Abstract
Specific screening tests to detect postpartum anxiety are as yet unavailable. The aim of this study was to test the ability of the Edinburgh Postnatal Depression Scale (EPDS) to detect anxiety disorders in women admitted to residential early parenting centres. Consecutive cohorts of English speaking women admitted with their infants to two centres in Melbourne, Australia completed the Composite International Diagnostic Interview and the Edinburgh Postnatal Depression Scale (EPDS). Anxiety and depression diagnoses were compared with EPDS scores. Of the 145 women (78% recruitment rate), 138 (95%) provided complete data of whom 35 (25%) had at least one anxiety disorder. EPDS scores over 12 correctly identified 28 women (44%) as having major depression, either alone or co-morbid with an anxiety disorder but 10 (16%) had only an anxiety disorder and were not depressed. All of the 26 (41%) women with EPDS scores over 12 with neither diagnosis met diagnostic criteria for minor depression or an adjustment disorder. EPDS scores were unable to distinguish between these diagnostic groups. The presumption that EPDS scores over 12 indicate only probable depression is an oversimplification. Current national initiatives recommend that EPDS scores over 12 warrant treatment for depression, which may lead to inappropriate labeling and therapy.
Similar content being viewed by others
References
Adewuya A, Afolabi O (2005) The course of anxiety and depressive symptoms in Nigerian postpartum women. Arch Womens Ment Health 8:257–259
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. 4th Edition. American Psychiatric Association, Washington, DC
Andrews G, Peters L (1998) The psychometric properties of the Composite International Diagnostic Interview. Soc Psychiatry Psychiatr Epidemiol 33:80
Austin M-P (2004) Antenatal screening and early intervention for “perinatal’ distress, depression and anxiety: where to from here? Arch Womens Ment Health 7:7
Austin M-P, Lumley J (2003) Antenatal screening for postnatal depression: a systematic review. Acta Psychiatr Scand 107:10–17
Austin M-P, Priest S (2005) Clinical issues in perinatal mental health: new developments in the detection and treatment of perinatal mood and anxiety. Acta Psychiatr Scand 112:97–104
Ayers S (2001) Assessing psychopathology in pregnancy and postpartum. J Psychosom Obstet Gynaecol 22:91–102
beyondblue National Depression Initiative (2007) Fact sheet 22—postnatal depression. Accessed 23 June
Boyce P, Stubbs J, Todd A (1993) The Edinburgh Postnatal Depression Scale: validation for an Australian sample. Aust NZ J Psychiatry 27:472–476
Boyd RC, Le HN, Somberg R (2005) Review of screening instruments for postpartum depression. Arch Womens Ment Health 8:13
Brockington I (2004) Postpartum psychiatric disorders. Lancet 363:8
Brockington I, Kumar C, eds (1982) Motherhood and mental illness. Academic Press, London
Brockington I, Macdonald E, Wainscott G (2006) Anxiety, obsessions and morbid preoccupations in pregnancy and the puerperium. Arch Womens Ment Health 9:253–263
Brouwers EPM, van Baar AL, Pop VJM (2001) Does the Edinburgh Postnatal Depression Scale measure anxiety? J Psychosom Res 51:659–663
Buist A, Bilszta J (2006) The beyondblue National Postnatal Depression Program. Prevention and Early Intervention 2001–2005. Final Report. Volume 1. National Screening Program Accessed 23 June 2007
Cox J, Holden J, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786
Eberhard-Gran M, Eskild A, Kristian T, Opjordsmoen S, Samulesen S (2001) Review of validation studies of the Edinburgh Postnatal Depression Scale. Acta Psychiatr Scand 104:243–249
Fisher J, Rowe H (2004) Building an evidence base for practice in early parenting centers. A systematic review of the literature and a report of an outcome study. Melbourne, Key Centre for Women’s Health in Society, School of Population Health, University of Melbourne
Fisher J, Feekery C, Rowe H (2003) Treatment of maternal mood disorder and infant behaviour disturbance in an Australian private mothercraft unit: a follow-up study. Arch Womens Ment Health 7(Suppl 1):s1–s5
Fisher J, Feekery CJ, Amir L, Sneddon M (2002) Health and social circumstances of women admitted to a private mother baby unit. Aust Fam Physician 31:966–973
Fisher JRW, Feekery CJ, Rowe-Murray HJ (2002) Nature, severity and correlates of psychological distress in women admitted to a private mother–baby unit. J Paediatr Child Health 38:140–145
