Predictive accuracy of Edinburgh Postnatal Depression Scale assessment during pregnancy for the risk of developing postpartum depressive symptoms: a prospective cohort study

ObjectiveTo investigate whether the 10-item Edinburgh Postnatal Depression Scale (EPDS) administered antenatally is accurate in predicting postpartum depressive symptoms, and whether a two-item EPDS has similar predictive accuracy.

DesignProspective cohort study.

SettingObstetric care in the Netherlands.

PopulationOne thousand six hundred and twenty women from the general population.

MethodsMean values, area under the receiver operating characteristics curve (AUC), sensitivity, specificity and predictive values of antenatal EPDS for the likelihood of developing postpartum depressive symptoms were calculated. Analyses were repeated for each trimester, several cut-off values and a two-item EPDS (low mood and anhedonia).

Main outcome measuresPostpartum depressive symptoms, defined as EPDS score 10.

ResultsMean EPDS scores were significantly higher during each trimester in women with postpartum depressive symptoms than in those without the symptoms (P

ConclusionsThe EPDS was not sufficiently accurate in predicting risk of postpartum depressive symptoms. Nevertheless, when using the 5 cut-off value, it may be adequate for initial screening, followed by further assessments and possibly antenatal intervention when positive. Furthermore, when negative, women may be reassured that postpartum depressive symptoms are unlikely. A two-item version showed poor predictive accuracy.