Cheng Junzhe, Ren Zhixuan, Rehman Shazia, Zhou Zhiruo, Wang Xinyi, Wang Yubo, Peng Yilin, Xiong Jintao, Qin Xuemei, Peng Zhuo, Mao Weiguo, Chen Mingfang, Zeng Yundi, Wang Mi, Zhang Li, Ju Yumeng, Liu Jin, Yu Yan, Liu Bangshan, Zhang Yan
Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China; Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha 410011, Hunan, China; Clinical Medicine Eight-Year Program, Xiangya School of Medicine, Central South University, Changsha, Hunan 41008, China.
Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China; Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha 410011, Hunan, China.
J Affect Disord. 2025 May 1;376:104-112. doi: 10.1016/j.jad.2025.02.004. Epub 2025 Feb 3.
The Patient Health Questionnaire-9 (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) are commonly used for assessing antenatal depression in China. However, clear guidelines for their application are lacking in China, leading to inconsistencies in prenatal mental health care. This study compares the psychometric properties of these scales to improve early detection and intervention strategies for antenatal depression.
The cross-sectional study included 44,220 women receiving prenatal care from January 1, 2020, to January 31, 2024. All the participants underwent a psychological screening during their maternity check-ups at the Shenzhen Baoan Women's and Children's Hospital, China. We evaluated the reliability, construct validity, and concurrent validity of the two scales using internal consistency indices, factor structures, correlations, and Cohen's kappa.
Both the PHQ-9 (Cronbach's α = 0.800) and EPDS (α = 0.783) demonstrated good internal consistency. The correlation between PHQ-9 and EPDS scores was moderate (ρ = 0.61). Exploratory factor analysis (EFA) revealed a two-factor structure for each scale. When combining all items from both scales, EFA identified four factors: "somatic symptoms," "negative cognitive bias and suicidal ideation," "anxiety and depression," and "anhedonia." The agreement was generally fair across various cutoff scores, with the highest Cohen's kappa being 0.493.
Both the EPDS and PHQ-9 exhibit strong internal consistency in screening for antenatal depression in China. While the EPDS emphasizes "depression and anxiety," the PHQ-9 focuses on "somatic symptoms," suggesting that combining the two may improve detection. Adjusting EPDS cutoff scores and incorporating the PHQ-9 could further enhance screening accuracy.
患者健康问卷-9（PHQ-9）和爱丁堡产后抑郁量表（EPDS）在中国常用于评估产前抑郁。然而，中国缺乏关于其应用的明确指南，导致产前心理健康护理存在不一致性。本研究比较这些量表的心理测量特性，以改进产前抑郁的早期检测和干预策略。
这项横断面研究纳入了2020年1月1日至2024年1月31日期间接受产前护理的44220名女性。所有参与者在中国深圳宝安妇幼保健院进行产检时接受了心理筛查。我们使用内部一致性指标、因子结构、相关性和科恩kappa系数评估了这两个量表的信度、结构效度和同时效度。
PHQ-9（克朗巴哈α系数=0.800）和EPDS（α系数=0.783）均显示出良好的内部一致性。PHQ-9和EPDS得分之间的相关性为中等（ρ=0.61）。探索性因子分析（EFA）揭示了每个量表的双因子结构。当将两个量表的所有项目合并时，EFA确定了四个因子：“躯体症状”、“消极认知偏差和自杀观念”、“焦虑和抑郁以及“快感缺失”。在不同的临界值分数下，一致性总体为中等，最高的科恩kappa系数为0.493。
在中国，EPDS和PHQ-9在筛查产前抑郁方面均表现出较强的内部一致性。虽然EPDS强调“抑郁和焦虑”，但PHQ-9侧重于“躯体症状”，这表明将两者结合可能会提高检测效果。调整EPDS临界值分数并纳入PHQ-9可以进一步提高筛查准确性。
