Re‐evaluation of the Edinburgh Postnatal Depression Scale as screening for post‐partum depression in Iwate Prefecture, Japan

Abstract

Aim: Although the Edinburgh Postnatal Depression Scale (EPDS) is widely used for screening for postpartum depression (PPD), screening time point and cut-off value in the current medical environment are not sufficiently examined. In this study, we examined appropriate timing and cut-off value of EPDS for the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. Methods: This study was a prospective cohort study of women who delivered at the Iwate Medical University Hospital from August 2016 to February 2019. The EPDS self-assessment was conducted at 4 days and at 1 month after delivery (4D-EPDS and 1M-EPDS), and the Center for Epidemiologic Studies-Depression scale (CES-D) self-assessment was conducted at 1 month after delivery (1M-CES-D) in eligible patients and the scores were tabulated. Participants were interviewed by a psychiatric specialist to identify PPD within 2 months after delivery. For each screening, a receiver operating characteristic analysis was performed to calculate the cut-off value for PPD. Sensitivity, specificity, positive predictive value, negative predictive value and correct diagnostic rate were evaluated. Results: Of the 80 post-partum women, PPD was found in nine cases (11.3%). The cut-off values for PPD were ≥10 for 4D-EPDS, ≥13 for 1M-EPDS and ≥21 for 1M-CES-D. No significant difference was found in the sensitivity, positive predictive value or negative predictive value among the three screening methods. However, a significant difference was found in the specificity, and the correct diagnosis rate and these values were relatively higher in 1M-EPDS. Conclusion: Based on the result of this Japanese cohort, 1M-EPDS with a cut-off value of ≥13 might be appropriate for PPD screening although that of ≥9 is currently employed.

Comparison of response options and actual symptom frequency in the Japanese version of the Edinburgh Postnatal Depression Scale in women in early pregnancy and non-pregnant women

“…The EPDS-S and FREQ-S both showed that non-pregnant women scored higher than pregnant women overall and pregnant women in their 20s, indicating that early pregnancy is a relatively less stressful situation than a regular life for female students in their 20s. However, it was clearly lower than the previously reported EPDS positivity rate in pregnant women [ 2 , 23 , 24 ]. The reason for the low positivity rate in this study might be that it was conducted in a general obstetrics and gynecology department.…”

“…According to the EPDS manual, 2nd edition [ 22 ], scores of 10 or more indicate high depressive symptoms, and a cutoff value of 10 is recommended for research use. The cutoff value for the Japanese version of the EPDS has been recommended by the Japanese Society of Obstetrics and Gynecology to be 9 points for postpartum pregnancy and 13 points for pregnancy, based on results of the studies by Usuda and Okano [ 2 , 23 , 24 ]. There is heterogeneity in the reported sensitivity and specificity of the cutoff scores among studies, which may be due to various factors, such as study methodology, language, or diagnostic criteria.…”

Assessment of Patient-Reported Outcome Measures for Maternal Postpartum Depression Using the Consensus-Based Standards for the Selection of Health Measurement Instruments Guideline

“…Results of the risk-of-bias assessment of the methods used to evaluate psychometric measurement properties of PROMs in individual studies are provided in eTable 1 in the Supplement. Thirty-three studies 25,26,29,30,[32][33][34][35][36][37][38]40,[42][43][44][45][46][47][48][49][50]52,[54][55][56][57][58][59][60][62][63][64]66 were graded as very good for methods, 11 studies 24,26-28,31,48,51,53,60,61,65 as adequate, and 2 studies 39,41 as doubtful (eTable 1 in the Supplement). were frequently downgraded for study design (convenience sampling predisposing to selection bias), 24,[27][28][29][30][31][32]35,36,49,51,53,54,…”

“…were frequently downgraded for study design (convenience sampling predisposing to selection bias), 24,[27][28][29][30][31][32]35,36,49,51,53,54,60 inadequate response rate (<60%), 37,[44][45][46]55,66 or low numbers of study patients (<100), resulting in imprecision. 31,33,35,36,57,58,60…”

Cerebral diffusion kurtosis imaging to assess the pathophysiology of postpartum depression

“…According to a recent report, 60% of mothers who committed suicide in the first year of childbirth in the 23 wards of Tokyo had mental illness, and postpartum depression (PPD) was the most common (33%) 1 . The incidence of PPD has been reported to be 10–15% 2 in developed countries and we reported an incidence of 11.3% in Japan in a previous study 3 . Depressive symptoms have been reported in more than 25% of perinatal women 2 , 4 .…”