The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.
To demonstrate validity, questionnaires should measure the same construct in different groups and across time. The Edinburgh Postnatal Depression Scale (EPDS) was designed as a unidimensional scale, but factor analyses of the EPDS have been equivocal, and demonstrate other structures: this may be because of sample characteristics and timing of administration. We aimed to examine the factor structure of the EPDS in pregnancy and postpartum at 4 time-points in a large population-based sample. We carried out exploratory and confirmatory factor analysis on the Avon Longitudinal Study of Parents and Children sample (n = 11,195-12,166) randomly split in 2. We used data from 18 and 32 weeks pregnancy gestation; and 8 weeks and 8 months postpartum. A 3-factor solution was optimal at all time-points, showing the clearest factor structure and best model fit: Depression (4 items) accounted for 43.5-47.2% of the variance; anhedonia (2 items) 10.5-11.1%; and anxiety (3 items) 8.3-9.4% of the variance. Internal reliability of subscales was good at all time points (Cronbach's s: .73-.78). The EPDS appears to measure 3 related factors of depression, anhedonia, and anxiety and has a stable structure in pregnancy and the first postnatal year. (PsycINFO Database Record
Edinburgh Postnatal Depression Scale Download
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A sample of 113 women has been recruited for the Italian validation of Edinburgh Post Natal Depression Scale (EPDS). These women, between the eighth and the twelfth week after delivery, were admnistered the EPDS and diagnosed according the DSM-III-R criteria using the MINI Interview. At the 8/9 cut-off score the sensitivity is 94.4%, specificity 87.4% and PPV 58.6%. The internal consistency of the EPDS Italian version was tested using Chronbach's alpha coefficient (0.7894) and Guttman split-half coefficient (0.8191). Finally a receiver operating characteristic (ROC) analysis was carried out to evaluate the global functioning of the scale: the area under ROC curve AUC is 0.7470 and the logistic estimate for the threshold score of 11/12 fitted the model sensitivity at 75% and model specificity at 67%. Our data confirm the validity of EPDS in identifying postnatal depression also in its Italian version and the scale could be used as an useful instrument in the clinical practice.
The Edinburgh Postnatal Depression Scale (EPDS) is the screening instrument most commonly used to identify women with postpartum mood disorders. This is a 10-item questionnaire which has been validated in many different populations and is available in almost every language. On this scale, a score of 10 or greater or an affirmative answer on question 10 (presence of suicidal thoughts) is suggestive of postpartum depression. (Setting the cut-off score of 12 improves the specificity of the EPDS for identifying major depression; however, the sensitivity falls off significantly, making it less useful for screening.) Most importantly it should be emphasized that an elevated score on the EPDS does not necessarily confirm the diagnosis of postpartum depression; this requires a more thorough diagnostic evaluation.
A recent study indicated that the EPDS may be further abbreviated to a three question version which can be used to screen for postpartum depression. Given the prevalence of anxiety symptoms among women with postpartum depression, the authors chose a screening tool using the 3 items which comprise the anxiety subscale of the EPDS:
Suicide is a leading cause of perinatal maternal deaths in industrialised countries but there has been little research to investigate prevalence or correlates of postpartum suicidality. The Edinburgh Postnatal Depression Scale is widely used in primary and maternity services to screen for perinatal depressive disorders, and includes a question on suicidal ideation (question 10). We aimed to investigate the prevalence, persistence and correlates of suicidal thoughts in postpartum women in the context of a randomised controlled trial of treatments for postnatal depression.
Women in primary care were sent postal questionnaires at 6 weeks postpartum to screen for postnatal depression before recruitment into an RCT. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for postnatal depression and in those with high levels of symptoms, a home visit with a standardised psychiatric interview was carried out using the Clinical Interview Schedule-Revised version (CIS-R). Other socio-demographic and clinical variables were measured, including functioning (SF12) and quality of the marital relationship (GRIMS). Women who entered the trial were followed up for 18 weeks.
Healthcare professionals using the EPDS should be aware of the significant suicidality that is likely to be present in women endorsing 'yes, quite often' to question 10 of the EPDS. However, suicidal ideation does not appear to predict poor outcomes in women being treated for postnatal depression.
Suicide is a leading cause of maternal deaths in the perinatal period in industrialised countries [1, 2]. Suicide is more common in people with suicidal thoughts [3] and suicidal thoughts are therefore a cause for concern when elicited by health professionals. Outside of the perinatal period, being female and having major depression are associated with the highest risk of acting on suicidal ideas [4] but there is some evidence that compared with non-pregnant populations, women in the antenatal and postnatal period are at lower risk, with risk being highest in women with severe disorders [5]. This may be due to concern for the unborn child being a protective factor or may reflect that women with a high risk of suicide are less likely to get pregnant. The relationship between suicidal thoughts and suicidal acts in the postpartum period is not clear but it is prudent to assume that suicidal thoughts are a marker of increased risk of suicide [5].
The Edinburgh Postnatal Depression Scale (EPDS) [9] is a widely used tool in primary care and community maternity services to screen for depressive disorders in the perinatal period [12]. There is growing evidence that it also identifies anxiety disorders [13]. Although there is some controversy about whether and when to use the EPDS in screening for postnatal mental disorders [14, 15] it is still used internationally in the primary care setting. We used the EPDS to identify women in the community who were possibly depressed, for recruitment into a randomised controlled trial comparing antidepressants and non - directive counselling in the treatment of postnatal depression (the RESPOND trial) [16]. This enabled us to investigate the prevalence of suicidal thoughts in postpartum women, the persistence and correlates of suicidal thoughts in postpartum women participating in a treatment trial, and to compare the EPDS measure of suicidality with the more comprehensive assessment used as part of the Clinical Interview Schedule-Revised version (CIS-R) [17].
We found that 4% of 4150 women in the community at around 6 weeks postpartum had suicidal ideation (SI) occurring sometimes or quite often, and 9% reported any suicidal ideation. This is a higher prevalence of significant SI than reported by previous studies in Finland and England [5] and this may reflect our study sample which was recruited from areas with higher levels of socioeconomic deprivation than in previous studies [16]. Endorsement of 'yes, quite often' SI on question 10 of the EPDS was associated with affirming at least two CIS-R items on suicidality. However, endorsement of 'sometimes' experiencing SI was not concordant with suicidality as measured by the CIS-R; the kappa statistic of 0.42 reflects this moderate level of agreement. We also confirmed that in women with an EPDS > 12 and a diagnosis of depression, women participating in a treatment trial for postnatal depression were more likely to experience SI if they had more depressive symptoms as measured on the EPDS; in addition they were more likely to be younger, unmarried, unemployed or have an unemployed partner, and have marital problems. In the multivariable analysis, younger age, having 3 or more children and a higher EPDS remained significantly associated with SI. However, SI at baseline was not associated with poorer outcome on follow-up, and this probably reflects the fact that these were women treated for depression in the RESPOND trial (either by medication or psychotherapy).
This study suggests that these professionals should be aware that endorsement of "often" will usually mean there is significant suicidality and depressive symptomatology warranting referral to an appropriate professional (e.g. general practitioner) for further assessment. However, suicidal ideation does not appear to predict poor outcomes in women who are treated for depression. Women with depressive symptoms and suicidal ideation should benefit from appropriate treatment for postnatal depression such as health visitor delivered non-directive counselling, cognitive behavioural therapy or antidepressants [16]. Women may have strong preferences regarding these treatments and where possible their preferred treatment should be offered as this may improve outcome further [16, 23, 24]. 9af72c28ce
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