Detection and diagnosis

• The Edinburgh Postnatal Depression Scale (EPDS) is a screening instrument used in the identification of women with postnatal depression. (1,2) Sensitivity results range from 34% to 100% and specificity from 44% to 100%. (3) The cut-off score of >12 has an overall positive predictive value of 57% and negative predictive value of 99%. Lower cut-off values (e.g., 10 or 11) may be used if the intention is to avoid false negatives. (4)
• ​In one large meta-analysis of studies comparing the PHQ-9 and EPDS, operating characteristics were nearly identical. (5)
  
• The diagnosis of postnatal depression requires assessment of the mother's mood (to elucidate features such as depressive symptoms and suicidal ideation); also there must be assessment of the mother's feelings for and attachment to the baby (6)

Primary care practices screening adults should have systems in place that ensure positive screening results are followed by accurate diagnosis, effective treatment, and careful follow-up. (7)

Reference:

1. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987 Jun;150:782-6.
2. Murray L, Carothers AD (1990). The validation of the Edinburgh Postnatal Depression Scale on a community sample. Br J Psychiatry, 157, 288-90.
3. Gibson J, McKenzie-McHarg K, Shakespeare J, et al. A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand. 2009 May;119(5):350-64.
4. American College of Obstetricians and Gynecologists. ACOG clinical practice guideline no. 4: screening and diagnosis of mental health conditions during pregnancy and postpartum. Jun 2023 [internet publication].
5. Wang L, Kroenke K, Stump TE, et al. Screening for perinatal depression with the Patient Health Questionnaire depression scale (PHQ-9): a systematic review and meta-analysis. Gen Hosp Psychiatry. 2021 Jan-Feb;68:74-82.
6. Antenatal and postnatal mental health: clinical management and service guidance. NICE Clinical Guideline (December 2014 - last updated February 2020)
7. Thombs BD, Arthurs E, Coronado-Montoya S, et al. Depression screening and patient outcomes in pregnancy or postpartum: a systematic review. J Psychosom Res. 2014 Jun;76(6):433-46.