Abstract
Perinatal depression currently receives considerable attention, but not all perinatal women presenting for psychiatric care are depressed. The Edinburgh Postnatal Depression Scale (EPDS) is now routinely administered, but high scores are interpreted as evidence for depressive illness only. This study examined psychiatric diagnoses and mean EPDS scores among perinatal women at a tertiary center. Women accessing care between March 2006 and June 2008 completed a clinical diagnostic interview and the EPDS. Mean EPDS scores were calculated for each psychiatric diagnosis; sensitivity and specificity were calculated for major depressive episode (MDE) and generalized anxiety disorder (GAD). The majority of the sample (N = 91), 49.5%, had GAD comorbid with MDE or another anxiety disorder, followed by MDE (38.5%) comorbid with an anxiety disorder. One third (29.7%) met criteria for MDE and GAD. Only 3.3% had MDE alone and 5.5% had GAD alone. Half the sample (50.5%) had more than one psychiatric disorder. Mean EPDS scores exceeded 11 for the majority of diagnostic groups. Sensitivity of the EPDS for MDE was 0.78 and 0.70 for GAD. Most women had an anxiety disorder and met criteria for more than one psychiatric disorder. Mean EPDS scores were consistently high. Sensitivity of the EPDS for MDE and GAD was comparable.
Similar content being viewed by others
References
Austin MP (2004) Antenatal screening and early intervention for “perinatal” distress, depression and anxiety: where to from here? Archives of Womens Mental Health 7:1–6
Battle CL, Zlotnick C, Miller IW et al (2006) Clinical characteristics of perinatal patients, a chart review study. Journal of Nervous and Mental Disorders 194:369–377
Bowen A, Bowen R, Maslany G et al (2008) Anxiety in a socially high-risk sample of pregnant women in Canada. Can J Psychiatry 53:435–440
Brouwers EP, van Baar AL, Pop VJ (2001) Does the Edinburgh Postnatal Depression Scale measure anxiety? J Psychosom Res 51:659–663
Carter AS, Garrity-Rokous FE, Chazan-Cohen R et al (2001) Maternal depression and comorbidity: predicting early parenting, attachment security, and toddler social–emotional problems and competencies. J Am Acad Child Adolesc Psychiatry 40:18–26
Coleman V, Carter M, Morgan M et al (2008) Obstetrician–gynecologists' screening patterns for anxiety during pregnancy. Depress Anxiety 25:114–123
Cox JL, Holden JM, Sagovsky R (1987) Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786
Eberhard-Gran M, Tambs K, Opjordsmoen S et al (2003) A comparison of anxiety and depressive symptomatology in postpartum and non-postpartum mothers. Soc Psychiatry Psychiatr Epidemiol 38:551–556
Gaynes BN, Gavin N, Meltzer-Brody S, et al. (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes—Agency for Healthcare Research and Quality. Evidence Report/Technology Assessment 119. ARHQ, Rockville, MD. AHRQ Publication 05-E006-2. http://www.ahrq.gov/downloads/pub/evidence/pdf/peridepr/peridep.pdf. Accessed 17 October 2008
Gibson J, McKenzie-McHarg K, Shakespeare J et al (2009) A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand 119:350–364
Grant K, McMahon C, Austin MP (2008) Maternal anxiety during the transition to parenthood: a prospective study. J Affect Disord 108:101–111
Grant KA, McMahon C, Reilly N, Austin MP (2010) Maternal sensitivity moderates the impact of prenatal anxiety disorder on infant mental development. Early Hum Dev 86:551–556, Epub 2010 Aug 14
Heron J, O’Connor TG, Evans J et al (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80:65–73
Huizink AC, Mulder EJH, Robles de Medina PG et al (2004) Is pregnancy anxiety a distinctive syndrome? Early Hum Dev 79:81–91
Loveland Cook CA, Flick LH, Horman SM et al (2004) Posttraumatic stress disorder in pregnancy: prevalence, risk factors and treatment. Obstet Gynecol 103:710–717
Matthey S, Barnett B, Howie P et al (2003) Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Disord 74:139–147
Montazeri A, Torkan B, Omidvari S (2007) The Edinburgh Postnatal Depression Scale (EPDS): translation and validation study of the Iranian version. BMC Psychiatry 7:11
