Depression prevalence based on the Edinburgh Postnatal Depression Scale compared to Structured Clinical Interview for DSM DIsorders classification: Systematic review and individual participant data meta-analysis.

OBJECTIVES: Estimates of depression prevalence in pregnancy and postpartum are based on the Edinburgh Postnatal Depression Scale (EPDS) more than on any other method. We aimed to determine if any EPDS cutoff can accurately and consistently estimate depression prevalence in individual studies. METHODS: We analyzed datasets that compared EPDS scores to Structured Clinical Interview for DSM (SCID) major depression status. Random-effects meta-analysis was used to compare prevalence with EPDS cutoffs versus the SCID. RESULTS: Seven thousand three hundred and fifteen participants (1017 SCID major depression) from 29 primary studies were included. For EPDS cutoffs used to estimate prevalence in recent studies (≥9 to ≥14), pooled prevalence estimates ranged from 27.8% (95% CI: 22.0%-34.5%) for EPDS ≥ 9 to 9.0% (95% CI: 6.8%-11.9%) for EPDS ≥ 14; pooled SCID major depression prevalence was 9.0% (95% CI: 6.5%-12.3%). EPDS ≥14 provided pooled prevalence closest to SCID-based prevalence but differed from SCID prevalence in individual studies by a mean absolute difference of 5.1% (95% prediction interval: -13.7%, 12.3%). CONCLUSION: EPDS ≥14 approximated SCID-based prevalence overall, but considerable heterogeneity in individual studies is a barrier to using it for prevalence estimation.

Depressive disorder and thyroid axis functioning during pregnancy.

BACKGROUND: Depression and thyroid dysfunction are prevalent in women, including pregnant women. The aim of this study was to assess the relationship between depression and thyroid function during pregnancy. METHODS: One hundred and ninety-nine pregnant women three times during pregnancy were assessed for depressive disorder and for thyroid stimulating hormone (TSH) and free thyroxine (FT(4)) concentrations. RESULTS: Prevalence of depressive disorder was 6.5% in early pregnancy, 3.0% in middle pregnancy and 3.5% in late pregnancy. There were no women with overt thyroid dysfunction. Subclinical hyperthyroidism was found in 23% of women in early pregnancy, in 5% of women in middle pregnancy and in 6% of women in late of pregnancy. In late pregnancy depressed women compared to non-depressed women had significantly higher FT(4) concentrations and a strong trend towards lower TSH concentrations as well as higher prevalence of subclinical hyperthyroidism. CONCLUSIONS: These findings show an association between thyroid dysfunction and depression in late pregnancy. Because gestational depression might interfere with pregnancy outcome, evaluation of thyroid function during gestation is warranted.

Screening for antenatal depression with the Edinburgh Depression Scale.

This study aimed to evaluate how precise the Edinburgh Depression Scale (EDS) is in screening for major depressive disorder (MDD) during different periods of pregnancy. A random sample of 230 pregnant women was interviewed in the first, second, and third trimesters of pregnancy using the EDS and not-patient version of the Structured Clinical Interview for DSM-III-R (SCID-NP). We evaluated test-retest reliability of the EDS; area under the ROC curve (AUC), sensitivity, specificity, and positive predictive value (PPV) of the EDS against the SCID-NP diagnoses in the first, second, and third trimesters of pregnancy. Test-retest reliability of the EDS was 0.81 (p < 0.001). An optimal cutoff score of the EDS for screening current SCID-NP diagnosis of MDD was 12 and higher in the first trimester of pregnancy (AUC 0.94, sensitivity 92%, specificity 95%, and PPV 52%) and 11 and higher in the second and third trimesters of pregnancy (AUC 0.96 and 0.90, respectively; sensitivity 100% and 88%, respectively; specificity 92% and 92%, respectively; PPV 25% and 29%, respectively). The EPDS is a reliable instrument for repeated evaluations of depressive symptoms during pregnancy. It has a good sensitivity and specificity for detecting antenatal MDD with optimal cutoff of 11/12 or higher.

Validation of the Lithuanian version of the Edinburgh Postnatal Depression Scale.

Depression is prevalent postpartum and is a major health problem. OBJECTIVE. In this study, we aimed to evaluate how precise the Edinburgh Postnatal Depression Scale (EPDS) is in screening for depressive disorders postpartum. MATERIALS AND METHODS. A random sample of 94 women was interviewed two weeks postpartum using the Composite International Diagnostics Interview Short-Form (CIDI-SF). In addition, they filled in the EPDS. We evaluated (a) internal consistency of the EPDS by the means of Cronbach's alpha coefficient; (b) area under the ROC curve, sensitivity, specificity of the EPDS against the CIDI-SF diagnoses of depressive disorders. RESULTS. The internal consistency of the EPDS was 0.83. The optimal cutoff score of the EPDS for screening CIDI-SF diagnoses of depressive disorders was found to be 7 and more with an area under the ROC curve of 0.83, sensitivity of 92%, and specificity of 73%. CONCLUSIONS. The EPDS has a good reliability as a screening instrument, and a cutoff score of 7 and more has to be used in screening for postpartum depressive disorders.

Psychosocial risk factors for depression during pregnancy.

OBJECTIVE: To assess the prevalence of antenatal depressive disorder in different trimesters and to evaluate the relation of psychosocial risk factors to antenatal depressive disorder. DESIGN: Cohort follow-up. SETTING: University Hospital, Kaunas, Lithuania. SAMPLE: Two hundred and thirty pregnant women consecutively admitted. METHODS: At 12-16 weeks, 22-26 weeks, and 32-36 weeks of pregnancy, participants were screened for depression using the World Health Organization's Composite International Diagnostic Interview Short Form (CIDI-SF). Women who gave at least one positive answer to the CIDI-SF depression-screening question were evaluated for depressive disorder using the non-patient version of the Structured Clinical Interview for DSM-III-R (SCID-NP). Psychosocial stressors and two Big Five Personality dimensions, neuroticism and extraversion, were also evaluated. MAIN OUTCOME MEASURES: Prevalence of depressive disorder. RESULTS: The prevalence of the antenatal depressive disorder at 12-16 weeks' gestation was 6.1%, at 22-26 weeks 3.5%, and at 32-36 weeks 4.4%. In the first trimester, a greater prevalence of current depressive disorder was independently associated with unplanned and unwanted pregnancy, high neuroticism, low education, and a previous history of depression; in the second trimester with unplanned and unwanted pregnancy and high neuroticism; in the third trimester with unplanned and unwanted pregnancy, high neuroticism, and the occurrence of psychosocial stressors during the last year. CONCLUSIONS: The highest prevalence of depressive disorders was found in the first trimester, the lowest in mid-pregnancy. Several determinants (unwanted and unplanned pregnancy, high neuroticism) were independent predictors of antenatal depressive disorders throughout whole pregnancy, while other determinants (low education, previous history of depression, the occurrence of psychosocial stressors at the end of pregnancy) were trimester specific.