Archives of Women's Mental Health

, Volume 16, Issue 6, pp 465–473 | Cite as

The EPDS-Lifetime: assessment of lifetime prevalence and risk factors for perinatal depression in a large cohort of depressed women

  • Samantha Meltzer-Brody
  • Lynn Boschloo
  • Ian Jones
  • Patrick F. Sullivan
  • Brenda W. Penninx
Original Article


Perinatal depression (PND) is a common complication of pregnancy and postpartum associated with significant morbidity. We had three goals: (1) to explore the performance of a new lifetime version of the Edinburgh Postnatal Depression Scale (EPDS-Lifetime) to assess lifetime prevalence of PND; (2) to assess prevalence of lifetime PND in women with prior histories of major depressive episode (MDE); and (3) to evaluate risk factors for PND. Subjects were from the Netherlands Study of Depression and Anxiety (NESDA). The EPDS was modified by adding lifetime PND screening questions, assessing worst episode, and symptom timing of onset. Of 682 women with lifetime MDD and a live birth, 276 (40.4 %) had a positive EPDS score of ≥12 consistent with PND. Women with PND more often sought professional help (p < 0.001) and received treatment (p = 0.001). Independent risk indicators for PND included younger age, higher education, high neuroticism, childhood trauma, and sexual abuse. We found that two in five parous women with a history of MDD had lifetime PND and that the PND episodes were more severe than MDD occurring outside of the perinatal period. The EPDS-Lifetime shows promise as a tool for assessing lifetime histories of PND in clinical and research settings.


Perinatal depression Postpartum depression Major depression Edinburgh Postnatal Depression Scale Risk factors Sexual abuse Trauma 



The infrastructure of the NESDA study fully supported this project and provided the critical assistance to interview the subjects who generously gave their time to participate in this study. We thank Dr. John Cox, the creator of the Edinburgh Postnatal Depression Scale, for his thoughtful review of the manuscript and willingness to allow us to modify the original version of the EPDS to assess lifetime episodes of perinatal depression.

The infrastructure for the NESDA study ( is funded through the Geestkracht program of the Netherlands Organization for Health Research and Development (Zon-MW, grant number 10-000-1002) and is supported by participating universities and mental health care organizations (VU University Medical Center, GGZinGeest, Arkin, Leiden University Medical Center, GGZ Rivierduinen, University Medical Center Groningen, Lentis, GGZ Friesland, GGZ Drenthe, IQ Healthcare, Netherlands Institute for Health Services Research (NIVEL), and Netherlands Institute of Mental Health and Addiction (Trimbos)). Dr. Meltzer-Brody is funded by the National Institutes of Health grant # K23MH85165.

Conflict of interest

All authors declare that they have no conflicts of interest.


