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Three-item measure reliably detects maternal depression, researchers find

Wednesday, October 01 2008 | Comments

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What's This? The 3-item anxiety subscale of the widely used Edinburgh Postpartum Depression Scale (EPDS) may be a practical, reliable method to screen for postpartum depression in the primary health care setting, suggests a study that compared the reliability of several different subscales in detecting maternal depression.

Anxiety is a more prominent feature of postpartum depression than of depression that occurs at other times in life, researchers explained. Thus, they set out to test the hypothesis that during the first 6 postpartum months, the 3-item anxiety subscale of the EPDS would be a better brief depression screener than 2 EPDS questions that are almost identical to the widely used Patient Health Questionnaire.

The researchers analyzed data from a cohort of 199 subjects aged 14 to 26 years who participated in an adolescent-oriented maternity program and completed the full EPDS at well-child visits during the first 6 months postpartum. Specifically, the investigators compared the reliability, stability, and construct validity of 3 subscales: the anxiety subscale (3 items; EPDS-3), the depressive symptoms subscale (7 items; EPDS-7), and 2 questions that resemble the Patient Health Questionnaire (EPDS-2).

Forty-one mothers (20.6%) met study criteria for referral for evaluation of depression (score >=10 on the full 10-item EPDS). The researchers found that the EPDS-3 exhibited the best screening performance characteristics, with a sensitivity of 95% and a negative predictive value of 98%. The EPDS-2 was the least reliable, with sensitivity ranging from 48% to 80%, depending on the cutoff used. This scale also lacked internal consistency across covariate groups, exhibiting excellent internal consistency among mothers with chronic depression but not among mothers who did not have chronic depression. The EPDS-7 had a sensitivity of 59% and a negative predictive value of 90%.

"Our analysis provides strong evidence for the validity and use of the EPDS-3 as an ultra-brief screening tool for identifying mothers at increased risk for postpartum depression in primary pediatric care settings," the authors concluded. They added, however, that future research should repeat the analysis in a larger cohort of mothers spanning a wider age range and that the criterion validity for the EPDS-3 should be established by comparison with a psychiatric interview. (Kabir K, et al. Pediatrics 2008;122:e696-e702.)

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