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Screening for postnatal depression in routine primary care: properties of the Edinburgh Postnatal Depression Scale in an Australian sample

Authors

  • Jeannette Milgrom,

  • Jennifer Ericksen,

  • Lisa Negri,

  • Alan W. Gemmill


  • Jennifer Ericksen, Research Coordinator; Alan W. Gemmill, Senior Research Officer
    Parent–Infant Research Institute, Austin Health, Melbourne, Australia

  • Lisa Negri, Lecturer
    Department of Psychology and Disability Studies, RMIT University, Melbourne, Australia

Jeannette Milgrom, Professor (Department of Psychology); Director (Department of Clinical and Health Psychology), (Correspondence)
Department of Psychology, School of Behavioural Science, University of Melbourne, Melbourne, Australia
Parent–Infant Research Institute, Department of Clinical and Health Psychology, Austin Health, PO Box 5444, Heidelberg West, Victoria 3081, Australia. Email:jeannette.milgrom@austin.org.au

Abstract

Objectives: First, to explore the utility of the Edinburgh Postnatal Depression Scale (EPDS) in routine primary care through a large community screening program. Next, to compare administration of a second EPDS versus the Beck Depression Inventory (BDI) in identifying postnatal depression in the prescreened population.

Method: Screening with the EPDS through Maternal and Child Health Centres at 4 months post-partum. Women scoring ≥12 were assessed against DSM-IV criteria and completed a BDI and a second EPDS. These data were subjected to receiver operating characteristic (ROC) analyses.

Results: Of 4148 screened, 533 (12.8%) scored ≥12. Of these, 344 were assessed against DSM-IV criteria: 193 (56%) – major depressive disorder; 67 (20%) – other diagnoses that incorporated depression. Positive predictive value at screening was therefore 76%. Another 45 (13%) had non-depressive disorders and 39 (11%) were psychiatric non-cases. The BDI was the better diagnostic instrument in the prescreened population, having a significantly higher efficiency as quantified by ROC curve analysis, though the absolute difference in efficiency was small (approximately 6%).

Conclusions: Screening with the EPDS integrated well into routine primary care. Two-step screening offers one way of achieving acceptable balances of operational simplicity and diagnostic accuracy.

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