title: Concordance of Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) to assess increased risk of depression among postpartum women.
abstract: OBJECTIVE
  To compare the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) as screening tools for postpartum depression.
  
  
  METHODS
  This study population included the first 500 women to enroll and return their packets during an ongoing study of postpartum depression.
  
  
  RESULTS
  The primary outcome of this study was to find rates of concordance and discordance in the EPDS and PHQ-9 categories of "normal" and "increased risk for major depressive disorder." Overall, 97% of eligible women enrolled and 70% returned the packets that included the EPDS and PHQ-9. Four hundred eighty-one of the first 500 packets had complete data, with elevated EPDS or PHQ-9 scores in 138 and 132 women, respectively. Concordance of the EPDS and PHQ-9 were present in 399 women (83%): 326 (67.8%) had "normal" score on both, and 73 (15.2%) had elevated scores for both. Discordant scores in 82 women included 17 with elevated PHQ-9 scores but normal EPDS scores and 65 with elevated EPDS scores and PHQ-9 scores <10. In multivariate logistic regression modeling, only age >30 and low education level were predictive of discordant scores, using EPDS and PHQ-9 scores of > or =10 as elevated (odds ratio, 1.9 and P = .02; and odds ratio, 2.3 and P = .01, respectively). PHQ-9 scores of 5 to 9 have been referred to as consistent with "mild depressive symptoms" and appropriate for "watchful waiting" and repeat PHQ-9 at follow-up. Using this follow-up approach would require re-evaluation of 120 (25%) of the women screened.
  
  
  CONCLUSIONS
  Postpartum depression screening is feasible in primary care practices, and for most women the EPDS and PHQ-9 scores were concordant. Further work is required to identify reasons for the 17% discordant scores as well as to provide definitive recommendations for PHQ-9 scores of 5 to 9.
authors.affiliation: Department of Research, Olmsted Medical Center, Rochester, MN 55904, USA. yawnx002@umn.edu
authors.forename: Barbara P
authors.initials: BP
authors.lastname: Yawn
authors.forename: Wilson
authors.initials: W
authors.lastname: Pace
authors.forename: Peter C
authors.initials: PC
authors.lastname: Wollan
authors.forename: Susan
authors.initials: S
authors.lastname: Bertram
authors.forename: Margary
authors.initials: M
authors.lastname: Kurland
authors.forename: Deborah
authors.initials: D
authors.lastname: Graham
authors.forename: Allen
authors.initials: A
authors.lastname: Dietrich
mesh_terms: D000293:Adolescent; D000328:Adult; D019052:Depression, Postpartum / Q000175:diagnosis / Q000209:etiology*; D005194:Family Practice; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000295:instrumentation*; D018570:Risk Assessment / Q000379:methods; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult