Errors in scoring the Edinburgh Postnatal Depression scale.

This study examined the errors made by clinicians when scoring the Edinburgh Postnatal Depression Scale (EPDS). This measure has items with reverse scoring that may increase the likelihood of errors being made. Four hundred ninety-six EPDS forms from client files in four clinical services were examined for item scoring errors and addition errors. Clinicians (N = 22) from the four services were also surveyed as to what rate of errors they expected the study would find and what rate would be unacceptable. Errors of either type were present in between 13.4 and 28.9% of forms across the four sites. These error rates were greater than most of the surveyed clinicians expected and were at a level that was considered by most to be problematic. However, the error rates did not have a meaningful impact on the rates of women scoring above various cutoff scores often used with the EPDS. The EPDS is often incorrectly scored by practitioners at a level that is of concern to clinicians of these services. Clinical teams should adopt the use of scoring templates and a double adding-up procedure when using measures such as the EPDS as a way that may reduce such scoring errors.

Maternal state of mind regarding attachment predicts persistence of postnatal depression in the preschool years.

BACKGROUND: This prospective study aimed to determine predictors of persistent postnatal depression between child age one and four years, in a sample of mothers already identified as having a high incidence of postnatal depression at four months after birth and a relatively high prevalence of symptoms of depression at child age one year. METHODS: Data (self-report questionnaires and interview) were initially collected from 127 mothers of first-born infants recruited from a parent-craft hospital at four months postpartum. Women again completed questionnaires and interviews one year after the birth. Persistence of depression between one and four years was assessed by symptom checklists and diagnostic interview. RESULTS: Ninety-two mothers (72%) of the original sample participated at four years. Eleven women who had first onset of depression after one year were excluded from analyses. Thirty-eight percent of the remaining sample (56% of those diagnosed with depression at 4 months) reported ongoing depression between one and four years. Severity of depressive symptoms at four months and maternal state of mind regarding attachment (assessed at 1 year) were significant predictors of persistent depression. Women with an insecure state of mind regarding attachment at one year were seven times more likely to report ongoing depression. CONCLUSIONS: Findings confirm that postnatal depression is ongoing for many women and that vulnerability to persistent depression needs to be viewed in the context of inter-generational family problems. Severity of symptoms at four months postpartum can be used to identify those mothers most at risk of persistent depression.

Maternal depression: relations with maternal caregiving representations and emotional availability during the preschool years.

This longitudinal study aimed to determine whether maternal depression was related to caregiving behavior and further whether this relationship was mediated and/or moderated by maternal caregiving representations. Ninety-two mothers were assessed for symptoms of depression when their children were 4, 12, and 15 months, and later at 4 years of age. At 4 years of age, mothers' caregiving representations of their child and their relationship were examined using the Parent Development Interview (PDI), and aspects of maternal behaviors were rated during mother-child play interactions using the Emotional Availability Scales (EA). The experience of chronic maternal depression was related to lower levels of maternal sensitivity, and this association was mediated by mothers' impaired capacity to take their child's perspective. The link between depression and lower maternal sensitivity was also moderated by perspective taking, indicating that poor perspective taking had a negative impact on sensitivity only for chronically depressed mothers. In conclusion, the current study demonstrated that mothers' representational models are affected by cognitive distortions associated with depression, and these distortions interfere with a mother's capacity to interact sensitively with her child.