Screening for postnatal depression--a summary of current knowledge.

BACKGROUND

Screening for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS), in combination with counselling sessions with a public health nurse (the Edinburgh method), has been introduced at many child health centres in Norway. In this article we provide a summary of the existing knowledge of how postnatal depression should be handled, with a particular emphasis on the benefits of screening.

MATERIAL AND METHOD

A literature search was conducted in PubMed, PsychInfo and Cochrane. National and international guidelines and related reports were downloaded from the websites of the respective health authorities.

RESULTS

Depressive symptoms occur in 10-15% of all new mothers. Several international studies have demonstrated a positive effect of the Edinburgh method, and screening for postnatal depression is recommended in a number of countries. In Norway no studies have yet been conducted to assess efficacy and resource use. The EPDS scale has been validated in several countries, and in a Norwegian validation study various threshold values for EPDS scores were compared with DSM-IV criteria for «major depression». Total score on the EPDS scale varies from 0 to 30. A threshold value of 10 yielded a sensitivity of 100% and a specificity of 87%, which resulted in many false positives. Higher threshold values yielded significantly lower sensitivity (67%). Two EPDS measurements plus an interview have been recommended, but have as yet been insufficiently tested.

INTERPRETATION

Screening for postnatal depression may be an appropriate measure. However, further knowledge is needed about the efficacy in Norway of the Edinburgh method and other models for follow-up, as well as agreement on the cut-off point for a positive test.