Mass General Hospital

Harvard Medical School

Using the EPDS to Screen for Anxiety disorders: Conceptual and Methodological Considerations

The Edinburgh Postnatal Depression Scale (EPDS) was designed to screen women for postnatal depression.  Cox and Holden (2003) state that the EPDS was not designed to measure anxiety.  However, recent emphasis on the importance of recognizing symptoms of perinatal anxiety disorders, coupled with findings in research, have led to the suggestion that the EPDS may be used as a multidimensional tool to screen for anxiety disorders in addition to depression during the perinatal period (Matthey et al, 2012).

Tuohy and McVey (2008) concluded that the EPDS encompasses three sub-categories: depression, anhedonia, and anxiety.

The three questions comprising this EPDS anxiety subscale are:

 1.      I have blamed myself unnecessarily when things went wrong

 2.      I have been anxious or worried for no good reason

 3.      I have felt scared or panicky for no very good reason

Matthey and colleagues (2012) analyzed a total of six studies which used the anxiety subscale of the EPDS (EPDS-3A) among perinatal women with different diagnoses.  The investigators discovered a consistent pattern where the total EPDS scores correlated with disorder type.  Women with no disorder scored the lowest, followed by women with anxiety only, then by women with depression only.  Finally, women with a combination of depression and anxiety scored the highest of the four. 

Four of the six studies interpreted these results as supporting the use of the total EPDS score to differentiate between women with depression versus women with anxiety.  Although the remaining two studies (Muzik et al, 2000 and Rowe et al, 2008) yielded similar results, they concluded that the EPDS may not reliably distinguish between depression and anxiety.

Two of the six studies identified a cut-off score for the EPDS-3A which could be used to identify women with different anxiety disorders.  Although the cut-off scores differed between the two studies, both came to the conclusion that the EPDS-3A succeeded in identifying about two-thirds of the women with identified anxiety disorders.  It is important to note that women scoring high on the EPDS-3A may not score high on the overall EPDS score and consequently may not be flagged if only the total EPDS score is used. This underscores the potential of using the EPDS as a multidimensional screening tool to better detect the needs of women with different disorders. 

Although the usefulness of the EPDS-3A in detecting anxiety disorders has been empirically shown, Matthey and colleagues (2012) warned that this method of screening tends to produce high rates of false positives.  Women with depression have elevated scores on the EPDS-3A as well, underscoring the importance of carefully interpreting and following up with results on the EPDS and the EPDS-3A.They also mention a study by Rowe and colleagues (2008) which did not find sufficient empirical evidence that the EPDS-3A distinguishes women with anxiety from women with depression.  Matthey and colleagues (2012) attributes this finding to a lack of statistical power despite large effect sizes. 

Matthey and colleagues (2012) concluded by stating that women with anxiety disorders have been found to score significantly higher on the EPDS than women with no disorder and lower than women with depression.  The investigators state that future research is required to pinpoint a specific EPDS-3A cutoff score for anxiety disorders and to determine whether using other anxiety measures may be more useful for the purposes of screening.

 Allison Marshall

References

Cox J, Holden J, 2003. Perinatal Mental Health: A guide to the Edinburgh Postnatal Depression Scale (EPDS),UK.  The RoyalCollegeofPsychiatrists, Gaskell. 

Matthey S, Ross-Hamid C. Repeat testing on the Edinburgh Depression Scale and the HADS-A in pregnancy: differentiating between transient and enduring distress.  J Affect Disord. 2012;141:213-21.

Matthey S, Valenti B, Souter K, Ross-Hamid C.  Comparison of four self-report measures and a generic mood question to screen for anxiety during pregnancy in English-speaking women.   J Affect Disord. 2013 Feb 2.

Muzik M, Klier CM, Rosenblum KL, et al, 2000.  Are commonly used self-report inventories suitable for screening postpartum depression and anxiety disorders.  Acta Psychiatrica Scandinavica 102, 71-73. 

Rowe HJ, Fisher J, Loh W, 2008.  The Edinburgh Postnatal Depression Scale detects but does not distinguish anxiety disorders from depression in mothers of infants.  Archives of Women’s Mental Health 11, 103-108. 

Tuohy A, McVey C, 2008.  Subscales measuring symptoms of non-specific depression, anhedonia, and anxiety in the Edinburgh Postnatal Depression Scale.  British Journal of Clinical Psychology 47, 153-169. 

, , , , , , , , , ,

No comments yet.

Leave a Reply