Gair S (1999) Distress and depression in new motherhood: research with adoptive mothers highlights important contributing factors. Child and Family Social Work 4:55–66
Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106:1071–1083
Green JM (1998) Postnatal depression or perinatal dysphoria? Findings from a longitudinal community-based study using the Edinburgh postnatal depression scale. J Reprod Infant Psychol 16:143–155
Hendrick V, Altshuler L, Strouse T, Grosser S (2000) Postpartum and nonpostpartum depression: differences in presentation and response to pharmacologic treatment. Depress Anxiety 11:66–72
Heron J, O’Connor T, Evans J, Golding J, Glover V (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80:65–73
Jones H, Venis J (2001) Identification and classification of postpartum psychiatric disorders. J Psychosoc Nurs Ment Health Serv 39:23–30
Kelly CM, Jorm AF (2007) Stigma and mood disorders. Curr Opin Psychiatry 20:13–16
Kendler K, Walters E, Neale M, Kessler R, Heath A, Eaves L (1995) The structure of the genetic and environmental risk factors for six major psychiatric disorders in women. Phobia, generalized anxiety disorder, panic disorder, bulimia, major depression, and alcoholism. Arch Gen Psychiatry 52:374–383
Lumley J, Austin M-P, Mitchell C (2004) Intervening to reduce depression after birth: a systematic review of the randomized trials. Int J Technol Assess Health Care 20:128–144
Matthey S (2004) Detection and treatment of postnatal depression (perinatal depression or anxiety). Curr Opin Psychiatry 17:21–29
Matthey S, Barnett B, Howie P, Kavanagh D (2003) Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Disord 74:139–147
Miller R, Pallant J, Negri L (2006) Anxiety and stress in the postpartum: is there more to postnatal distress than depression? BMC Psychiatry 6:12
Muzik M, Klier CM, Rosenblum KL, Holzinger A, Umek W, Katschnig H (2000) Are commonly used self-report inventories suitable for screening postpartum depression and anxiety disorders? Acta Psychiatr Scand 102:71–73
National Centre for Classification in Health (1998) The International Statistical Classification of Diseases and Related Health Problems. 10th Revision, Australian Modification (ICD-10, AM) Sydney
Nylen K, Moran T, Franklin C, O'Hara M (2006) Maternal depression: a review of relevant treatment approaches for mothers and infants. Infant Mental Health Journal I 27:327–343
Pitt B (1968) “Atypical” depression following childbirth. Br J Psychiatry 114:1325–1335
Riley M, King J, Davey M (2005) Births in Victoria. Perinatal data collection unit. Public Health Department of Human Services, Victoria
Ross L, McLean L (2006) Anxiety disorders during pregnancy and the postpartum period: a systematic review. J Clin Psychiatry 67:1285–1298
Ross L, Gilbert Evans S, Sellers E, Romach M (2003) Measurement issues in postpartum depression part 1: anxiety as a feature of postpartum depression. Arch Womens Ment Health 6:51–57
Skari H, Skreden M, Malt UF, Dalholt M, Ostensen AB, Egeland T, Emblem R (2002) Comparative levels of psychological distress, stress symptoms, depression and anxiety after childbirth a prospective population-based study of mothers and fathers. BJOG 109:1154–1163
SPSS (2005) Statistical product and service solutions for Windows. Release 14.0.1. SPSS, Chicago
Stuart S, Couser G, Schilder K, O’Hara MW, Gorman L (1998) Postpartum anxiety and depression: onset and comorbidity in a community sample. J Nerv Ment Dis 186:420–424
World Health Organization (1997) Composite International Diagnostic Interview-Auto Version 2.1: administrators’ guide and reference. Training and Reference Centre for WHO CIDI Sydney
Zigmond A, Snaith R (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67:361–370
Acknowledgements
The authors wish to acknowledge the women who generously participated in this research and the staff of the two residential early parenting units for their cooperation. Ms Lauren Matheson, Ms Lara Williamson and Ms Amy Williamson provided research assistance. Funding for the project was awarded by the diamond Consortium, beyondblue Victorian Centre of Excellence in Depression and Related Disorders.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rowe, H.J., Fisher, J.R.W. & Loh, W.M. The Edinburgh Postnatal Depression Scale detects but does not distinguish anxiety disorders from depression in mothers of infants. Arch Womens Ment Health 11, 103–108 (2008). https://doi.org/10.1007/s00737-008-0003-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-008-0003-z