Muzik M, Klier C, Rosenblum K et al (2000) Are commonly used self-report inventories suitable for screening postpartum depression and anxiety disorders? Acta Psychiatr Scand 102:71–73
Navarro P, Ascaso C, Garcia-Esteve L et al (2007) Postnatal psychiatric morbidity: a validation study of the GHQ- 12 and the EPDS as screening tools. Gen Hosp Psychiatry 29:1–7
Navarro P, García-Esteve L, Ascaso C et al (2008) Non-psychotic psychiatric disorders after childbirth: prevalence and comorbidity in a community sample. J Affect Disord 109:171–176
O’Connor TG, Heron J, Glover V (2002) Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. J Am Acad Child Adolesc Psychiatry 41:1470–1477
O’Hara MW, Swain AM (1996) Rates and risk of postpartum depression—a meta analysis. Int Rev Psychiatry 8:37–54
Phillips J, Charles M, Sharpe L, Matthey S (2009) Validation of the subscales of the Edinburgh Postnatal Depression Scale in a sample of women with unsettled infants. J Affect Disord 118(1–3):101–112
Reck C, Struben K, Backenstrass M et al (2008) Prevalence, onset, and comorbidity of postpartum anxiety and depressive disorders. Acta Psychiatr Scand 118:459–468
Ross LE, McLean LM (2006) Anxiety disorders during pregnancy and the postpartum period: a systematic review. J Clin Psychol 67:1286–1298
Rowe H, Fisher J, Loh W (2008) 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
Sheehan DV, Lecrubier Y, Sheehan KH et al (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59:22–33
Smith MV, Rosenheck RA, Cavaleri MA et al (2004) Screening for and detection of depression, panic disorder, and PTSD in public-sector obstetric clinics. Psychiatr Serv 55:407–414
Stuart S, Couser G, Schilder K et al (1998) Postpartum anxiety and depression: onset and comorbidity in a community sample. J Nerv Ment Dis 186:420–424
Sutter-Dallay AL, Giaconne-Marcesche V, Glatigny-Dallay E et al (2004) Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort. Eur Psychiatry 19:459–463
Tuohy A, McVey C (2008) Subscales measuring symptoms of non-specific depression, anhedonia, and anxiety in the Edinburgh Postnatal Depression Scale. Br J Clin Psychol 47(Pt 2):153–169
Wenzel A, Gorman L, O’Hara MW et al (2001) The occurrence of panic and obsessive compulsive symptoms in women with postpartum dysphoria: a prospective study. Arch Womens Ment Health 4:5–12
Wenzel A, Haugen EN, Jackson LC et al (2003) Prevalence of generalized anxiety at eight weeks postpartum. Arch Womens Ment Health 6:43–49
Wenzel A, Haugen EN, Jackson LC et al (2005) Anxiety symptoms and disorders at eight weeks postpartum. J Anxiety Disord 19:295–311
Zar M, Wijma K, Wijma B (2002) Relations between anxiety disorders and fear of childbirth during late pregnancy. Clin Psychol Psychother 9:122–130
Funding, support, and acknowledgments
The authors would like to thank Women’s College Hospital for internal funding to support this project, Drs. Svetlana Emilianova and Jasmine Gandhi for their assistance with recruitment, Tasha Schumann and Laura Orlando for assisting with various phases of the work, and all the patients who contributed their time to this project at a very difficult time in their lives.
Dr. Grigoriadis has a New Investigator Award in Women's Health Research from the Canadian Institutes of Health Research (CIHR, NOW-182838) in partnership with the Ontario Women's Health Council. Dr. L. Ross is supported by a New Investigator Award from CIHR and the Ontario Women’s Health Council, Award NOW-84656. In addition, support to CAMH for salary of scientists and infrastructure has been provided by the Ontario Ministry of Health and Long-Term Care. The views expressed here do not necessarily reflect those of the Ministry of Health and Long-Term Care.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Grigoriadis, S., de Camps Meschino, D., Barrons, E. et al. Mood and anxiety disorders in a sample of Canadian perinatal women referred for psychiatric care. Arch Womens Ment Health 14, 325–333 (2011). https://doi.org/10.1007/s00737-011-0223-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-011-0223-5