Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders

Area of Science:

• Psychiatry
• Perinatal Mental Health
• Psychometrics

Background:

• Postnatal depression screening commonly uses the Edinburgh Postnatal Depression Scale (EPDS) with a cut-off of 13+ for major depression.
• Anxiety disorders can occur postnatally independent of depression in both women and men.
• The EPDS-3A (items 3, 4, 5) is a subset of EPDS items that cluster on an anxiety factor for women.

Purpose of the Study:

• To determine the optimal cut-off score on the EPDS-3A for screening specified anxiety disorders in postpartum women and men.
• To validate the EPDS-3A as a screening tool for anxiety in the context of postnatal mood disorders.

Main Methods:

• A sample of 238 women and 218 men completed the EPDS and underwent diagnostic interviews for anxiety and depressive disorders at 6 weeks postpartum.
• Receiver operating characteristic (ROC) analysis was used to identify optimal cut-off scores on the EPDS-3A.

Main Results:

• The optimal EPDS-3A cut-off score for screening anxiety in women is 6 or more (range 0-9).
• The optimal EPDS-3A cut-off score for screening anxiety in men is 4 or more (range 0-9).
• The factor structure of the EPDS-3A may differ between men and women.

Conclusions:

• The EPDS can effectively screen for probable depression (EPDS total score 13+) and probable anxiety (EPDS-3A score 6+) in women.
• The EPDS-3A score of 4+ can be used to screen for probable anxiety disorders in fathers, pending further research on its factor structure in men.
• Validated total cut-off scores for depression and anxiety in men exist (6+), but EPDS-3A offers an alternative screening for anxiety in fathers.