Archives of Women's Mental Health

, Volume 11, Issue 4, pp 277–285 | Cite as

The Pregnancy Depression Scale (PDS): a screening tool for depression in pregnancy

  • Lori L. Altshuler
  • Lee S. Cohen
  • Allison F. Vitonis
  • Stephen V. Faraone
  • Bernard L. Harlow
  • Rita Suri
  • Richard Frieder
  • Zachary N. Stowe
Original Contribution

Abstract

Depression in pregnancy can be underdiagnosed as a consequence of the symptoms being misattributed to “normal pregnancy.” There are currently no validated clinician-rated scales that assess for depression specifically during pregnancy. We sought to develop a brief, convenient screening tool to identify depression in pregnant women in the community setting. Prospective mood data using the 28-item Hamilton Depression Rating Scale (HDRS) were collected monthly in 196 pregnant women with a history of a major depressive disorder. These data were analyzed to delineate those HDRS items associated (elevated) with normal pregnancy vs. those indicative of a pregnant woman meeting diagnostic criteria for a major depressive episode. Endorsement of symptoms on seven items of the HDRS were highly predictive of having a major depressive episode during pregnancy. We present a well-validated, brief scale to screen pregnant women for clinical depression. Whether this study will generalize to women who do not have a history of major depression remains to be studied.

