Different cutoff points for different trimesters? The use of Edinburgh Postnatal Depression Scale and Beck Depression Inventory to screen for depression in pregnant Taiwanese women.
OBJECTIVE
Validating self-reported questionnaires to detect depression during pregnancy, compared to depression during postpartum, has gained much less attention. Furthermore, it is unknown whether it is appropriate to use the same cutoff point to detect depression on different trimesters of pregnancy. The aims of this study, conducted in pregnant Taiwanese women, were: (a) to validate the Taiwanese version of the Edinburgh Postnatal Depression Scale (EPDS-T) and the second edition of the Beck Depression Inventory (BDI-II); (b) to compare the EPDS-T and the BDI-II on their validity in detecting depression; and (c) to determine if these scales have different cutoff points in detecting major depressive disorder for different trimesters.


METHODS
One hundred eighty-five pregnant Taiwanese women who completed the EPDS-T and the BDI-II were interviewed by psychiatrists with the structural interview Mini-International Neuropsychiatric Interview (MINI) to establish a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of major depressive disorder. We analyzed and compared the sensitivity, specificity and validity of the EPDS-T and the BDI-II against the MINI diagnosis on the second and third trimesters.


RESULTS
We identified 12/13 as the optimal cutoff of the EPDS-T, at which the sensitivity of the scale was 83% and the specificity was 89%. The optimal cutoff of the BDI-II was 11/12, at which the sensitivity of the scale was 74% and the specificity was 83%. The area under the curve of the receiver operating characteristic analysis was 0.92 for the EPDS-T and 0.84 for the BDI. There exist different optimal cutoff points of the EPDS-T for detecting major depression during different trimesters: 13/14 for the second trimester and 12/13 for the third trimester. No different optimal cutoff point for the BDI-II was found for different trimesters.


CONCLUSIONS
The EPDS-T has satisfactory sensitivity and specificity and better validity than the BDI-II for detecting major depressive disorder during pregnancy in pregnant Taiwanese women. We suggest that more studies with larger sample sizes be performed to confirm if there exist different cutoff points in detecting depression for different trimesters of gestation.
Su
Kuan-Pin
KP
Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan. cobolsu@gmail.com
Chiu
Tsan-Hung
TH
Huang
Chieh-Liang
CL
Ho
Ming
M
Lee
Chieh-Chung
CC
Wu
Po-Lun
PL
Lin
Cher-Yeang
CY
Liau
Chun-Hui
CH
Liao
Chin-Chih
CC
Chiu
Wei-Che
WC
Pariante
Carmine M
CM
D000328:Adult; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D019052:Depression, Postpartum / Q000453:epidemiology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008403:Mass Screening / Q000295:instrumentation / Q000379:methods*; D011247:Pregnancy; D011264:Pregnancy Trimesters / Q000523:psychology*; D011446:Prospective Studies; D011594:Psychometrics; D011795:Surveys and Questionnaires; D013624:Taiwan