  1. Beck CT (2001) Predictors of postpartum depression: an update. Nurs Res 50(5):275–285PubMedCrossRefGoogle Scholar
  2. Beesdo K, Bittner A et al (2007) Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Arch Gen Psychiatry 64(8):903–912PubMedCrossRefGoogle Scholar
  3. Bergman K, Sarkar P et al (2010) Maternal prenatal cortisol and infant cognitive development: moderation by infant-mother attachment. Biol Psychiatry 67(11):1026–1032PubMedCrossRefGoogle Scholar
  4. Bijl RV, van Zessen G et al (1998) The Netherlands Mental Health Survey and Incidence Study (NEMESIS): objectives and design. Soc Psychiatry Psychiatr Epidemiol 33(12):581–586PubMedCrossRefGoogle Scholar
  5. Bland JM, Altman DG (1997) Cronbach's alpha. BMJ 314(7080):572PubMedCrossRefGoogle Scholar
  6. Bloch M, Schmidt PJ et al (2000) Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry 157(6):924–930PubMedCrossRefGoogle Scholar
  7. Boschloo L, Vogelzangs N et al (2011) Comorbidity and risk indicators for alcohol use disorders among persons with anxiety and/or depressive disorders: findings from the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord 131(1–3):233–242PubMedCrossRefGoogle Scholar
  8. Boyd RC, Le HN et al (2005) Review of screening instruments for postpartum depression. Arch Womens Ment Health 8(3):141–153PubMedGoogle Scholar
  9. Brugha T, Bebington P, Tennant C, Hurry J (1985) The list of threatening experiences: a subset of 12 life event categories with considerable long-term contextual treat. Psychol Med 15:189–194PubMedCrossRefGoogle Scholar
  10. Brugha T, Sharp H et al (1998) The Leicester 500 Project. Social support and the development of postnatal depressive symptoms, a prospective cohort survey. Psychol Med 28(01):63–79PubMedCrossRefGoogle Scholar
  11. Buist A (1998) Childhood abuse, parenting and postpartum depression. Aust N Z J Psychiatry 32(4):479–487PubMedCrossRefGoogle Scholar
  12. Campbell SB, Brownell CA et al (2004) The course of maternal depressive symptoms and maternal sensitivity as predictors of attachment security at 36 months. Dev Psychopathol 16(2):231–252PubMedCrossRefGoogle Scholar
  13. Costa PT Jr, McCrae RR (1995) Domains and facets: hierarchical personality assessment using the revised NEO personality inventory. J Pers Assess 64(1):21PubMedCrossRefGoogle Scholar
  14. Cox JL, Rooney A, Thomas PF, Wrate RW (1984) How accurately do mothers recall postnatal depression? Further data from a 3 year follow-up study. J Psychosom Obstet Gynecol 3(3–4):185–189CrossRefGoogle Scholar
  15. Cox JL, Holden JM et al (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry J Ment Sci 150:782–786CrossRefGoogle Scholar
  16. Cox JL, Murray D et al (1993) A controlled study of the onset, duration and prevalence of postnatal depression. Br J psychiatry J Ment sci 163:27–31CrossRefGoogle Scholar
  17. Donker T, Comijs H et al (2010) The validity of the Dutch K10 and extended K10 screening scales for depressive and anxiety disorders. Psychiatry Res 176(1):45–50PubMedCrossRefGoogle Scholar
  18. Dott M, Rasmussen S et al (2010) Association between pregnancy intention and reproductive-health related behaviors before and after pregnancy recognition, National Birth Defects Prevention Study, 1997–2002. Matern Child Health J 14(3):373–381PubMedCrossRefGoogle Scholar
  19. DSM-IV, Ed (1994) Diagnostic and statistical manual of mental disorders (DSM-IV), 4th edn. American Psychiatric Association, WashingtonGoogle Scholar
  20. Elliott S (2000) Report on the satra bruk workshop on classification of postnatal mental disorders on November 7–10, 1999. Convened by Birgitta Wickberg, Philip Hwang and John Cox. Arch Womens Ment Health 3:27–33Google Scholar
  21. Feldman R, Granat A et al (2009) Maternal depression and anxiety across the postpartum year and infant social engagement, fear regulation, and stress reactivity. J Am Acad Child Adolesc Psychiatry 48(9):919–927PubMedCrossRefGoogle Scholar
  22. Field T (2010) Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Behav Dev 33(1):1–6PubMedCrossRefGoogle Scholar
