Using the EPDS to Measure Postpartum Depression Severity

Using the EPDS to Measure Postpartum Depression Severity

 

The Edinburgh Postnatal Depression Scale (EPDS) is the instrument most commonly used to identify depression in postpartum women.  Traditionally, a cut-off score of 13 is used to distinguish depressed from nondepressed women.  Because depression exists along a continuum with regard to severity, this yes-or-no approach to the diagnosis of depression has its limitations.  By labeling women with EPDS scores of less than 13 as “not depressed”, we may be missing women who have high levels of postpartum distress or milder depression, women who may benefit from certain types of interventions, including support groups and counseling.  Furthermore, all women with an EPDS score of 13 or higher are not identical in terms of severity; some women are severely depressed and require urgent or emergent interventions, whereas others have milder forms of depression and may benefit from other, less aggressive types of intervention.

As we continue to move toward universal screening for depression in pregnant and postpartum women, one of our concerns has been how to appropriately manage and refer the women who screen positive for depression. We cannot assume that all women will have identical needs, and we must be able to identify those women in greatest need of services.  A recent research study uses the EPDS to measure the severity of depression in postpartum women.  Although clinically there is consensus that a woman who scores 30 on the EPDS has more symptoms and is “more depressed” than a woman who scores 10, we do not have a good sense of how the EPDS correlates with other instruments typically used to measure the severity of depression.

In this study, a sample of 1516 postpartum women completed the EPDS and the Beck Depression Inventory (BDI). Severity ranges on the EPDS were established by identifying EPDS scores that corresponded to established severity ranges on the BDI.

The following severity ranges were established for the EPDS:

None or minimal depression (0–6),

Mild depression (7–13),

Moderate depression (14–19),

Severe depression (19–30).

It is interesting to note that many women had scores between 7 and 13, what we would label as nondepressed on the EPDS but a score that would be called “mild depression” using more conventional scales of depression severity.

As more health care providers (many of whom are not mental health providers) are employing the EPDS to screen peripartum women in a variety of settings, being able to classify women according to severity of illness is important and will help to make appropriate referrals and treatment decisions. Other studies are needed to determine which interventions are ideally suited for each group.

Ruta Nonacs, MD PhD

Jennifer E. McCabe-Beane , Lisa S. Segre , Yelena Perkhounkova , Scott Stuart , Michael W. O’Hara  The identification of severity ranges for the Edinburgh Postnatal Depression Scale.  Journal of Reproductive and Infant Psychology Feb 2015.

One Comment

  1. Margaret Altemus March 24, 2016 at 7:13 am

    Another point to keep in mind is that there are false positive screens with the EPDS. Studies that use diagnostic interviews to validate the EPDS show a wide range of positive predictive values, but often 40-60% of subjects who score above an optimal cut-off value for combined major and minor depression, or for just major depression, do not meet criteria for those diagnoses.

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