Knights Jayci E, Salvatore Michelle L, Simpkins Gunda, Hunter Krystal, Khandelwal Meena
Department of Obstetrics & Gynecology at Cooper University Hospital, Camden, NJ, USA; Cooper Medical School of Rowan University, Camden, NJ, USA.
Department of Obstetrics & Gynecology at Cooper University Hospital, Camden, NJ, USA; Cooper Medical School of Rowan University, Camden, NJ, USA.
Eur J Obstet Gynecol Reprod Biol. 2016 Nov;206:99-104. doi: 10.1016/j.ejogrb.2016.08.030. Epub 2016 Sep 7.
Postpartum depression (PPD) causes significant morbidity in postpartum women and their newborns. Universal screening is mandated in many states despite little information on optimal interval and frequency of screening.
The objective of this study was to determine whether the early Edinburgh Postnatal Depression Scale (EPDS) score (done within 96h after delivery) is predictive of the late EPDS score (done at outpatient postpartum visit).
This retrospective cohort study selected 256 women delivered at Cooper University Hospital in Camden, NJ in 2013. All patients who presented to the office during the postpartum period completed the EPDS questionnaire, in accordance to our usual practice. The delivery and outpatient records were reviewed for demographic data, EPDS scores and outcomes. Three groups of EPDS scoring were analyzed: <10 (low risk for PPD), 10-13 (borderline risk for PPD), and ≥14 (high risk for PPD). Early and late EPDS scores were compared using Pearson Chi Square test. The relationship between scores was calculated using the Spearman Rho Correlation test. Assuming the EPDS groups would not change, a sample of 200 was needed with 80% power and 5% α-error.
EPDS scores remained the same or improved in 92.2% (189/205) of women. The 16 women whose scores worsened were more likely to have had a diagnosis of prior psychiatric illness (50% vs 16.4%, p=0.003) and/or a diagnosis of fetal anomaly (12.5 vs 1.6%, p=0.05). An early EPDS score of <10 had a 92.7% probability of maintaining low risk screening (EPDS <10) at a later time.
In low risk women, there is good correlation between early and late EPDS scores and so these women may not need to be rescreened. Therefore, we should redirect the limited available resources from screening low risk women multiple times, towards provision of follow-up care for the smaller number of women at highest risk. We propose that "women know your number" (EPDS prior to discharge); and providers re-screen only those women who score positive on PAP10, which stands for Psychiatry history, Anomaly, Preterm delivery, and EPDS score of 10 or more.
产后抑郁症（PPD）会给产后女性及其新生儿带来严重的健康问题。尽管关于最佳筛查间隔和频率的信息很少，但许多州仍强制进行普遍筛查。
本研究的目的是确定早期爱丁堡产后抑郁量表（EPDS）评分（在分娩后96小时内完成）是否能预测晚期EPDS评分（在产后门诊就诊时完成）。
这项回顾性队列研究选取了2013年在新泽西州卡姆登的库珀大学医院分娩的256名女性。所有在产后期间到办公室就诊的患者均按照我们的常规做法完成了EPDS问卷。查阅分娩和门诊记录以获取人口统计学数据、EPDS评分和结果。分析了三组EPDS评分：<10（PPD低风险）、10 - 13（PPD边缘风险）和≥14（PPD高风险）。使用Pearson卡方检验比较早期和晚期EPDS评分。使用Spearman Rho相关检验计算评分之间的关系。假设EPDS分组不变，需要200个样本，检验效能为80%，α错误为5%。
92.2%（189/205）的女性EPDS评分保持不变或有所改善。评分恶化的16名女性更有可能有既往精神疾病诊断（50%对16.4%，p = 0.003）和/或胎儿异常诊断（12.5%对1.6%，p = 0.05）。早期EPDS评分<10的女性在后期保持低风险筛查（EPDS<10）的概率为92.7%。
在低风险女性中，早期和晚期EPDS评分之间具有良好的相关性，因此这些女性可能无需再次筛查。因此，我们应将有限的可用资源从多次筛查低风险女性，转向为少数高风险女性提供后续护理。我们建议“女性了解自己的评分”（出院前的EPDS评分）；医疗服务提供者仅对在PAP10上呈阳性的女性进行再次筛查，PAP10代表精神病史、异常情况、早产以及EPDS评分为10或更高。
