Generating an efficient version of the Edinburgh Postnatal Depression Scale in an urban obstetrical population

Abstract

Background Postpartum depression incurs significant burden and suffering. Methods We investigated the latent structure of the most commonly used screening measure, the Edinburgh Postnatal Depression Scale (EPDS) in women (N = 15,172) and tested its predictive validity for the diagnosis of depression as determined with a structured clinical interview. Exploratory and confirmatory factor analyses, Receiver Operating Characteristic curves, and logistic regression analyses were conducted. Results A seven-item one factor scale (items 1, 2, 6, 7, 8, 9, 10) emerged with a Goodness of Index Fit Index (GFI) = 0.96, relative to the ten-item two factor version of the EPDS (GFI =0.94). The seven-item EPDS achieved good sensitivity and specificity in predicting the 10-item EPDS, with a cut point score of 4 on the seven item EPDS to predict a 10-item EPDS score of 10 or more (sensitivity = 95%, specificity = 91%). The seven and 10-item EPDS showed a similar ability to predict a diagnoses of depression (area under the ROC curve=0.795 for the 10-item, 0.770 for the seven-item EPDS). Logistic regression analyses showed similar predictive ability between the seven- and 10-item scales in predicting scores higher than 18 on the clinical interview. Limitations The sample represents women from one Midwest medical center and the EPDS was measured via phone. Conclusion The seven-item one factor version of the EPDS is an efficient and effective measure of depression severity on par with the two factor 10-item version of the EPDS.

Establishing a coherent and replicable measurement model of the Edinburgh Postnatal Depression Scale

“…The EPDS (J. L. Cox et al., 1987 ) is a 10-item self-report screening tool measure of PND. The cut-off criteria for screening has been noted to vary between studies and clinical populations ( Gollan et al., 2017 , Matthey and Agostini, 2017 ), however, the ‘classic’ cut-point threshold is 12/13for probable PND (J. L. Cox et al., 1987 ). A 9/10 cut-point for screening has been suggested (J.L.…”

“…Despite, the extensive use of the EPDS as a screening instrument, the measure has also been noted for some contradictory observations in terms of its measurement structure. The measure itself was originally developed to be a unitary measure of (postnatal) depression, however, a multitude of studies have demonstrated the EPDS to have an underlying multi-dimensional factor structure ( Brouwers et al., 2001 , Gollan et al., 2017 , Jomeen and Martin, 2007 , Matthey, 2008 , Phillips et al., 2009 , Reichenheim et al., 2011 , Ross et al., 2003 , Tuohy and McVey, 2008 ). The findings of such studies constructively suggest that the EPDS may comprise sub-scale domains of potential and added clinical value ( Matthey, 2008 ).…”

“…The findings of such studies constructively suggest that the EPDS may comprise sub-scale domains of potential and added clinical value ( Matthey, 2008 ). At the same time they indicate that the tool itself does not appear to measure what it was designed to measure (depression) and consequently may be limited in terms of both screening effectiveness ( Matthey and Agostini, 2017 ) and links to a coherent clinical and unidimensional model of postnatal depression ( Gollan et al., 2017 ). Nevertheless, the notion of a multi-dimensional underlying structure to the EPDS need not necessarily detract from its clinical utility, with identification of robust independent sub-scales embedded within the tool not anticipated by the instrument developers ( Matthey, 2008 ).…”

“… Determine the equivalence of EPDS total and sub-scale correlational relationships between time points. Evaluate case classification rate concordance between the conventional 10-item EPDS and the recent 7-item EPDS suggested by Gollan et al. (2017) .…”

“…Evaluate case classification rate concordance between the conventional 10-item EPDS and the recent 7-item EPDS suggested by Gollan et al. (2017) .…”