Comparative performance of two depression screening instruments in adolescent mothers

Screening for symptoms of postpartum depression (PPD) is an important preliminary step to diagnosis and treatment, but the effectiveness of depression screening is dependent on the reliability and validity of the screening instruments in the population. Both the Edinburgh Postnatal Depression Scale (EPDS) and the Center for Epidemiologic Studies of Depression instrument (CES-D) have been used to screen adolescent mothers for PPD, but it is not clear which instrument best predicts a diagnosis of PPD, leading to the need for the current study.

Adolescent mothers (n = 59) at 4-6 weeks postpartum completed the EPDS and two versions of the CES-D in random order, followed by a mental health diagnostic evaluation for PPD. The diagnostic evaluation was completed by a mental health professional who was blind to study aims and screening scores. Performance measures were evaluated for all instruments.

The mental health clinician diagnosed 16.9% of adolescent mothers as depressed. Using the established cutoff scores for major depression for the instruments, the EPDS achieved the best performance measures. For example, the EPDS had the highest area under the receiver operating characteristic (ROC) curve. None of the results from the screening instruments were related to the mental health diagnostic evaluation.

EPDS may be the best screening tool for PPD in adolescent mothers. Considering only a clinical diagnosis of depression in adolescent mothers, however, may underestimate the number who experience psychological difficulty; assessment of anxiety should also be included.