The Edinburgh Postnatal Depression Scale (EPDS) is the screening instrument most commonly used to identify women with postpartum mood disorders. This is a 10-item questionnaire which has been validated in many different populations and is available in almost every language. On this scale, a score of 10 or greater or an affirmative answer on question 10 (presence of suicidal thoughts) is suggestive of postpartum depression. (Setting the cut-off score of 12 improves the specificity of the EPDS for identifying major depression; however, the sensitivity falls off significantly, making it less useful for the purposes of screening.) Most importantly it should be emphasized that an elevated score on the EPDS does not necessarily confirm the diagnosis of postpartum depression; this requires a more thorough diagnostic evaluation.
A recent study indicated that the EPDS may be further abbreviated to a three question version which can be used to screen for postpartum depression. Given the prevalence of anxiety symptoms among women with postpartum depression, the authors honed done the EPDS, creating a screening tool comprised of the 3 items which comprise the anxiety subscale of the EPDS:
- I have blamed myself unnecessarily when things went wrong
- I have been anxious or worried for no good reason
- I have felt scared or panicky for no very good reason
The 3-item EPDS was compared to the 10-item version in a cohort of 199 14- to 26-year-old new mothers at well-child visits during the first 6 postpartum months. A total of 41 mothers (20.6%) met criteria for depression (EPDS-10 score > 10). The EPDS-3 exhibited better screening performance characteristics, with a sensitivity of 95% and a negative predictive value of 98%. (The negative predictive value is the probability that subjects with a negative screening test truly don’t have the illness.) Interestingly, the EPDS-3 identified 16% more mothers as depressed than the EPDS-10.
Another study (presented at the American College of Obstetricians and Gynecologists’ 2016 Annual Clinical and Scientific Meeting held in May 2016 in Washington, DC) tested the EPDS-3 in a larger population of women. Study subjects (n=914) were evaluated with the EPDS-10 as part of the screening process for perinatal depression. A score for the EPDS-3 was calculated for each subject and adjusted in order to use the same numerical cut-off as is used for the EPDS-10.
When the EPDS-3 was used for screening, the number of women with probable depression increased by 40.1%. Furthermore, when the researchers looked at the subjects who were identified with probable depression using the EPDS-10, all were identified using the EPDS-3 score.
So when it comes to the EPDS for screening, it looks as if less is more.
Ruta Nonacs, MD PhD
Kabir K, Sheeder J, Kelly LS. Identifying postpartum depression: are 3 questions as good as 10? Pediatrics 2008; Sep;122(3): e696-702.
Bodenlos KL, Maranda L, Deligiannidis KM. Comparison of the Use of the EPDS-3 vs. EPDS-10 to Identify Women at Risk for Peripartum Depression. Obstetrics & Gynecology 2016; May 127: 89S-90S.