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Predictive accuracy of Edinburgh Postnatal Depression Scale assessment during pregnancy for the risk of developing postpartum depressive symptoms: a prospective cohort study
Author(s) -
Meijer JL,
Beijers C,
Pampus MG,
Verbeek T,
Stolk RP,
Milgrom J,
Bockting CLH,
Burger H
Publication year - 2014
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12759
Subject(s) - edinburgh postnatal depression scale , medicine , prospective cohort study , obstetrics , population , predictive value of tests , postpartum depression , positive predicative value , pregnancy , cohort study , receiver operating characteristic , cohort , depression (economics) , predictive value , depressive symptoms , psychiatry , anxiety , environmental health , macroeconomics , biology , economics , genetics
Objective To investigate whether the 10‐item Edinburgh Postnatal Depression Scale ( EPDS ) administered antenatally is accurate in predicting postpartum depressive symptoms, and whether a two‐item EPDS has similar predictive accuracy. Design Prospective cohort study. Setting Obstetric care in the Netherlands. Population One thousand six hundred and twenty women from the general population. Methods Mean values, area under the receiver operating characteristics curve ( AUC ), sensitivity, specificity and predictive values of antenatal EPDS for the likelihood of developing postpartum depressive symptoms were calculated. Analyses were repeated for each trimester, several cut‐off values and a two‐item EPDS (low mood and anhedonia). Main outcome measures Postpartum depressive symptoms, defined as EPDS score ≥10. Results Mean EPDS scores were significantly higher during each trimester in women with postpartum depressive symptoms than in those without the symptoms ( P < 0.001). Using the prevailing cut‐off (≥13), the AUC was reasonable (0.74), sensitivity was 16.8% (95% CI 11.0–24.1), positive predictive value was 41.8% (95% CI 28.7–55.9), specificity was 97.8% (95% CI 97.0–98.5) and negative predictive value was 92.7% (95% CI 91.3–94.0). Using a lower cut‐off value (≥5), sensitivity was 70.8% (95% CI 62.4–78.3) and specificity was 65.4% 4 (95% CI 62.9–67.8), but positive predictive value was low (15.9%, 95% CI 13.1–19.0). Negative predictive value was exceedingly high at 96.0% (95% CI 94.6–97.2). Results were similar during the second and third trimester. The predictive accuracy of the two‐item EPDS appeared inferior. Conclusions The EPDS was not sufficiently accurate in predicting risk of postpartum depressive symptoms. Nevertheless, when using the ≥5 cut‐off value, it may be adequate for initial screening, followed by further assessments and possibly antenatal intervention when positive. Furthermore, when negative, women may be reassured that postpartum depressive symptoms are unlikely. A two‐item version showed poor predictive accuracy.