title: Improving discrimination in antepartum depression screening using the Edinburgh Postnatal Depression Scale.
abstract: Universal screening of pregnant women for postpartum depression has recently been recommended; however, optimal application of depression screening tools in stratifying risk has not been defined. The current study examines new approaches to improve the ability of the Edinburgh Postnatal Depression Scale (EPDS) to stratify risk for postpartum depression, including alternate cut points, use of a continuous measure, and incorporation of other putative risk factors.
  
  
  
  An observational cohort study of 4939 women screened both antepartum and postpartum with a negative EPDS screen antepartum(i.e. EPDS<10). The primary outcome was a probable postpartum major depressive episode(EPDS cut-off ≥10). Area under the receiver operating characteristics curve(AUC), sensitivity, specificity, and predictive values were calculated.
  
  
  
  287 women(5.8%) screened positive for postpartum depression. An antepartum EPDS cut-off<5 optimally identified women with a low risk of postpartum depression with a negative predictive value of 97.6%; however, overall discrimination was modest(AUC 0.66, 95%CI: 0.64-0.69); sensitivity was 78.7%, and specificity was 53.8%, and the positive predictive value was low at 9.5%. The negative predictive values were similar(>95%) at all antepartum EPDS cut-off values from 4 to 8. Discrimination was improved(AUC ranging from 0.70 to 0.73) when the antepartum EPDS was combined with a prior history of major depressive disorder before pregnancy.
  
  
  
  An inability to assess EPDS subscales and a relatively low prevalence of depression in this cohort.
  
  
  
  Though an antepartum EPDS cut-off score <5 yielded the greatest discrimination identifying women at low risk for postpartum depression, the negative predictive value was insufficient to substitute for postpartum screening.
authors.affiliation: Dept. of Obstetrics and Gynecology, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA, United States. Electronic address: kvenkatesh@partners.org.
authors.forename: Kartik K
authors.initials: KK
authors.lastname: Venkatesh
authors.affiliation: Division of Maternal Fetal Medicine, Dept. of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States.
authors.forename: Anjali J
authors.initials: AJ
authors.lastname: Kaimal
authors.affiliation: Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Castro
authors.affiliation: Center for Experimental Drugs and Diagnostics, Dept. of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Roy H
authors.initials: RH
authors.lastname: Perlis
mesh_terms: D000328:Adult; D015331:Cohort Studies; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008403:Mass Screening; D008404:Massachusetts / Q000453:epidemiology; D049590:Postpartum Period; D011247:Pregnancy; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D012680:Sensitivity and Specificity
keywords: Depression; EPDS; Postpartum; Prediction; Pregnancy; Screening