grigoriadis S, Villegas L, and Ross LE. The relationship between sexual functioning and depressive symptomatology in postpartum women: A pilot study. J Sex Med 2011;8:792–799.     

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.     

Prospective Testing of the Brisbane Postnatal Depression Index

Abstract: Background: Over 50 percent of women have one or more risk factors for postnatal depression during pregnancy or in the perinatal period, but only 10 to 15 percent become clinically depressed. The objective of this study was to prospectively test the Brisbane Postnatal Depression Index (referred to here as Index), to validate a theoretical index that was developed earlier, and to establish whether the index could be introduced as a clinically useful method to detect women who may be at risk for developing postnatal depression. Methods: Antenatally, women were asked about social support and about personal and family history of mental illness, including postnatal depression. Responses were scored according to predefined ratings on the Index. In the postnatal wards, 353 women were recruited and their scores for “blues,” social support, feelings about the baby, and satisfaction with the birth process were added. Sixteen weeks after hospital discharge, women were asked to complete the Edinburgh Postnatal Depression Scale. The Brisbane Index was validated by the number of women scoring more than 12 on the Edinburgh Postnatal Depression Scale at 16 weeks postpartum who were correctly predicted by a score of more than 6 on the Index. Sensitivity, specificity, positive predictive value, and negative predictive value for the Index, using >6 as a cutoff point, were calculated. “Ease of use” was assessed informally with participants and staff responsible for administration and scoring the instrument. Results: Compared with results from the derivation study, prospective testing of the index showed an improvement in sensitivity from 36.3 to 47.5 percent and a small decrease in specificity, but no improvement on the positive predictive value from 39.8 to 39.6 percent. Conclusion: The Brisbane Postnatal Depression Index was validated in a prospective sample, but its sensitivity and specificity require improvement before introduction as a measure of prediction. (BIRTH 33:1 March 2006)     

Impact of Postnatal Depression on Breastfeeding Duration

Abstract: Background: Postnatal depression can cause adverse effects on both mother and infant, but its impact on breastfeeding duration is poorly understood. The aim of this study was to investigate the relationship between maternal postnatal depression and breastfeeding duration. Methods: A cohort of 1745 women was recruited on the postnatal wards of two large Australian obstetric hospitals. Self‐report questionnaires were completed at recruitment, and at 2, 6, and 12 months postpartum. Breastfeeding status was determined at each follow‐up, and the Edinburgh Postnatal Depression Scale was used to screen for symptoms of depression. Diagnostic psychological interviews were conducted on a subsample of women at each interval. Results: Breastfeeding was initiated by 96 percent of the participants; at 2 months 79 percent were still breastfeeding, 57 percent at 6 months, and 22 percent at 12 months. Of the 18 percent of participants diagnosed with postnatal depression, the onset occurred before 2 months in 63 percent of cases. Median duration of breastfeeding was 26 weeks for women with early‐onset depression, 28 weeks for women with late‐onset depression, and 39 weeks for women without depression. After adjustment for confounding factors, early cessation of breastfeeding was found to be significantly associated with postnatal depression (adjusted hazard ratio 1.25, 95% CI 1.03–1.52). Onset of postnatal depression occurred before cessation of breastfeeding in most cases. Conclusions: Postnatal depression has a significant negative impact on breastfeeding duration. Assistance with breastfeeding issues should be included in the management of postnatal depression. (BIRTH 30:3 September 2003)     

Predicting Postnatal Depression Among Pregnant Women

ABSTRACT: Background : Depression after the birth of a baby is a common cause of maternal morbidity, and its prevalence in Australia is 10 to 15 percent at 6 to 9 months postpartum. This study assesses the prediction of postnatal depression at 6 weeks postpartum, Method : Women at 24 weeks' gestation or less were invited to complete a Modified Antenatal Screening Questionnaire (MASQ) that identified women more vulnerable to becoming depressed after childbirth. Of these 249 women, 144 (58%) screened more vulnerable, and were randomly allocated to receive either a supportive intervention to reduce postnatal depression or to receive no intervention. At 6 weeks postpartum the women completed the Edinburgh Postnatal Depression Scale (EPDS) to assess their mood after the birth. Results : No difference occurred at 6 weeks postpartum between the MASQ vulneruble group (return rate 64/68) and the MASQ less vulnerable group (return rate 44/51) in the frequency of those who screened as potential candidates for major depression using the EPDS. For major depression the MASQ's sensitivity was 73 percent, specificity 43 percent, positive predictive value 17 percent, and negative predictive value 91 percent; for minor depression its sensitivity was 81, 48, 34, and 89 percent, respectively. The MASQ was able to predict minor depression. More women in the vulnerable group scored at increased risk of minor depression on the EPDS at 6 weeks postpartum. Conclusion : Further studies are needed to extend this work and develop a screening test with higher specificity and greater positive predictive value.     

