Screening for perinatal depression in Australia: Validation of the Edinburgh Postnatal Depression Scale in pregnancy and the postpartum

Background: Universal screening of all perinatal women using the Edinburgh Postnatal Depression Scale is currently recommended in Australian National Guidelines, yet Australian validation studies of this measure are limited and with mixed findings. This study aims to address a current gap using the largest Australian sample to include both antenatal and postpartum periods to evaluate the performance screening for Major Depression. Method: Data from 887 women is drawn from the Mercy Pregnancy and Emotional Wellbeing Study, a prospective cohort, in Melbourne, Perth and regional and rural Western Australia. Participants completed an Edinburgh Postnatal Depression Scale and Structured Clinical Interview for DSM diagnostic interview between weeks 12 and 20 of pregnancy and then again at 6 months postpartum. Data are compared to report internal validity and receiver operator characteristics including area under the curve, sensitivity, specificity, positive predictive value, negative predictive value and optimal cutoffs for the Edinburgh Postnatal Depression Scale. Results: Internal consistency was good. With recommended Edinburgh Postnatal Depression Scale cutoffs of 13 or above in the postpartum and 15 and above antenatally the Edinburgh Postnatal Depression Scale was found to have a positive predictive value of 52% and 58%, respectively. Overall, the receiver operator characteristic analysis suggests fair to poor performance of the Edinburgh Postnatal Depression Scale for detecting Major Depression in both the antenatal and postpartum periods. Conclusions: Clinicians and researchers using recommended Edinburgh Postnatal Depression Scale cutoffs may expect to have one in two of those women screening positive later receive a diagnosis of Major Depression, and one in five who screen negative representing missed cases. Clinical implications and recommendations are discussed.