Elsevier

Psychiatry Research

Volume 226, Issue 1, 30 March 2015, Pages 113-119
Psychiatry Research

Combined use of the postpartum depression screening scale (PDSS) and Edinburgh postnatal depression scale (EPDS) to identify antenatal depression among Chinese pregnant women with obstetric complications

https://doi.org/10.1016/j.psychres.2014.12.016Get rights and content

Highlights

  • It is the first time to combined use the screening scales to identify antenatal depression among Chinese pregnant women with obstetric complications.

  • This study supports the high prevalence of risk factors for antenatal depression, and encourages the active screening and earlier identification.

  • The results confirmed the positive relationship between the scores of the PDSS and the EPDS and suggest that the optimal cutoffs for detecting antenatal depression among each screening tool may be lower than generally recommended (i.e., standard) cutoffs.

Abstract

The purpose of the present study was to evaluate antenatal depression screening employing two scales: the Postpartum Depression Screening Scale (PDSS) and Edinburgh Postnatal Depression Scale (EPDS) for the population of Chinese pregnant women with obstetric complications. A convenience sample of 842 Chinese pregnant women with complications participated in this study. The PDSS total score correlated strongly with the EPDS total score (r=0.652, p=0.000). Each tool performed extremely well for detecting major and major/minor depressions with PDSS resulting in a better psychometric performance than EPDS (p<0.01). If combined use, the recommended EPDS cut-off score was 8/9 for major depression, at which the sensitivity (71.6%) and specificity (87.6%) were the best, and the recommended PDSS cut-off score was 79/80 for major depression, along with its best sensitivity (86.4%) and specificity (100%). The study concluded that EPDS and PDSS appear to be reliable assessments for major and minor depression among the Chinese pregnant women with obstetric complications. Combined use of these tools should consider lower cutoff scores to reduce the misdiagnosis and improve the screening validity.

Introduction

Obstetric complications are common and highly distressing events (Ariadna et al., 2009). Women with obstetric complications reported significantly more negative experiences during their recent childbirth (Thornton et al., 2010, Blom et al., 2010, Gausia et al., 2012). Early recognition of depression in pregnant women can eliminate the length of time that these women have to suffer with debilitating perinatal depression and can decrease the potentially harmful effects on the infants involved (Neiman et al., 2010).

Only a minority of pregnant women suffering from depression are identified by health care providers despite its importance. A major impediment to depression detection is the difficulty in the administration of depression screening tests in busy clinical settings. If there were simplified and appropriate screening instruments, the obstetricians and obstetrical nurses would be able to identify women with obstetric complications who have depressive symptoms more efficiently and effectively (Choi et al., 2012).

In both research and clinical practice, a positive screen for depression in the obstetrical patient should be followed by a confirmed clinical diagnosis through a structured diagnostic survey or semi-structured interview based on DSM disorders (SCID) criteria for major depression (Daniels, 2013, Tandon et al., 2012). However, Gjerdingen et al. (2011) found the SCID might be less convenient or comfortable for mothers because some individuals cannot be reached for an interview, resulting in missed opportunities for diagnosis, selection bias, and possible treatment disparities. In contrast, using a depression survey during a convenient perinatal visit to the obstetrician׳s office, though perhaps less accurate, could be easily administered, is more cost-effective, and more inclusive of screening all women.

Fortunately, there are many different, easily administered depression screening tools to help identify those who are at greatest risk, according to SCID criteria, are widely accepted and have been developed to screen for postnatal and antenatal depression in the primary care setting (Boyd et al., 2005, Breedlove and Fryzelka, 2011), two widely utilized screening scales are the Edinburgh Postnatal Depression Scale (EPDS) (Cox et al., 1987) and the Postpartum Depression Screening Scale (PDSS) (Beck and Gable, 2000).