  23. First MB, Spitzer RL, Gibbon M, Williams JBW (1995) Structured clinical interview for DSM-IV (SCID). American Psychiatric Association, WashingtonGoogle Scholar
  24. Fleming AS, Corter C (1988) Factors influencing maternal responsiveness in humans: usefulness of an animal model. Psychoneuroendocrinology 13(1–2):189–212PubMedCrossRefGoogle Scholar
  25. Flynn HA, Davis M et al (2004) Rates of maternal depression in pediatric emergency department and relationship to child service utilization. Gen Hosp Psychiatry 26(4):316–322PubMedCrossRefGoogle Scholar
  26. Flynn HA, Sexton M et al (2011) Comparative performance of the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9 in pregnant and postpartum women seeking psychiatric services. Psychiatry Res 187(1–2):130–134PubMedCrossRefGoogle Scholar
  27. Fyer AJ, Weissman MM (1999) Genetic linkage study of panic: clinical methodology and description of pedigrees. Am J Med Genet 88(2):173–181PubMedCrossRefGoogle Scholar
  28. Gavin NI, Gaynes BN et al (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106(5 Pt 1):1071–1083PubMedCrossRefGoogle Scholar
  29. Gaynes BN, Gavin N et al (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ) 119:1–8Google Scholar
  30. Gigantesco A, Morosini P (2008) Development, reliability and factor analysis of a self-administered questionnaire which originates from the World Health Organization's Composite International Diagnostic Interview-Short Form (CIDI-SF) for assessing mental disorders. Clin Pract Epidemiol Ment Health CP & EMH 4:8CrossRefGoogle Scholar
  31. Grimstad H, Backe B et al (1998) Abuse history and health risk behaviors in pregnancy. Acta Obstet Gynecol Scand 77(9):893–897PubMedCrossRefGoogle Scholar
  32. Wittchen HU (1994) Reliability and validity studies of the WHO—Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res 28(1):57–84PubMedCrossRefGoogle Scholar
  33. Hewitt CE, Gilbody SM (2009) Is it clinically and cost effective to screen for postnatal depression: a systematic review of controlled clinical trials and economic evidence. BJOG 116(8):1019–1027PubMedCrossRefGoogle Scholar
  34. Kendall-Tackett KA (2007) Violence against women and the perinatal period: the impact of lifetime violence and abuse on pregnancy, postpartum, and breastfeeding. Trauma Violence Abuse 8(3):344–353PubMedCrossRefGoogle Scholar
  35. Kendler KS, Bulik CM et al (2000) Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. Arch Gen Psychiatry 57(10):953–959PubMedCrossRefGoogle Scholar
  36. Kessler RC, Andrews G et al (2002) Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 32(6):959–976PubMedCrossRefGoogle Scholar
  37. Kumar R, Robson KM (1984) A prospective study of emotional disorders in childbearing women. Br J psychiatry J Ment sci 144:35–47CrossRefGoogle Scholar
  38. Kupfer DJ, Frank E et al (2011) Major depressive disorder: new clinical, neurobiological, and treatment perspectives. Lancet 379(9820):1045–1055PubMedCrossRefGoogle Scholar
  39. Landman-Peeters KM, Hartman CA et al (2005) Gender differences in the relation between social support, problems in parent-offspring communication, and depression and anxiety. Soc Sci Med 60(11):2549–2559PubMedCrossRefGoogle Scholar
  40. Leeners B, Richter-Appelt H et al (2006) Influence of childhood sexual abuse on pregnancy, delivery, and the early postpartum period in adult women. J Psychosom Res 61(2):139–151PubMedCrossRefGoogle Scholar
  41. Leeners B, Stiller R et al (2010) Pregnancy complications in women with childhood sexual abuse experiences. J Psychosom Res 69(5):503–510PubMedCrossRefGoogle Scholar
  42. Leserman J (2005) Sexual abuse history: prevalence, health effects, mediators, and psychological treatment. Psychosom Med 67(6):906–915PubMedCrossRefGoogle Scholar
  43. Leserman J, Drossman DA et al (1996) Sexual and physical abuse history in gastroenterology practice: how types of abuse impact health status. Psychosom Med 58(1):4–15PubMedGoogle Scholar
