Identifying Postpartum Depression: 3 Questions Are As Good As 10

University of Colorado and Health Sciences Center, Children's Hospital, Department of Pediatrics, 1056 E 19th St, Box B025, Denver, CO 80218, USA.
PEDIATRICS (Impact Factor: 5.47). 09/2008; 122(3):e696-702. DOI: 10.1542/peds.2007-1759
Source: PubMed

ABSTRACT Postpartum depression is the most common medical problem that new mothers face. Anxiety is a more prominent feature of postpartum depression than of depression that occurs at other times in life. Routine, universal screening significantly improves detection in primary health care settings. Thus, an ultrabrief scale that could be incorporated into a general health survey or interview would be useful.
We tested the hypothesis that, during the first 6 postpartum months, the 3-item anxiety subscale of the Edinburgh Postpartum Depression Scale is a better ultrabrief depression screener than 2 Edinburgh Postpartum Depression Scale questions that are almost identical to the widely used Patient Health Questionnaire.
A cohort of 199 14- to 26-year-old participants in an adolescent-oriented maternity program completed the Edinburgh Postpartum Depression Scale at well-child visits during the first 6 postpartum months. Three subscales of the Edinburgh Postpartum Depression Scale were examined as ultrabrief alternatives: the anxiety subscale (3 items; Edinburgh Postpartum Depression Scale-3), the depressive symptoms subscale (7 items; Edinburgh Postpartum Depression Scale-7), and 2 questions that resemble the Patient Health Questionnaire (Edinburgh Postpartum Depression Scale-2). The reliability, stability, and construct validity of the Edinburgh Postpartum Depression Scale and 3 subscales were compared. Criterion validity was assessed by comparison with a score of >/=10 on the full, 10-item Edinburgh Postpartum Depression Scale.
A total of 41 mothers (20.6%) met study criteria for referral for evaluation of depression (Edinburgh Postpartum Depression Scale-10 score >/= 10). The Edinburgh Postpartum Depression Scale-3 exhibited the best screening performance characteristics, with sensitivity at 95% and negative predictive value at 98%. It identified 16% more mothers as depressed than the Edinburgh Postpartum Depression Scale did. The performance of the Edinburgh Postpartum Depression Scale-2 was markedly inferior, with sensitivity at 48% to 80%. Moreover, the Edinburgh Postpartum Depression Scale-2 was unreliable for mothers who had not been depressed in the past.
The brevity, reliability, and operating characteristics of the Edinburgh Postpartum Depression Scale-3 make it an attractive postpartum depression screening tool for primary health care settings in which the goal is to detect depression, not to assess its severity. Validation by diagnostic psychiatric interview is needed.

