Validation of the Edinburgh Postnatal Depression Scale (EPDS) in Spanish mothers.

BACKGROUND: The EPDS is a 10-items self-report scale designed as a specific instrument to detect postnatal depression. It was validated in the UK and in other countries, but not in Spain. METHOD: We report data from all women (n=1201) attending in a routine postnatal check-up at 6 weeks postpartum during 1 year. A two-stage method was used: for the first stage, all individuals selected completed the EPDS; in the second one, 'probable cases' (n=261) with EPDS score >/=9, and a randomised sample of 10% with EPDS score less than 9 (n=126) were interviewed by a psychiatrist using the Structured Clinical Interview for DSM-IV, non-patient (SCID-NP), to establish psychiatric diagnosis of major and minor depression. RESULTS: The best cut-off of the Spanish validation of the EPDS was 10/11 for combined major and minor depression, the sensitivity was 79%, and specificity was 95.5%, with a positive predictive value of 63.2% and a negative predictive value of 97.7%. At this cut-off all cases of major depression were detected. The area under the ROC curve was 0.976 (P<0.0001) with an asymptotic interval of confidence of 95% between 0.968 and 0.984. CONCLUSIONS: Our data confirm the validity of the EPDS to identify postnatal depression in its Spanish version. The cut-off 10/11 for major and minor combined depression is useful to screen for a posterior psychiatric evaluation in Spanish sample.

[Prevalence of postpartum depression in Spanish mothers: comparison of estimation by mean of the structured clinical interview for DSM-IV with the Edinburgh Postnatal Depression Scale]. / Prevalencia de la depresión posparto en las madres españolas: comparación de la estimación mediante la entrevista clínica estructurada y la escala de depresión posparto de Edimburgo.

BACKGROUND AND OBJECTIVE: Our objectives were: To estimate the prevalence of postpartum depression (PD) by two evaluation methods: Structured Clinical Interview for DSM-IV (SCID), and self-report Edinburgh Postnatal Depression Scale (EPDS), and to identify the EPDS cut-off to provide an unbiased estimation of PD prevalence. PATIENTS AND METHOD: We report data from all women (n = 1191) attending to postnatal routine checking visits at six weeks postpartum during one year in the Gynaecology and Obstetrics Department of the Hospital Clínic of Barcelona (Spain). A two-stage method was used. In the first stage, all women selected completed the EPDS. In the second stage, all women with an EPDS score >= 9 (probable PD cases) and a randomized sample of 16% with a score < 9 were evaluated by a psychiatrist using the SCID interview to establish a psychiatric diagnosis of major and minor depression. 402 postpartum women were offered the SCID interview; 68 of them refused to participate. RESULTS: The prevalence of depression according to the SCID interview was 10.15% (CI 95%, 8.43-11.87). The prevalence of major depression was 3.6% (CI 95%, 2.55-4.67) and it was 6.5% (CI 95%, 5.14-7.95) for minor depression. An EPDS cut-off of 11/12 provided an unbiased estimation of the postpartum depression prevalence rate. CONCLUSIONS: Our results justify the need to use different EPDS cut-offs. A cut-off of 10/11 is effective for identifying the population at risk and a cut-off of 11/12 is useful to estimate the prevalence in epidemiological studies.

Prevalencia de la depresión posparto en las madres españolas: comparación de la estimación mediante la entrevista clínica estructurada y la escala de depresión posparto de Edimburgo / Prevalence of postpartum depression in Spanish mothers: comparison of estimation by mean of the structured clinical interview for DSM-IV with the Edinburgh Postnatal Depression Scale

FUNDAMENTO Y OBJETIVO: Estimar la prevalencia de la depresión posparto (DPP) en una muestra poblacional mediante dos métodos de evaluación: la entrevista clínica estructurada para el DSM-IV (SCID) y la medida de autoinforme de la Edinburgh Postnatal Depressión Scale (EPDS), así como identificar el punto de corte del EPDS que proporcione una estimación sin sesgo de la prevalencia de DPP. PACIENTES Y MÉTODO: Se incluyó en el estudio a todas las madres (n = 1.191) que, durante el período de un año, acudieron al Servicio de Obstetricia y Ginecología del Hospital Clínic de Barcelona para realizar la visita de control del puerperio (6 semanas posparto). Se utilizó un método en dos fases. En la primera etapa, todas las madres incluidas completaron el EPDS. En la segunda, todas aquellas con una puntuación en la EPDS de 9 o superior (casos probables de DPP), y una muestra aleatoria del 16 por ciento de madres con puntuaciones de la EPDS inferior a 9 fueron evaluadas por una psiquiatra utilizando la entrevista SCID, para establecer el diagnóstico de depresión mayor y menor. Se invitó a realizar la entrevista SCID a un total de 402 mujeres, de las cuales 68 no quisieron participar. RESULTADOS: La prevalencia de depresión según la entrevista SCID fue del 10,15 por ciento (intervalo de confianza [IC] del 95 por ciento, 8,43-11,87). La prevalencia de depresión mayor fue del 3,6 por ciento (IC del 95 por ciento, 2,55-4,67) y la de depresión menor del 6,5 por ciento (IC del 95 por ciento, 5,14-7,95). El punto de corte 11/12 de la EPDS permite realizar una estimación sin sesgo de la tasa de prevalencia de DPP. CONCLUSIONES: El presente estudio justifica la necesidad de utilizar diferentes puntos de corte de la EPDS: el punto de corte 10/11 para identificar la población de riesgo y el 11/12 para estimar la prevalencia en estudios epidemiológicos (AU)