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Postpartum Depression: Overlap Between Symptom-Based and Register-Based Measures.

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Definitions for postpartum depression (PPD) vary, with limited overlap between symptom scores and healthcare register data. This highlights the need to consider different PPD measurement methods in research.

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Area of Science:

  • Reproductive Health
  • Mental Health Research
  • Epidemiology

Background:

  • Postpartum depression (PPD) is a significant concern, measurable via symptom questionnaires or administrative health databases.
  • Existing methods for PPD assessment, including the Edinburgh Postnatal Depression Scale (EPDS) and healthcare registers, may yield different results.
  • Understanding the concordance between these measurement approaches is crucial for accurate epidemiological studies.

Purpose of the Study:

  • To examine the overlap between symptom-based (EPDS ≥ 11) and register-based (antidepressant prescription or hospital diagnosis) PPD definitions.
  • To assess the consistency of exposure-outcome associations using both PPD measurement methods.
  • To evaluate how different PPD definitions impact findings related to demographic, obstetric, and health factors.

Main Methods:

  • Linked Danish nationwide health registers with EPDS screening data (2015-2021).
  • Defined symptom-based PPD using EPDS scores and register-based PPD using treatment/diagnosis records within one year postpartum.
  • Employed logistic regression to compare PPD definitions and calculate ratios of odds ratios (ROR) for various exposures.

Main Results:

  • A total of 157,193 mothers were included; 7.1% had symptom-based PPD and 1.5% had register-based PPD.
  • Overlap was limited: 8.8% of symptom-based PPD cases also met register-based criteria, while 40.8% of register-based cases met symptom-based criteria.
  • Consistency in exposure-outcome associations varied, with higher consistency for obstetric factors compared to demographic and health factors.

Conclusions:

  • Substantial differences and limited overlap exist between symptom-based and register-based PPD definitions.
  • Register-based measures primarily capture hospital-based diagnoses and pharmacological treatment, potentially missing other healthcare interactions.
  • Findings underscore the importance of carefully considering PPD measurement methods and their implications in epidemiological research.