Keywords

Pregnancy Depression Screening Rating scale 

References

  1. Adouard F, Glangeaud-Freudenthal NM, Golse B (2005) Validation of the Edinburgh postnatal depression scale (EPDS) in a sample of women with high-risk pregnancies in France. Arch Womens Ment Health 8:89–95PubMedCrossRefGoogle Scholar
  2. Andersson L, Sundstrom-Poromaa I, Wulff M, Astrom M, Bixo M (2004) Neonatal outcome following maternal antenatal depression and anxiety: a population-based study. Am J Epidemiol 159:872–881PubMedCrossRefGoogle Scholar
  3. Austin MP, Hadzi-Pavlovic D, Saint K, Parker G (2005) Antenatal screening for the prediction of postnatal depression: validation of a psychosocial Pregnancy Risk Questionnaire. Acta Psychiatr Scand 112:310–317PubMedCrossRefGoogle Scholar
  4. Beck CT (1995) Screening methods for postpartum depression. J Obstet Gynecol Neonatal Nurs 24:308–312PubMedCrossRefGoogle Scholar
  5. Campagne DM (2004) The obstetrician and depression during pregnancy. Eur J Obstet Gynecol Reprod Biol 116:125–130PubMedCrossRefGoogle Scholar
  6. Chung TK, Lau TK, Yip AS, Chiu HF, Lee DT (2001) Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosom Med 63:830–834PubMedGoogle Scholar
  7. Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC, Suri R, Burt VK, Hendrick V, Reminick AM, Loughead A, Vitonis AF, Stowe ZN (2006) Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA 295:499–507PubMedCrossRefGoogle Scholar
  8. Cutrona CE (1983) Causal attributions and perinatal depression. J Abnorm Psychology 92:161–172CrossRefGoogle Scholar
  9. Dayan J, Creveuil C, Marks MN, Conroy S, Herlicoviez M, Dreyfus M, Tordjman S (2006) Prenatal depression, prenatal anxiety, and spontaneous preterm birth: a prospective cohort study among women with early and regular care. Psychosom Med 68:938–946PubMedCrossRefGoogle Scholar
  10. de Tychey C, Spitz E, Briancon S, Lighezzolo J, Girvan F, Rosati A, Thockler A, Vincent S (2005) Pre- and postnatal depression and coping: a comparative approach. J Affect Disord 85:323–326PubMedCrossRefGoogle Scholar
  11. Diego MA, Jones NA, Field T, Hernandez-Reif M, Schanberg S, Kuhn C, Gonzalez-Garcia A (2006) Maternal psychological distress, prenatal cortisol, and fetal weight. Psychosom Med 68:747–753PubMedCrossRefGoogle Scholar
  12. Evans J, Heron J, Francomb H, Oke S, Golding J (2001) Cohort study of depressed mood during pregnancy and after childbirth. BMJ 323:257–260PubMedCrossRefGoogle Scholar
  13. Felice E, Saliba J, Grech V, Cox J (2006) Validation of the Maltese version of the Edinburgh Postnatal Depression Scale. Arch Womens Ment Health 9:75–80PubMedCrossRefGoogle Scholar
  14. Fergerson SS, Jamieson DJ, Lindsay M (2002) Diagnosing postpartum depression: can we do better? Am J Obstet Gynecol 186:899–902PubMedCrossRefGoogle Scholar
  15. Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, Brody S, Miller WC (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ)(119):1–8Google Scholar
  16. Gordon TE, Cardone IA, Kim JJ, Gordon SM, Silver RK (2006) Universal perinatal depression screening in an Academic Medical Center. Obstet Gynecol 107:342–347PubMedGoogle Scholar
  17. Gotlib IH, Whiffen VE, Mount JH, Milne K, Cordy NI (1989) Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. J Consult Clin Psychol 57:269–274PubMedCrossRefGoogle Scholar
  18. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62PubMedGoogle Scholar
  19. Hedegaard M, Henriksen TB, Sabroe S, Secher NJ (1993) Psychological distress in pregnancy and preterm delivery. BMJ 307:234–239PubMedGoogle Scholar
  20. Huber PJ (1967) The behavior of maximum likelihood estimates under non-standard conditions. In: Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability, vol. 1, pp 221–233Google Scholar
  21. Kumar R, Robson KM (1984) A prospective study of emotional disorders in childbearing women. Br J Psychiatry 144:35–47PubMedCrossRefGoogle Scholar
  22. Mancuso RA, Schetter CD, Rini CM, Roesch SC, Hobel CJ (2004) Maternal prenatal anxiety and corticotropin-releasing hormone associated with timing of delivery. Psychosom Med 66:762–769PubMedCrossRefGoogle Scholar
  23. Marcus SM, Flynn HA, Blow FC, Barry KL (2003) Depressive symptoms among pregnant women screened in obstetrics settings. J Womens Health (Larchmt) 12:373–380CrossRefGoogle Scholar
  24. Morris-Rush JK, Freda MC, Bernstein PS (2003) Screening for postpartum depression in an inner-city population. Am J Obstet Gynecol 188:1217–1219PubMedCrossRefGoogle Scholar
  25. Neggers Y, Goldenberg R, Cliver S, Hauth J (2006) The relationship between psychosocial profile, health practices, and pregnancy outcomes. Acta Obstet Gynecol Scand 85:277–285PubMedCrossRefGoogle Scholar
  26. O’Hara MW, Schlechte JA, Lewis DA, Varner MW (1991) Controlled prospective study of postpartum mood disorders: psychological, environmental, and hormonal variables. J Abnorm Psychology 100:63–73CrossRefGoogle Scholar
  27. Orr ST, Miller CA (1995) Maternal depressive symptoms and the risk of poor pregnancy outcome. Review of the literature and preliminary findings. Epidemiol Rev 17:165–171PubMedGoogle Scholar
  28. Paton S, Kessler R, Kandel D (1977) Depressive mood and adolescent illicit drug use: a longitudinal analysis. J Genet Psychol 131:267–289PubMedGoogle Scholar
  29. Perfetti J, Clark R, Fillmore CM (2004) Postpartum depression: identification, screening, and treatment. WMJ 103:56–63PubMedGoogle Scholar
  30. Pritchard CW (1994) Depression and smoking in pregnancy in Scotland. J Epidemiol Community Health 48:377–382PubMedGoogle Scholar
  31. Rosenthal NE, Hefferman ME (1987) Bulimia, carbohydrate craving and depression: a central connection? In: Wurtman RJ, Wurtman JJ (eds) Nutrition and the brain. vol. 7. Raven, New York, pp 139–166Google Scholar
  32. Rubertsson C, Wickberg B, Gustavsson P, Radestad I (2005) Depressive symptoms in early pregnancy, two months and one year postpartum-prevalence and psychosocial risk factors in a national Swedish sample. Arch Womens Ment Health 8:97–104PubMedCrossRefGoogle Scholar
  33. Steer RA, Scholl TO, Hediger ML, Fischer RL (1992) Self-reported depression and negative pregnancy outcomes. J Clin Epidemiol 45:1093–1099PubMedCrossRefGoogle Scholar
  34. Suri R, Altshuler LA, Mintz J (2004) Depression and the decision to abort. Am J Psychiatry 161:1502PubMedCrossRefGoogle Scholar
  35. Thoppil J, Riutcel TL, Nalesnik SW (2005) Early intervention for perinatal depression. Am J Obstet Gynecol 192:1446–1448PubMedCrossRefGoogle Scholar
  36. Watson JP, Elliott SA, Rugg AJ, Brough DI (1984) Psychiatric disorder in pregnancy and the first postnatal year. Br J Psychiatry 144:453–462PubMedCrossRefGoogle Scholar
  37. Wu J, Viguera A, Riley L, Cohen L, Ecker J (2002) Mood disturbance in pregnancy and the mode of delivery. Am J Obstet Gynecol 187:864–867PubMedCrossRefGoogle Scholar
  38. Zajicek E (1981) Psychiatric problems during pregnancy. In: Wolkind S, Zajicek E (eds) Pregnancy: a psychological and social study. Academic, London, pp 57–73Google Scholar
  39. Zuckerman B, Bresnahan K (1991) Developmental and behavioral consequences of prenatal drug and alcohol exposure. Pediatr Clin North Am 38:1387–1406PubMedGoogle Scholar
  40. Zuckerman B, Amaro H, Bauchner H, Cabral H (1989) Depressive symptoms during pregnancy: relationship to poor health behaviors. Am J Obstet Gynecol 160:1107–1111PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Lori L. Altshuler
    • 1
  • Lee S. Cohen
    • 2
  • Allison F. Vitonis
    • 3
  • Stephen V. Faraone
    • 4
    • 5
  • Bernard L. Harlow
    • 6
  • Rita Suri
    • 1
  • Richard Frieder
    • 7
  • Zachary N. Stowe
    • 8
  1. 1.Mood Disorders Research Program, Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesUSA
  2. 2.Perinatal and Reproductive Psychiatry Clinical Research Program, Department of Psychiatry, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  3. 3.Obstetrics and Gynecology Epidemiology CenterBrigham and Women’s HospitalBostonUSA
  4. 4.Department of Psychiatry and Neuroscience, Upstate Medical UniversityState University of New York Upstate Medical UniversitySyracuseUSA
  5. 5.Department of Physiology, Upstate Medical UniversityState University of New York Upstate Medical UniversitySyracuseUSA
  6. 6.Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisUSA
  7. 7.Department of Obstetrics and Gynecology, Department of Family MedicineUniversity of CaliforniaLos AngelesUSA
  8. 8.Women’s Mental Health Program, Department of Psychiatry and Behavioral Sciences, School of MedicineEmory UniversityAtlantaUSA

Personalised recommendations