The factor structure of the Edinburgh Postnatal Depression Scale among perinatal high-risk and community samples in London

Abstract

Timely and accurate detection of perinatal mental health problems is essential for the wellbeing of both mother and child. Growing evidence has suggested that the Edinburgh Postnatal Depression Scale (EPDS) is not a unidimensional measure of perinatal depression, but can be used to screen for anxiety disorders. We aimed to assess the factor structure of the EPDS in 3 different groups of women: n = 266 pregnant women at high-risk of depression (“Perinatal Stress Study”), n = 471 pregnant women from a community sample, and n = 637 early postnatal women from a community sample (“developing Human Connectome Project”). Exploratory factor analysis (40% of each sample) and confirmatory factor analysis (60% of each sample) were performed. The relationship between EPDS scores and history of mental health concerns was investigated. Results suggested that a 3-factor model (depression, anxiety, and anhedonia) is the most appropriate across groups. The anxiety subscale (EPDS-3A) emerged consistently and was related to maternal history of anxiety disorders in the prenatal sample (W = 6861, p < 0.001). EPDS total score was related to history of mental health problems in both the prenatal (W = 12,185, p < 0.001) and postnatal samples (W = 30,044, p < 0.001). In both high-risk and community samples in the perinatal period, the EPDS appears to consist of depression, anxiety, and anhedonia subscales. A better understanding of the multifactorial structure of the EPDS can inform diagnosis and management of women in the prenatal and postnatal period. Further research is required to validate the EPDS-3A as a screening tool for anxiety.

Associated factors of depression in primiparas with hypothyroidism during pregnancy

“…A lack of good or effective communication can easily lead to depression when pregnant women are experiencing considerable psychological fluctuations and pressure. [17,18] For primiparas with hypothyroidism and depression, appropriate psychological care can be given in clinical practice. Specific ways of providing this care include the following.…”

The approach to managing perinatal anxiety: A mini-review

“…It has been suggested that the GAD-2 might not be appropriate to use at antenatal appointments, as it is not specific enough to the experience of pregnant women ( 37 ). In some instances HCPs might try to use aspects of EPDS to assess PNA as it has been suggested that the EPDS is sufficiently ‘bi-dimensional' in order to be able to accurately screen for PNA by several studies ( 38 , 39 ). However, there is some disagreement within the literature around this with critics of the EPDS suggesting that as it was originally designed to case find for PND it misses some of the nuances of PNA diagnosis, and is not able to adequately differentiate between symptoms of PND and PNA ( 40 ).…”

Postnatal maternal depressive symptoms and behavioural outcomes in term-born and preterm-born toddlers: a longitudinal UK community cohort study

“…Exclusion criteria for the DHCP included: contraindications to MRI, babies being too unwell to tolerate a scan and language difficulties preventing informed consent. 34 Toddlers were invited to the Centre for the Developing Brain, St Thomas’ Hospital, London, for neurodevelopmental assessment at 18 months post expected delivery date; appointments were made according to family availability as close as possible to this time point. Inclusion criteria for our follow-up study were: mother and baby attendance for MRI at term-equivalent age; completed toddler neurodevelopmental assessment.…”

“…Participants were enrolled in the Developing Human Connectome Project (DHCP, http://www.developingconnectome.org/), a neuroimaging-focused project, with eligibility criteria including pregnant women (aged ≥16 years) with a gestational age of 20–42 weeks, and newborn infants aged 24–44 weeks; infants enrolled in the DHCP had MRI at term-equivalent age. Exclusion criteria for the DHCP included: contraindications to MRI, babies being too unwell to tolerate a scan and language difficulties preventing informed consent 34. Toddlers were invited to the Centre for the Developing Brain, St Thomas’ Hospital, London, for neurodevelopmental assessment at 18 months post expected delivery date; appointments were made according to family availability as close as possible to this time point.…”

“…Participants were informed that the results would be discussed with them and consented to information being shared with their general practitioner in the case of high scores. The EPDS questionnaire was scored by a member of the DHCP team 34…”