National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK.
School of Nursing and Midwifery, Queens University Belfast, Northern Ireland, UK.
J Affect Disord. 2019 May 15;251:8-14. doi: 10.1016/j.jad.2019.03.002. Epub 2019 Mar 4.
Early identification of postnatal depression is important in order to minimize adverse outcomes. The Edinburgh Postnatal Depression Scale (EPDS) is commonly used as a screening tool but a single, direct question on depression may offer an alternative means of identifying women in need of support. This study examines the agreement between these methods and characteristics of women who self-identify as depressed and those with EPDS ≥ 13.
Secondary analysis of two national maternity surveys conducted in England and Northern Ireland. Agreement between the direct question and EPDS scores was assessed using Cohen's kappa. Logistic regression was used to identify characteristics of women in each group.
6752 women were included. At three months postpartum, 6.1% of women self-identified as having depression, 9.1% scored EPDS ≥ 13, 2.8% were positive on both. Agreement between the two methods was minimal (Cohen's kappa < 0.3). Women who self-identified as having depression had higher odds of being aged > 40 years (OR 1.8; 95% CI 1.2-2.8). EPDS ≥ 13 was associated with < 16 years of education (OR 1.4; 95% CI 1.1-1.8), minority ethnicity (OR 1.4; 95% CI 1.1-1.9), living without a partner (OR 1.7; 95% CI 1.3-2.2), and a less than happy reaction to the pregnancy (OR 1.7; 95% CI 1.4-2.1).
Low survey response limits the representativeness of findings. The absence of a diagnostic interview limits conclusions on accuracy or internal validity of the measures.
A direct question about postnatal depression may offer a valuable addition to screening tools to identify women in need of support.
早期识别产后抑郁症对于减轻不良后果非常重要。爱丁堡产后抑郁量表（EPDS）通常被用作筛查工具，但关于抑郁的单一直接问题可能提供了一种识别需要支持的女性的替代方法。本研究检验了这两种方法之间的一致性，以及自我报告抑郁的女性和 EPDS≥13 的女性的特征。
对在英格兰和北爱尔兰进行的两项全国性产妇调查进行二次分析。使用 Cohen 的 kappa 评估直接问题和 EPDS 评分之间的一致性。使用逻辑回归来确定每组女性的特征。
共纳入 6752 名女性。产后三个月时，6.1%的女性自我报告患有抑郁症，9.1%的女性 EPDS≥13，2.8%的女性两种方法均呈阳性。两种方法之间的一致性较低（Cohen 的 kappa<0.3）。自我报告患有抑郁症的女性年龄>40 岁的可能性更高（OR 1.8；95%CI 1.2-2.8）。EPDS≥13 与<16 年受教育程度（OR 1.4；95%CI 1.1-1.8）、少数族裔（OR 1.4；95%CI 1.1-1.9）、无伴侣生活（OR 1.7；95%CI 1.3-2.2）和对怀孕反应不快乐（OR 1.7；95%CI 1.4-2.1）相关。
低调查应答率限制了研究结果的代表性。缺乏诊断访谈限制了对这些措施准确性或内部有效性的结论。
关于产后抑郁症的直接问题可能为识别需要支持的女性的筛查工具提供有价值的补充。