  44. Lindahl V, Pearson JL et al (2005) Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health 8(2):77–87PubMedCrossRefGoogle Scholar
  45. Lukasse M, Vangen S et al (2011) Fear of childbirth, women's preference for cesarean section and childhood abuse: a longitudinal study. Acta Obstet Gynecol Scand 90(1):33–40PubMedCrossRefGoogle Scholar
  46. Marmorstein NR, Malone SM et al (2004) Psychiatric disorders among offspring of depressed mothers: associations with paternal psychopathology. Am J Psychiatry 161(9):1588–1594PubMedCrossRefGoogle Scholar
  47. McCauley J, Kern DE et al (1997) Clinical characteristics of women with a history of childhood abuse: unhealed wounds. JAMA 277(17):1362–1368PubMedCrossRefGoogle Scholar
  48. Meltzer-Brody S, Zerwas S et al (2011) Eating disorders and trauma history in women with perinatal depression. J Womens Health (Larchmt) 20(6):863–870CrossRefGoogle Scholar
  49. Micali N, Simonoff E et al (2011) Pregnancy and post-partum depression and anxiety in a longitudinal general population cohort: the effect of eating disorders and past depression. J Affect Disord 131(1–3):150–157PubMedCrossRefGoogle Scholar
  50. Milgrom J, Gemmill AW et al (2008) Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord 108(1–2):147–157PubMedCrossRefGoogle Scholar
  51. Moffitt TE, Harrington H et al (2007) Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Arch Gen Psychiatry 64(6):651–660PubMedCrossRefGoogle Scholar
  52. Munk-Olsen T, Laursen TM et al (2006) New parents and mental disorders: a population-based register study. JAMA 296(21):2582–2589PubMedCrossRefGoogle Scholar
  53. Munk-Olsen T, Laursen TM et al (2011) Psychiatric disorders with postpartum onset: possible early manifestations of bipolar affective disorders. Arch Gen Psychiatry 69(4):428–434PubMedGoogle Scholar
  54. Murray L, Cooper P (1997) Effects of postnatal depression on infant development. Arch Dis Child 77(2):99–101PubMedCrossRefGoogle Scholar
  55. Murray L, Stein A (1989) The effects of postnatal depression on the infant. Baillieres Clin Obstet Gynaecol 3(4):921–933PubMedCrossRefGoogle Scholar
  56. Network NECCR (1999) Chronicity of maternal depressive symptoms, maternal sensitivity, and child functioning at 36 months. Dev Psychol 35(5):1297–1310CrossRefGoogle Scholar
  57. Nurnberger JI Jr, Blehar MC et al (1994) Diagnostic interview for genetic studies: rationale, unique features, and training. Arch Gen Psychiatry 51(11):849–859PubMedCrossRefGoogle Scholar
  58. O'Connor TG, Zeanah CH (2003) Current perspectives on attachment disorders: rejoinder and synthesis. Attach Hum Dev 5(3):321–326PubMedCrossRefGoogle Scholar
  59. O'Hara MW (2009) Postpartum depression: what we know. J Clin Psychol 65(12):1258–1269PubMedCrossRefGoogle Scholar
  60. O'Hara MW, Swain AM (1996) Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatry 8(1):37–54CrossRefGoogle Scholar
  61. Onoye JM, Goebert D et al (2009) PTSD and postpartum mental health in a sample of Caucasian, Asian, and Pacific Islander women. Arch Womens Ment Health 12(6):393–400PubMedGoogle Scholar
  62. Paulson JF, Dauber S et al (2006) Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics 118(2):659–668PubMedCrossRefGoogle Scholar
  63. Penninx BW, Beekman AT et al (2008) The Netherlands Study of Depression and Anxiety (NESDA): rationale, objectives and methods. Int J Methods Psychiatr Res 17(3):121–140PubMedCrossRefGoogle Scholar
  64. Penninx BW, Nolen WA et al (2011) Two-year course of depressive and anxiety disorders: results from the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord 133(1–2):76–85PubMedCrossRefGoogle Scholar
  65. Rahman A, Iqbal Z et al (2004) Impact of maternal depression on infant nutritional status and illness: a cohort study. Arch Gen Psychiatry 61(9):946–952PubMedCrossRefGoogle Scholar
  66. Records K, Rice MJ (2009) Lifetime physical and sexual abuse and the risk for depression symptoms in the first 8 months after birth. J Psychosom Obstet Gynaecol 30(3):181–190PubMedCrossRefGoogle Scholar
