The goal was to describe the accuracy of the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory II (BDI-II), and Postpartum Depression Screening Scale (PDSS) in identifying major depressive disorder (MDD) or minor depressive disorder (MnDD) in low-income, urban mothers attending well childcare (WCC) visits during the postpartum year.
Mothers (N=198) attending WCC visits with their infants 0 to 14 months of age completed a psychiatric diagnostic interview (standard method) and 3 screening tools. The sensitivity and specificity of each screening tool were calculated in comparison with diagnoses of MDD or MDD/MnDD. Receiver operating characteristic curves were calculated and the areas under the curves for each tool were compared to assess accuracy for the entire sample (representing the postpartum year) and sub-samples (representing early, middle and late postpartum time frames). Optimal cut-points were calculated.
At some point between 2 weeks and 14 months postpartum, 56% of mothers met criteria for either MDD (37%) or MnDD (19%). When used as a continuous measures, all scales performed equally well (areas under the curves of ≥ 0.8). With traditional cut-points, the measures did not perform at the expected levels of sensitivity and specificity. Optimal cut-points for the BDI-II (≥14 for MDD, ≥11 for MDD/MnDD) and EPDS (≥9 for MDD, ≥7 for MDD/MnDD) were lower than currently recommended. For the PDSS, the optimal cut-point was consistent with current guidelines for MDD (≥80) but higher than recommended for MDD/MnDD (≥ 77).
Large proportions of low-income, urban mothers attending WCC visits experience MDD or MnDD during the postpartum year. The EPDS, BDI-II and PDSS have high accuracy in identifying depression but cutoff points may need to be altered to more accurately identify depression in urban, low-income mothers.
Keywords: Postpartum Depression, Maternal Depression, Well Childcare, Validity, Screening Tools