Identifying depression in the first postpartum year: guidelines for office-based screening and referral

• Published in: Journal of affective disorders Vol. 80; no. 1; pp. 37 - 44
• Main Authors: Peindl, Kathleen S., Wisner, Katherine L., Hanusa, Barbara H.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.05.2004; Elsevier
• Subjects: Adolescent; Adult; Antidepressive Agents, Tricyclic - therapeutic use; Biological and medical sciences; Depression, Postpartum - diagnosis; Depression, Postpartum - epidemiology; Depression, Postpartum - prevention & control; Double-Blind Method; Edinburgh Postnatal Depression Scale; Female; Humans; Interview, Psychological - methods; Mass Screening - methods; Medical sciences; Middle Aged; Nortriptyline - therapeutic use; Personality Inventory - statistics & numerical data; Postpartum depression; Practice Guidelines as Topic; Primary Health Care - methods; Primary Health Care - standards; Prospective Studies; Psychiatric Status Rating Scales - statistics & numerical data; Psychology. Psychoanalysis. Psychiatry; Psychometrics; Psychometrics. Diagnostic aid systems; Psychopathology. Psychiatry; Referral and Consultation - standards; Screen for depression; Secondary Prevention; Sensitivity and Specificity; Surveys and Questionnaires; Techniques and methods; Treatment Outcome; United States; North America; America; Screen for depression; Edinburgh Postnatal Depression Scale; Postpartum depression; Human; Mood disorder; Social environment; Relapse; Evaluation scale; Prediction; Mental health; Depression; Psychometrics; Maternal diseases; Puerperium; Recommendation; Test validation; Follow up study; Young adult; Risk factor; Adult; Female; Public health
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/S0165-0327(03)00052-1

Background: Some 10–15% of women experience postpartum-onset major depression (PPMD). The objective of this study was to determine if the Edinburgh Postnatal Depression Scale (EPDS) is an effective screen for major depression (MD) prospectively. The outcome of the study was identification of a recurrence of major depression in the first year postpartum by a clinical interview and the EPDS. We had the unique opportunity to examine the relationship between EPDS scores and PPMD. Methods: Participants were pregnant women who had experienced an episode of previous PPMD but were well during their index pregnancy. This study was part of a double-blind, randomized clinical trial in which new mothers received nortriptyline or placebo within 24 h following delivery for prevention of PPMD. Recurrence of depression was established according to Research Diagnostic Criteria. Participants completed the EPDS weekly through 20 weeks postpartum and into a 1-year follow-up phase. Results: Out of 50 women, 13 experienced recurrence of MD in the first 20 weeks postpartum with a total of 20 out of 50 recurring in the first year. The EPDS score of >9 at week 4 postpartum identified 60% of women who nurtured in the first 20 weeks and 80% who recurred in the first postpartum year. Limitations: The study population included only women who had a previous episode of postpartum depression. The generalizability to all women is limited. Conclusions: The EPDS is an effective depression screen for women who had a previous episode of PPMD. Clinical guidelines are provided for use of the EPDS to identify MD in the first postpartum year in primary care settings.