Perinatal determinants of depressive disorder profile in high-income women: testing current cut-off thresholds

Although the Edinburgh Postnatal Depression Scale (EPDS) is not diagnostic for antenatal and postpartum depressive disorders, understanding perinatal risk factors is crucial for the early identification of women's risk profiles and for providing them with targeted support. This cross-sectional study aimed to identify determinants of depressive disorder risk in the early puerperium, utilizing EPDS cut-offs ≥ 9 and ≥ 12.

In a three-year period (January 2020 to August 2023), the self-reported EPDS questionnaire was distributed to 2,561 eligible at term women on the second day postpartum, prior to their discharge from the maternity ward of the Abano Polyclinic in Abano Terme (Italy). We estimated the risk of depressive disorder using the EPDS cut-off thresholds ≥ 9 and ≥ 12 and identified the concurrent obstetric and perinatal determinants of the maternal depressive profile using the Univariable Logistic Regression Model.

On the second day postpartum, the EPDS low cut-off ≥ 9 captured a larger group of puerperae (664/2,561; 25.14%) in comparison to the high cut-off ≥ 12 (279/2,561; 10.89). Statistically significant determinants of high depressive disorder risk in women with a cut-off ≥ 9 were younger maternal age (OR 0.97, 95% CI 0.96-0.99, p = 0.0004), complementary feeding (OR 1.40, 95% CI 1.16-1.69, p = 0.0004) and formula feeding (OR 1.83, 95% CI 1.21-2.77, p = 0.004), whereas being employed was protective (OR 0.71, 95% CI 0.53-0.95, p = 0.023). In contrast, the odds of belonging to the ≥ 12 group demonstrated that formula feeding was associated with a higher risk of depressive symptoms (OR 95% CI 2.35; 1.47-3.76, p 0.0003).

These results suggest that adopting EPDS cut-off thresholds of ≥ 9 or ≥ 12 on the second day postpartum significantly influences the estimated rate of postpartum depressive symptoms and may aid in identifying obstetric and perinatal determinants associated with depressive symptom profiles.

Not applicable.