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Postdelivery Screening for Postpartum Depression

From the Department of Psychiatry (D.T.S.L., S.S.M.C., W.S.W.) and Department of Obstetrics and Gynaecology (A.S.K.Y., M.H.Y.T., W.S.W., T.K.H.C.), Chinese University of Hong Kong, Sha Tin, Hong Kong; and Department of Social Medicine (D.T.S.L.), Harvard Medical School, Boston, Massachusetts.

Address reprint requests to: Dr. Dominic TS Lee, Department of Psychiatry, Chinese University of Hong Kong, Sha Tin, Hong Kong. Email: tak_lee{at}hms.harvard.edu

OBJECTIVE: Postpartum depression (PPD) is a serious psychiatric disorder affecting 10% to 20% of women after childbirth. Research has shown that systematic screening for PPD using self-report questionnaires helps improve the identification of PPD and expedite treatment. Most studies on PPD screening have been conducted in the second and third postpartum months; little is known about whether PPD screening can be carried out on the days immediately after delivery.

METHODS: A prospective cohort of 145 women completed the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI), and General Health Questionnaire (GHQ) within 2 days of delivery. Six weeks after delivery, the participants were interviewed by a psychiatrist, who used the Structured Clinical Interview for DSM-III-R (SCID, nonpatient version) to establish the diagnosis. The psychometric performance of the EPDS, BDI, and GHQ in detecting PPD was assessed using the SCID diagnosis as the gold standard.

RESULTS: When the cutoffs of the EPDS, BDI, and GHQ were lowered to achieve a sensitivity of 80%, the positive predictive values of these scales were to 13%, 18%, and 21%, respectively. When the cutoffs were raised to achieve a positive predictive value of 50%, the sensitivity rates were 6% (EPDS), 14% (GHQ), and 36% (BDI).

CONCLUSIONS: When commonly used depression rating scales were administered to identify PPD immediately after delivery, their psychometric properties were unsatisfactory. Healthcare providers should not screen for PPD in the first few days after delivery.

Key Words: postnatal depression, • screening, • rating scales.

Abbreviations: AUC = area under the curve;; BDI = Beck Depression Inventory;; EPDS = Edinburgh Postnatal Depression Scale;; GHQ = General Health Questionnaire;; NPV = negative predictive value;; PPD = postpartum depression;; PPV = positive predictive value;; ROC = receiver operating characteristics;; SCID-NP = nonpatient version of the Structured Clinical Interview for DSM-III-R;; SENS = sensitivity;; SPEC = specificity.

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