About 10% to 15% of women experience clinically significant depressive symptoms during pregnancy. Furthermore, women with a history of major depression appear to be at high risk for recurrent illness during pregnancy particularly in the setting of antidepressant discontinuation. We have long argued that it is important to identify and to offer treatment to women who suffer from depression during pregnancy, but we have yet to agree on what is the best instrument for this purpose.
Using the EPDS to Identify Depression During Pregnancy?
The Edinburgh Postnatal Depression Scale (EPDS), although initially engineered to detect postpartum depression, has been used in pregnant populations; however, there has been considerable variability in the estimates of the sensitivity and specificity of the EPDS in this setting.
Can Traditional Screening Tools Be Used in Pregnant Women?
Researchers have long been concerned that the tools commonly used to identify and measure depressive symptoms in the general population, such as the Hamilton Rating Scale for Depression (HAM-D) and the Beck Depression Inventory (BDI), include multiple questions about physical symptoms, such as changes in appetite and sleep disturbance. While these symptoms are typical depressive symptoms, they are also symptoms of a normal pregnancy.
A study carried out in Brazil women indicates that these screening tools work just as well as the more commonly used Edinburgh Postnatal Depression Scale (EPDS). The researchers concluded that the scales examined can be considered as valid screening tools for antenatal depression. All three screening tools had narrow confidence intervals and yielded positive predictive values greater than 0.75. Moreover, all scales had good internal consistency. In fact, the BDI has better psychometric properties (with the highest AUC value of 0.90) than the more widely used EPDS.
Ruta Nonacs, MD PhD
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