title: Drawing the line in the Edinburgh Postnatal Depression Scale (EPDS): a vital decision.
abstract: BACKGROUND
  The Edinburgh Postnatal Depression Scale (EPDS) is widely used in early child health care. This study examined the appropriateness of the recommended EPDS cut-off score 11/12.
  
  
  METHODS
  Two main analyses were performed: 1. Associations between EPDS scores and maternal health behaviour, stress, life events, perceived mother-child interaction quality and child behaviour. 2. Screening parameters of the EPDS, i.e., sensitivity, specificity and positive predictive value. EPDS scores were available for 438 mothers and maternal questionnaires for 361 mothers.
  
  
  RESULTS
  Already in the EPDS score intervals 6-8 and 9-11, there were notable adversities, according to maternal questionnaires, in stress, perceived quality of mother-child interaction, perceived child difficultness and child problem behaviours. Using maternal questionnaire reports about sadness/distress postpartum as standard, the recommended EPDS cut-off score 11/12 resulted in a very low sensitivity (24%). The cutoff score 6/7 yielded a sensitivity of 61%, a specificity of 82% and a positive predictive value of 61%.
  
  
  CONCLUSIONS
  In terms of both clinical relevance and screening qualities, an EPDS cut-off score lower than 11/12 seems recommendable.
authors: Department of Women's and Children's Health, Section for Paediatrics, Uppsala University, Children's Hospital, Uppsala, Sweden. dagmar.lagerberg@kbh.uu.se
authors: Dagmar
authors: D
authors: Lagerberg
authors: Margaretha
authors: M
authors: Magnusson
authors: Claes
authors: C
authors: Sundelin
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002675:Child, Preschool; D019052:Depression, Postpartum / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D008403:Mass Screening / Q000379:methods; D009034:Mother-Child Relations; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012680:Sensitivity and Specificity