Beck C T, Gable R K
School of Nursing, University of Connecticut, Storrs 06269-2026, USA.
Nurs Res. 2001 Jul-Aug;50(4):242-50. doi: 10.1097/00006199-200107000-00008.
Postpartum depression affects approximately 13% of mothers but up to 50% of all cases of this tragic illness can go undetected.
The purpose of this study was to compare the performance of a newly created instrument, the Postpartum Depression Screening Scale (PDSS), with the Edinburgh Postnatal Depression Scale (EPDS) and a general depression scale, the Beck Depression Inventory-II (BDI-II).
In this methodological design a total of 150 new mothers completed these three instruments in random order, followed immediately by a DSM-IV diagnostic interview. Using the LABROC I program, the areas under each of the instrument's Receiver Operator Characteristic (ROC) curves were compared to determine if they were significantly different.
Eighteen (12%) of the women were diagnosed with major postpartum depression, 28 women (19%) with minor postpartum depression, and 104 women (69%) with no depression. Compared to the EPDS, the PDSS had a significantly larger area under the ROC curve when screening for major or minor postpartum depression. When using the published recommended cut-off scores for major depression for the three instruments, the PDSS achieved the highest combination of sensitivity, 94%, and specificity, 98%. When detecting women with major or minor postpartum depression, the PDSS again yielded the highest combination of sensitivity (91%) and specificity (72%) of the three instruments. The PDSS identified 17 (94%) of the women diagnosed with major postpartum depression, the EPDS identified 14 of these women (78%), and the BDI-II identified 10 of the 18 women (56%).
If mothers identified as "most depressed" are substantially determined by the instrument used, the implications for both research and clinical practice are significant. Researchers and clinicians need to be aware of the differential sensitivity of depression instruments which, while supposedly measuring the same construct, are focused on different components of this mood disorder.
产后抑郁症影响着约13%的母亲，但这种悲剧性疾病高达50%的病例可能未被发现。
本研究旨在比较新创建的产后抑郁筛查量表（PDSS）与爱丁堡产后抑郁量表（EPDS）以及一般抑郁量表贝克抑郁量表第二版（BDI-II）的性能。
在本方法学设计中，共有150名新妈妈按随机顺序完成这三种量表，随后立即进行《精神疾病诊断与统计手册》第四版（DSM-IV）诊断访谈。使用LABROC I程序，比较各量表的受试者工作特征（ROC）曲线下面积，以确定它们是否存在显著差异。
18名（12%）女性被诊断为重度产后抑郁症，28名女性（19%）为轻度产后抑郁症，104名女性（69%）无抑郁症。与EPDS相比，在筛查重度或轻度产后抑郁症时，PDSS的ROC曲线下面积显著更大。当使用三种量表已公布的重度抑郁症推荐临界值时，PDSS的敏感性（94%）和特异性（98%）组合最高。在检测重度或轻度产后抑郁症女性时，PDSS的敏感性（91%）和特异性（72%）组合再次在三种量表中最高。PDSS识别出17名（94%）被诊断为重度产后抑郁症的女性，EPDS识别出其中14名女性（78%），BDI-II识别出18名女性中的10名（56%）。
如果被认定为“最抑郁”的母亲很大程度上由所使用的量表决定，那么对研究和临床实践都具有重大意义。研究人员和临床医生需要意识到抑郁量表的不同敏感性，这些量表虽然本应测量相同的结构，但关注的是这种情绪障碍的不同组成部分。
