title: Accuracy of brief screening tools for identifying postpartum depression among adolescent mothers.
abstract: OBJECTIVE
  To evaluate the accuracy of the Edinburgh Postnatal Depression Scale (EPDS) and 3 subscales for identifying postpartum depression among primiparous adolescent mothers.
  
  
  METHODS
  Mothers enrolled in a randomized controlled trial to prevent postpartum depression completed a psychiatric diagnostic interview and the 10-item EPDS at 6 weeks, 3 months, and 6 months postpartum. Three subscales of the EPDS were assessed as brief screening tools: 3-item anxiety subscale (EPDS-3), 7-item depressive symptoms subscale (EPDS-7), and 2-item subscale (EPDS-2) that resemble the Patient Health Questionnaire-2. Receiver operating characteristic curves and the areas under the curves for each tool were compared to assess accuracy. The sensitivities and specificities of each screening tool were calculated in comparison with diagnostic criteria for a major depressive disorder. Repeated-measures longitudinal analytical techniques were used.
  
  
  RESULTS
  A total of 106 women contributed 289 postpartum visits; 18% of the women met criteria for incident postpartum depression by psychiatric diagnostic interview. When used as continuous measures, the full EPDS, EPDS-7, and EPDS-2 performed equally well (area under the curve >0.9). Optimal cutoff scores for a positive depression screen for the EPDS and EPDS-7 were lower (≥ 9 and ≥ 7, respectively) than currently recommended cutoff scores (≥ 10). At optimal cutoff scores, the EPDS and EPDS-7 both had sensitivities of 90% and specificities of >85%.
  
  
  CONCLUSIONS
  The EPDS, EPDS-7, and EPDS-2 are highly accurate at identifying postpartum depression among adolescent mothers. In primary care pediatric settings, the EPDS and its shorter subscales have potential for use as effective depression screening tools.
authors.affiliation: Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, 101 Dudley St, Providence, RI 02905. mphipps@wihri.org.
authors.forename: Kartik K
authors.initials: KK
authors.lastname: Venkatesh
authors.forename: Caron
authors.initials: C
authors.lastname: Zlotnick
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Triche
authors.forename: Crystal
authors.initials: C
authors.lastname: Ware
authors.forename: Maureen G
authors.initials: MG
authors.lastname: Phipps
mesh_terms: D000293:Adolescent; D019052:Depression, Postpartum / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015233:Models, Statistical; D011581:Psychological Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: postpartum depression; pregnancy; screening; teenage; validity