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Available from: Jeanelle Sheeder, Sep 26, 2015
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    • "The EPDS has been used with large samples and validated with both standardized psychiatric interviews (Affonso et al. 2000) and physician diagnosis of Major Depressive Disorder in the postpartum period (Cox et al. 1987). The shorter EPDS-3, although not a measure of depression severity, is considered a reliable screening tool to detect depression (Kabir et al. 2008). The EPDS is available in many languages (Gibson et al. 2009). "
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    ABSTRACT: To evaluate the effect of telephone-based peer support on maternal depression and social support BACKGROUND: Postpartum depression is a global health concern and lack of treatment options mean many mothers are depressed beyond the first year after birth. Strong evidence has shown telephone-based peer support, provided by a mother recovered from depression, effectively improves depression outcomes. This model has not been tested with mothers with depression any time up to two years postpartum. Quasi-experimental, one group pre-test, posttest. The study population was mothers in New Brunswick, Canada with depression up to 24 months after delivery. The sample (N = 64) was recruited between May 2011-October 2013. Peer volunteers recovered from postpartum depression were trained and delivered an average of 8·84 (Range 1-13) support telephone calls. Depression and social support outcomes were assessed at intervention mid-point (average 7·43 weeks, n = 37) and end (average 13·9 weeks, n = 34). Mean depression significantly declined from baseline, 15·4 (N = 49), to mid-point, 8·30 and end of the study, 6·26. At mid-point 8·1% (n = 3/37) of mothers were depressed and at endpoint 11·8% (4/34) were depressed suggesting some relapse. Perceptions of social support significantly improved and higher support was significantly related with lower depression symptoms. Findings offer promise that telephone-based peer support is effective for both early postpartum depression and maternal depression up to two years after delivery. © 2015 John Wiley & Sons Ltd.
    Journal of Advanced Nursing 02/2015; 71(7). DOI:10.1111/jan.12622 · 1.74 Impact Factor
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    • "The utility of the anxiety factor (items 3, 4 and 5) is discussed in some studies as follows. Some studies have suggested that items 3, 4 and 5 can measure anxiety disorder [18], [36], and other studies suggested that items 3, 4 and 5 are enough for PPD screening [14] [37]. Although the utility of the anxiety factor (item 3, 4 and 5) varies by study, as mentioned before, there is some possibility of common utility of the anxiety factor around the world. "
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    ABSTRACT: Background The Edinburgh Postnatal Depression Scale (EPDS) is a widely used screening tool for postpartum depression (PPD). Although the reliability and validity of EPDS in Japanese has been confirmed and the prevalence of PPD is found to be about the same as Western countries, the factor structure of the Japanese version of EPDS has not been elucidated yet. Methods 690 Japanese mothers completed all items of the EPDS at 1 month postpartum. We divided them randomly into two sample sets. The first sample set (n = 345) was used for exploratory factor analysis, and the second sample set was used (n = 345) for confirmatory factor analysis. Results The result of exploratory factor analysis indicated a three-factor model consisting of anxiety, depression and anhedonia. The results of confirmatory factor analysis suggested that the anxiety and anhedonia factors existed for EPDS in a sample of Japanese women at 1 month postpartum. The depression factor varies by the models of acceptable fit. Conclusions We examined EPDS scores. As a result, “anxiety” and “anhedonia” exist for EPDS among postpartum women in Japan as already reported in Western countries. Cross-cultural research is needed for future research.
    PLoS ONE 08/2014; 9(8):e103941. DOI:10.1371/journal.pone.0103941 · 3.23 Impact Factor
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    • "Therefore, this study aimed to look for evidence of impact of postpartum anxiety and depression on children’s mental development across all the five domains. Here we have used the term postpartum anxiety and depression , as anxiety is a more prominent feature of PPD than depression that occurs at other times in life [26,27]. "
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    ABSTRACT: Postpartum anxiety and depression has detrimental effects on the overall mental development of children. This study aims to assess the impact of postpartum anxiety and depression on children's mental development on all sub-scales in a Pakistani population. A quasi-experimental study was conducted in two peri-urban communities of Karachi, a mega city of Pakistan, to assess the impact of postpartum anxiety and depression on children's growth and mental development. A total of 420 women were enrolled, who had given consent out of 651 pregnant women identified, during February 2004 to December 2005. Data for socio-demographic, home environment and family relationship variables were collected between 36 weeks of pregnancy and within 10 days of childbirth. Mother's levels of anxiety and depression were assessed at 1, 2, 6, 12, 18, 24, and 30 months of childbirth. An indigenous, validated screening instrument- Aga Khan University Anxiety and Depression scale was used and diagnostic confirmation was done through a psychologist's interview, based on DSM IV criteria. Children's growth and development was monitored in the same sequence using an Early Childhood Development tool that consists of five subscales; socio emotional, language, cognitive, gross motor and fine motor development. Physical growth was monitored by measuring height and weight of the child. Data was analyzed using SAS 9.2. Multivariable Generalized Estimating Equations (GEE) logistic regression was conducted to identify association of postpartum anxiety and depression with each early childhood development indicator, adjusting for parental and child factors. A significant association of postpartum anxiety and depression with delayed development on all five subscales of children's mental development was found in our study. Interestingly, our study found that higher maternal age had adverse effects on child's emotional whereas positive impact on child's cognitive development. Children's stunting had an adverse impact on all five subscales of children's development. Male children were at higher risk for delayed language and gross motor development relative to female children. Our study found that postpartum anxiety and depression is associated with adverse outcomes regarding children's mental development on all sub-scales. The impact was accentuated by low family income or child's increasing age.
    BMC Psychiatry 10/2013; 13(1):274. DOI:10.1186/1471-244X-13-274 · 2.21 Impact Factor
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