Lee D T, Yip A S, Chiu H F, Chung T K
Department of Psychiatry, Chinese University of Hong Kong, Shatin.
Psychosom Med. 2000 Mar-Apr;62(2):258-63. doi: 10.1097/00006842-200003000-00018.
Postnatal depression affects 10% to 15% of women after childbirth. Self-report rating instruments, such as the Edinburgh Postnatal Depression Scale (EPDS), have been developed and administered to postpartum women to facilitate early detection. Most postnatal depression screening scales, however, focus solely on depressive symptomatology. We hypothesized that applying two complementary rating scales of symptoms and functioning as a double test would significantly enhance the positive predictive value of screening.
A prospective cohort study was conducted at the postnatal clinic of a university teaching hospital. One hundred forty-five Chinese women completed the EPDS and 12-item General Health Questionnaire (GHQ) 6 weeks after delivery. They were then interviewed by a psychiatrist, who used the Structured Clinical Interview for third revised edition of the Diagnostic and Statistical Manual of Mental Disorders, nonpatient version (SCID-NP), to validate the diagnoses.
The positive predictive value of the EPDS and GHQ, when administered independently, was 44% and 52%, respectively, at their respective optimal cutoff scores. When the EPDS-GHQ double test was administered, the positive predictive value was significantly increased to 78%.
Simultaneous administration of the EPDS and GHQ can substantially improve identification of women with postnatal depression. This can potentially reduce unnecessary referrals to general practitioners and psychiatrists and may enhance the overall cost-effectiveness of population-wide screening.
产后抑郁症影响着10%至15%的产后女性。诸如爱丁堡产后抑郁量表（EPDS）等自我报告评定工具已被开发出来并应用于产后女性，以促进早期发现。然而，大多数产后抑郁筛查量表仅关注抑郁症状。我们假设应用症状和功能的两种互补评定量表进行双重检测会显著提高筛查的阳性预测值。
在一家大学教学医院的产后诊所进行了一项前瞻性队列研究。145名中国女性在分娩6周后完成了爱丁堡产后抑郁量表（EPDS）和12项一般健康问卷（GHQ）。然后由一名精神科医生对她们进行访谈，该医生使用《精神疾病诊断与统计手册》第三版修订本非患者版的结构化临床访谈（SCID-NP）来验证诊断。
在各自的最佳临界值时，单独使用爱丁堡产后抑郁量表（EPDS）和一般健康问卷（GHQ）的阳性预测值分别为44%和52%。当进行爱丁堡产后抑郁量表-一般健康问卷双重检测时，阳性预测值显著提高到78%。
同时使用爱丁堡产后抑郁量表（EPDS）和一般健康问卷（GHQ）可以显著改善产后抑郁症女性的识别。这可能会减少不必要的转介给全科医生和精神科医生的情况，并可能提高全人群筛查的总体成本效益。