Some studies have compared the psychometric properties of the EPDS and other screening scales. For example, Tandon et al.,(2012) enrolled 32 pregnant women and 63 women with a child <6 months in home visitation programs. Each woman completed a structured clinical interview and three depression screening tools: the EPDS, Center for Epidemiologic Studies Depression Scale (CES-D), and Beck Depression Inventory II (BDI-II). The results indicated that each screening tool appear to be reliable and brief assessments of major and minor depression among low-income African American perinatal women. However, given that no women during pregnancy met criteria for minor depression, it was not possible to determine optimal prenatal cutoff scores. In addition, Zhong et al. (2014) recruited 1517 women receiving prenatal care to evaluate the psychometric properties of the Patient Health Questionnaire (PHQ-9) and EPDS, and found both of them are reliable and valid scales for antepartum depression assessment. But the study results could not determine the extent to which scores from each scales are predictive of adverse maternal and perinatal outcomes.

There are few studies evaluating the comparability of the EPDS and PDSS, to date, in China, only one study (Li et al., 2011) screened 387 normal pregnant mothers within 12 weeks postpartum and compared the performance of the Chinese version of the EPDS and PDSS. Given the high prevalence of depressive symptoms among high-risk pregnant women and the lack of studies combined the EPDS and the PDSS during pregnancy, we conducted the present study to expand the body of research for perinatal depression screening by employing and analyzing the validity of the combined use of them, for antenatal depression screen in a population of Chinese pregnant women with obstetric complications. More specifically, if combined use, we wanted to determine the cutoff scores of the PDSS and the EPDS to screen for antenatal depression among this population. Previous research indicates that screening pregnant women for depression is clinically indicated; and, combining the EPDS and the PDSS might build upon the strengths of each scale to increase the validity of antenatal depression screening. Such information could encourage other researchers and clinicians to test the validity of the combined use of the different screening instruments to identify depression during the perinatal period in multiple obstetric settings.

Section snippets

Sample

The convenience sample included 842 high-risk pregnant women in various gestational weeks during November 2013 to January 2014 at the antenatal department of the Fudan University affiliated Women׳s Hospital.

Data collection

Convenience sampling included all of the women with obstetric complications who attended antenatal clinics within the data collection period noted above. The researcher approached the eligible women and invited them to participate in the study. All of the women who were approached were given

Sample characteristics

The demographic characteristics of the participants are presented in Table 1. Eight hundred and forty two Chinese pregnant women with obstetric complications in their different gestational weeks (M= 24.86, S.D.=7.75, range=10–39 weeks of gestation) participated in the study. Among study participants, 57 (6.8%) were 12 weeks or less gestational age, 413 (49.0%) were between 13 and 27 weeks, 334 (39.7%) were between 28 and 36 weeks, and 38 (4.5%) were 37 weeks or more. The mean participant age

Discussion

Consistent with previous research (Blom et al., 2010, Tan et al., 2011), major and minor depressions were highly prevalent in the present study sample of Chinese pregnant women with obstetric complications. The prevalence of antenatal major and minor depressions was 9.6% and 30.5%, respectively, which reflects a higher than normal depression rate level reported in other studies done by Qiao et al. (2009), Bunevicius et al. (2009) and Gaynes et al. (2005). Our study indicated that pregnancy with

Conclusion

In conclusion, depression screening plus “high-risk” feedback to providers improves the recognition of depression (Gjerdingen and Yawn, 2007). However, for screening to positively impact clinical outcomes, it needs to be combined with the complete screening system that provides valid screening tools, strong collaborative relationships between primary care and mental health providers, and longitudinal case management, to assure appropriate treatment and follow-up. In the present study, employing

Role of funding source

This study (Protocol no. 10-020-201206) was funded by the China Medical Board (CMB).

Conflict of interest

There are no personal, organizational or financial conflicts of interest.

Acknowledgment

We are deeply grateful to all women who participated in the present study. To doctors, nurses and administrative personnel, we would equally like to thank their collaboration.

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