Use of Edinburgh postnatal depression scale in a north American population

Prog. Neuro-Psycl'opharnmcoL & Bk>LPsyclO.at. 1993, Vol. 17, pp. 501-504 Printed in Great Brltatn. All rights reserved

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U S E O F EDINBURGH P O S T N A T A L D E P R E S S I O N S C A L E IN A N O R T H A M E R I C A N P O P U L A T I O N

Alec Roy,I Peggy Gang,2 Karyl Cole '1 Monlca Rutsky,3 Leslie Reese 3 and JoAnrl WeisbordI 1Hillside Hospital and 2Departments of Nursing and 3Social Work, Long Island Jewish Medical Center New Hyde Park, NY, USA (Final form, May 1992)

Abstract Roy, Alec, Peggy Gang, Karyl Cole, Monica Rutsky, Leslie Reese and JoAnn Weisbord; Use of Edinburgh Postnatal Depression Scale in a North American Population. Prog. NeuroPsychopharmacol & Biol Psychiat. 1993, 17(3): 501-504. 1. The authors mailed the Edinburgh Post-natal Depression Scale to 308 women at six weeks postpartum. 2. It was completed and return by 185 women (60.0%). 3. Thirty-two of them (17.4%) scored 12 and above, the threshold reported to identify most women with postpartum depressive disorder. Key words: depression, postpartum, screening ~

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Edinburgh Post-natal Depression Scale (EPDS) Introduction

Prevalence estimates of nonpsychotic depression occurring within six months after childbirth and meeting recognized diagnostic criteria, range from 7 to 15 percent (Gitlin and Pasnau, 1989, Cox, 1989). There is a marked tendency for the onset of depression to be in the first three months after delivery rather than evenly throughout the postpartum year (Cooper et al, 1988). This skewed distribution suggests that postpartum psychiatric morbidity may be amenable to detection and treatment as these women are, or have very recently been, in contact with the health services. 501

502

A. Roy et oL

Cox et al (1987) developed the Edinburgh Post-natal Depression Scale (EPDS) as a screening tool for postpartum depression to be admires"tered by health visitors. It is a ten item self report scale that is short, simple, and easy to score. It has been demonstrated to have acceptable sensitivity, specificity, and positive predictive value for depression in the post-natal period (Murray and Carothers, 1990). However, it has not been used in the United States. As part of developing a postpartum depression program the authors wished to find out how acceptable American women would be to receive it in the mail, what the response rate would be, and what the range of scores would be. Method Subiects One of us (PG) approached 308 women in the obstetric service at Long Island Jewish (LIJ) Medical Center who had had a live birth in the previous two days. They were asked if we could send them the EPDS in the mail six weeks later. Only one patient refused. At approximately six weeks after delivery each woman was mailed a letter reminding her of our contact in the obstetric ward, telling her the purpose of the study and asking her to complete and return an enclosed EPDS. A stamped addressed envelope was included. This study had the approval of the LIJ Human Subjects Review Committee. Results

Completed questionnaires were returned by 185 of the 307 women to whom they were sent. One was returned by the postal service as undeliverable. A range of scores from 0 to 24 were obtained (the maximum possible score is 30). Thirty two of the 184 women scored 12 or above - the threshold reported by Cox et al, (1987) to identify women with depressive disorder (see Table 1). The rest of the 152 women scored from 0 to 11.

Edinburgh postnatal depression scale

Table 1 Scores on EPDS of 32 women who scored 12 or above EPDS Score

Number of Subjects

12

6

13

3

14

9

15

2

16

1

17

2

18

1

19

2

20

1

21

1

22

1

23

2

24

1

Discussion We found that 60% of the women in our sample completed and returned the EPDS. This percent is substantially less than the 97.3% reported by Murray et al (1990) among 702 English women who were similarly sent the EPDS at six weeks postpartum. This difference may partly be explained by the initial recruitment method. Murray et ars (1990) subjects were recruited "into a study of factors influencing infant development" whereas our subjects were told that we wished to screen for postpartum depression and were reminded of this in the letter that we sent them with the EPDS. However, it is noteworthy that only one of the 308 women we approached indicated that she did not wish to participate. Thus, it would appear that American women are accepting of the idea of administration of the EPDS by mall but that the response rate will be about sixty percent.

503

504

A. Roy et oL Cox et al (1987) blindly interviewed mothers who had completed the EPDS and used diagnostic criteria to make psychiatric diagnoses. They reported that mothers scoring above a threshold score of 12/13 "were likely to be suffering from a depressive illness." They reported a sensitivity of 86% while Murray et al reported a sensitivity of 67.7%. In our study we found that 32 of the 185 women (17.3%) had EPDS scores of 12 and above. Thus, although only approximately 60 percent of American women returned the questionnaire, mall administration will yield a subsample of high scorers probably containing women with postpartum depression. Conclusiort The EPDS is easy to administer. Mall administration leads to returns by about 60% of women among whom approximately 1 in 6 have a high score. References

COOPER., P. CAMPBELL E. DAY A KENNEDY, H. and BOND, A. (1988) Nonpsychotic psychiatric disorder after childbirth: A Prospective study of prevalence incidence, course and nature. B i t J Psychiatry 152: 799-806.

COX, J. (1989) Postnatal depresS~n: A serious and neglected postpartum complication. Chap9 Balliere's Clinical Obstetrics and Gyneaecology 3: 839-855.

COX, J. HOLDEN, J. and SAGOVSKY R. (1987) Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. Brit J Psychiatry 150: 782-786. G1TLIN, M. and PASNAU, R. (1989) Psychiatric syndromes linked to reproductive function in women: A review of current knowledge. Am J Psychiatry, 146: 1413-1422. MURRAY, L. and CAROTHERS, A. (1990) The validation of the Edinburgh post-natal depression scale on a community sample. Brit J Psychiatry, 157: 288-290.

Inquiries and reprint requests should be addressed to: Alec Roy, M.B. 140 Dwight Place Englewood, NJ 07631, USA

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