Hanusa Barbara H, Scholle Sarah Hudson, Haskett Roger F, Spadaro Kathleen, Wisner Katherine L
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
J Womens Health (Larchmt). 2008 May;17(4):585-96. doi: 10.1089/jwh.2006.0248.
Postpartum depression, the most prevalent complication of childbirth, is often unrecognized. Our objective was to compare the effectiveness of three screening instruments--Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ-9), and the 7-item screen of the Postpartum Depression Screening Scale (PDSS)--for identifying women with postpartum depression in the first 6 months after delivery.
We administered the three instruments via telephone to women who were > or =18 years and had delivered infants 6-8 weeks earlier. We arranged home interviews to confirm DSM-IV criteria current major depressive disorder (MDD) in women who had an above-threshold score on any of the instruments. For women who screened negative on the 6-8 week call, we repeated the screening at 3 months and 6 months to identify emergent symptoms. The primary outcome measures were the screening scores and DSM-IV diagnoses.
Of 135 women reached, 123 (91%) were screened, 29 (24%) had home visits, and 13 (11%) had an MDD within 6 months of delivery. Analyses of the scores at 6-8 weeks postpartum and the DSM-IV diagnoses indicated the EPDS at a cutoff point of > or =10 identified 8 (62%) of cases, the PHQ-9 at a cutoff point of > or =10 identified 4 (31%), and the PDSS 7-item Short Form (PDSS_SF) at a cutoff point of > or =14 identified 12 (92%). However, 15 of 16 (94%) women without current MDD screened positive on the PDSS_SF. The EPDS was significantly more accurate (p = 0.01) than the PDSS_SF and PHQ-9 with the cutoff points used. After correcting for verification bias, we found the EPDS and the PDSS_SF were significantly more accurate than the PHQ-9 (p < 0.03).
Administering the EPDS by phone at 6-8 weeks postpartum is an efficient and accurate way to identify women at high risk for postpartum depression within the first 6 months after delivery.
产后抑郁是分娩最常见的并发症，常未被识别。我们的目的是比较三种筛查工具——爱丁堡产后抑郁量表（EPDS）、患者健康问卷（PHQ - 9）以及产后抑郁筛查量表（PDSS）的7项筛查表——在分娩后前6个月识别产后抑郁女性的有效性。
我们通过电话向年龄大于或等于18岁且在6 - 8周前分娩婴儿的女性发放这三种工具。对于在任何一种工具上得分高于临界值的女性，我们安排家访以确认其符合《精神疾病诊断与统计手册》第四版（DSM - IV）标准的当前重度抑郁症（MDD）。对于在6 - 8周电话筛查中呈阴性的女性，我们在3个月和6个月时重复筛查以识别新发症状。主要结局指标为筛查分数和DSM - IV诊断。
在联系到的135名女性中，123名（91%）接受了筛查，29名（24%）接受了家访，13名（11%）在分娩后6个月内患有MDD。对产后6 - 8周时的分数及DSM - IV诊断进行分析表明，EPDS在临界值大于或等于10时识别出8例（62%）病例，PHQ - 9在临界值大于或等于10时识别出4例（31%），PDSS的7项简表（PDSS_SF）在临界值大于或等于14时识别出12例（92%）。然而，16名当前未患MDD的女性中有15名（94%）在PDSS_SF筛查中呈阳性。使用所采用的临界值时，EPDS比PDSS_SF和PHQ - 9显著更准确（p = 0.01）。在校正验证偏倚后，我们发现EPDS和PDSS_SF比PHQ - 9显著更准确（p < 0.03）。
产后6 - 8周通过电话发放EPDS是在分娩后前6个月内识别产后抑郁高危女性的一种有效且准确的方法。