  67. Robertson E, Grace S et al (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 26(4):289–295PubMedCrossRefGoogle Scholar
  68. Romans S, Belaise C et al (2002) Childhood abuse and later medical disorders in women. An epidemiological study. Psychother Psychosom 71(3):141–150PubMedCrossRefGoogle Scholar
  69. Rubertsson C, Waldenström U et al (2003) Depressive mood in early pregnancy: prevalence and women at risk in a national Swedish sample. J Reprod Infant Psychol 21(2):113–123CrossRefGoogle Scholar
  70. Rubinow DR (2005) Reproductive steroids in context. Arch Womens Ment Health 8:1–5PubMedCrossRefGoogle Scholar
  71. Rubinow DR, Schmidt PJ (2006) Gonadal steroid regulation of mood: the lessons of premenstrual syndrome. Front Neuroendocrinol 27(2):210–216PubMedCrossRefGoogle Scholar
  72. Schmidt PJ, Nieman LK et al (1998) Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med 338(4):209–216PubMedCrossRefGoogle Scholar
  73. Silverman ME, Loudon H (2010) Antenatal reports of pre-pregnancy abuse is associated with symptoms of depression in the postpartum period. Arch Womens Ment Health 13(5):411–415PubMedCrossRefGoogle Scholar
  74. Smith MV, Shao L et al (2010) Perinatal depression and birth outcomes in a Healthy Start project. Matern Child Health J 15(3):401–409CrossRefGoogle Scholar
  75. Suellentrop K, Morrow B, Williams L, D'Angelo D (2006) Monitoring progress toward achieving Maternal and Infant Healthy People 2010 objectives—19 states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000–2003. MMWR Surveill Summ 55(9):1–11PubMedGoogle Scholar
  76. Tammentie T, Tarkka M-T et al (2002) Sociodemographic factors of families related to postnatal depressive symptoms of mothers. Int J Nurs Pract 8(5):240–246PubMedCrossRefGoogle Scholar
  77. Viguera AC, Tondo L et al (2011) Episodes of mood disorders in 2,252 pregnancies and postpartum periods. Am J Psychiatry 168(11):1179–1185PubMedGoogle Scholar
  78. Warner R, Appleby L et al (1996) Demographic and obstetric risk factors for postnatal psychiatric morbidity. Br J Psychiatry 168(5):607–611PubMedCrossRefGoogle Scholar
  79. Wiersma J, Hovens JG, Oppen P, Giltay EJ, Schaik DV, Beekman AT, Penninx BW (2009) The importance of childhood trauma and childhood life events for chronicity of depression in adults. J Clin Psychiatry 70:983–989PubMedCrossRefGoogle Scholar
  80. Wisner KL, Parry BL et al (2002) Clinical practice. Postpartum depression. N Engl J Med 347(3):194–199PubMedCrossRefGoogle Scholar
  81. Wisner KL, Moses-Kolko EL et al (2010) Postpartum depression: a disorder in search of a definition. Arch Womens Ment Health 13(1):37–40PubMedCrossRefGoogle Scholar
  82. Wittchen H-U, Burke JD et al (1989) Recall and dating of psychiatric symptoms: test-retest reliability of time-related symptom questions in a standardized psychiatric interview. Arch Gen Psychiatry 46(5):437–443PubMedCrossRefGoogle Scholar
  83. Wittchen H, Robins L et al (1991) Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials. Br J Psychiatry 159(5):645–653 [published erratum appears in Br J Psychiatry 1992 Jan;160:136]PubMedCrossRefGoogle Scholar
  84. Yonkers KA, Ramin SM et al (2001) Onset and persistence of postpartum depression in an inner-city maternal health clinic system. Am J Psychiatry 158(11):1856–1863PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Samantha Meltzer-Brody
    • 1
  • Lynn Boschloo
    • 2
  • Ian Jones
    • 4
  • Patrick F. Sullivan
    • 1
    • 5
  • Brenda W. Penninx
    • 3
  1. 1.Department of Psychiatry, CB# 7160University of North Carolina at Chapel HillChapel HillUSA
  2. 2.University Medical Center GroningenGroningenThe Netherlands
  3. 3.Department of Psychiatry and EMGO InstituteVU University Medical Center AmsterdamAmsterdamThe Netherlands
  4. 4.Institute of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
  5. 5.Department of GeneticsUniversity of North Carolina at Chapel HillChapel HillUSA

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