Domestic violence, lifetime trauma and psychological health of childbearing women

OBJECTIVE: Although histories of abuse are associated with psychiatric illness in women, health professionals rarely enquire directly about such experiences. This study examined the association between physical and sexual violence and lifetime trauma and depressive and posttraumatic stress symptoms in women receiving maternity care. DESIGN: Cross sectional study. SETTING: South London Hospital maternity services. POPULATION: Two hundred women receiving postnatal or antenatal care. METHODS: Two hundred women receiving postnatal or antenatal care at a South London maternity service were screened for lifetime experiences of trauma and domestic violence. Information was obtained about self-harming behaviour, suicidal thoughts and attempts and psychiatric history. Women completed the Edinburgh Postnatal Depression Scale (EPDS) and the Posttraumatic Diagnostic Scale (PTDS). MAIN OUTCOME MEASURES: RESULTS: One hundred and twenty-one (60.5%) women reported at least one traumatic event and two-thirds of these had experienced multiple traumatic events. The most frequent (34%) was witnessing or experiencing physical assault by a family member. Forty-seven (23.5%) women had experienced domestic violence. Physical and sexual abuse commonly co-occurred. Thirteen (10.7%) women with a trauma history had current posttraumatic stress disorder. Severe posttraumatic symptoms were associated with physical and sexual abuse histories and repeat victimisation. Adult and childhood physical and sexual abuse histories were also associated with more severe depressive symptomatology. Significant social factors associated with depression were being single, separated or in a non-cohabiting relationship. CONCLUSION: Traumatic events are under-recognised risk factors in the development of depressive and posttraumatic stress symptoms in childbearing women. Childhood abuse creates a vulnerability to re-traumatisation in adulthood. Awareness of the impact of trauma and abuse on psychological health may enable more appropriate targeting of clinical services and support for women receiving maternity care.     

A randomised controlled trial of empowerment training for Chinese abused pregnant women in Hong Kong

OBJECTIVE: To evaluate the effectiveness of an empowerment intervention in reducing intimate partner violence (IPV) and improving health status. DESIGN: Randomised controlled trial. SETTING: Antenatal clinic in a public hospital in Hong Kong. SAMPLE: One hundred and ten Chinese pregnant women with a history of abuse by their intimate partners. METHODS: Women were randomised to the experimental or control group. Experimental group women received empowerment training specially designed for Chinese abused pregnant women while the control group women received standard care for abused women. Data were collected at study entry and six weeks postnatal. MAIN OUTCOMES MEASURES: IPV [on the Conflict Tactics Scale (CTS)], health-related quality of life (SF-36) and postnatal depression [Edinburgh Postnatal Depression Scale (EPDS)]. RESULTS: Following the training, the experimental group had significantly higher physical functioning and had significantly improved role limitation due to physical problems and emotional problems. They also reported less psychological (but not sexual) abuse, minor (but not severe) physical violence and had significantly lower postnatal depression scores. However, they reported more bodily pain. CONCLUSION: An empowerment intervention specially designed for Chinese abused pregnant women was effective in reducing IPV and improving the health status of the women.     

Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms

OBJECTIVE: To study whether women with antepartum depression have an increased risk for adverse perinatal outcome. METHODS: From a sample of 1,489 women, an index group (n = 259) of all women with depressive symptoms on the Edinburgh Postnatal Depression Scale in gestational week 35-36 was selected. Two hundred fifty-nine women with no depressive symptoms on the Edinburgh Postnatal Depression Scale antepartum or postpartum were randomly chosen as the reference group. Medical, gynecologic, and obstetric history, socioeconomic status, pregnancy, and perinatal data were collected from standardized medical records for all women. RESULTS: Women with antepartum depressive symptoms were more often multiparas with a history of earlier obstetric complications. Complications during the present pregnancy were more frequent in the antepartum-depressed group of women. There were no differences concerning outcome of delivery, puerperium, and neonatal health between the index and reference groups. Forty-six percent of the women with antepartum depressive symptoms had depressive symptoms at 6-8 weeks or 6 months postpartum or both. CONCLUSION: Women depressed during pregnancy constitute a group without an increased risk for adverse obstetric or neonatal outcome but with a high risk for postpartum depressive symptoms.     

Postnatal Depression: Its Nature,Effects, and Identification Using the Edinburgh Postnatal Depression Scale

ABSTRACT: Postnatal depression, or clinical depression in mothers during the months after childbirth, occurs at a time when heavy demands are placed on these women's resources, and when infant learning and development are taking place. Identification and treatment are facilitated when health professionals and services are in close contact with the family and can provide beneficial intervention. Two studies examined whether women with nonpsychotic postnatal depression could be recognized and treated within existing services, using the Edinburgh Postnatal Depression Scale and a randomized, controlled trial of counseling intervention with health visitors.     

Rates and risk factors associated with depressive symptoms during pregnancy and with postpartum onset

Abstract

The objectives of this study were to evaluate the prevalence of depressive symptoms in the third trimester of pregnancy and at 3 months postpartum and to prospectively identify risk factors associated with elevated depressive symptoms during pregnancy and with postpartum onset. About 364 women attending antenatal clinics or at the time of their ultrasound were recruited and completed questionnaires in pregnancy and 226 returned their questionnaires at 3 months postpartum. Depressed mood was assessed by the Edinburgh Postnatal Depression Scale (EPDS; score of?≥?10). The rate of depressed mood during pregnancy was 28.3% and 16.4% at 3 months postpartum. Among women with postpartum depressed mood, 6.6% were new postpartum cases. In the present study, belonging to a non-Caucasian ethnic group, a history of emotional problems (e.g. anxiety and depression) or of sexual abuse, comorbid anxiety, higher anxiety sensitivity and having experienced stressful events were associated with elevated depressed mood during pregnancy. Four risk factors emerged as predictors of new onset elevated depressed mood at 3 months postpartum: higher depressive symptomatology during pregnancy, a history of emotional problems, lower social support during pregnancy and a delivery that was more difficult than expected. The importance of identifying women at risk of depressed mood early in pregnancy and clinical implications are discussed.