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Background:Ten to fifteen percent of women will experience postpartum onset of a major depressive disorder yet systematic screening is often neglected. The Edinburgh Postpartum Depression Screen (EPDS) is widely available, easy to score and has well established reliability and validity. Review of the postpartum depression (PPD) literature indicates that the timing of onset may be highly variable and 25%-50% of cases may arise antenatally. Research also demonstrates significant correlation between EPDS scores administered in the early postpartum period and a later EPDS screen. 

Purpose:One objective of this study was to administer the EPDS on the inpatient units of a large, level two tertiary care center during the immediate postpartum period and compare the results of a 6 weeks repeated screen to examine correlations between the two scores. A second objective of this study was to validate a shorter 2-question screen adaptable to electronic record.

Methods:A convenience sample of patients who delivered a viable infant were given the EPDS, HRSA-UIC Screen and the Postpartum Depression Predictors Inventory-R were given during inpatient stay.  Patients who screened high risk for PPD were provided with a diagnostic interview by the inpatient mental health service. All study participants were provided with one of 3 levels of intervention based on their EPDS score: routine counseling on PPD for low risk scores, targeted counseling for intermediate risk scores, and a diagnostic interview with referral or treatment for high risk scores. Six weeks postpartum patients were sent a second EPDS to return by mail.

Results:One hundred fifty nine completed the initial inpatient screen of which have 57% completed the second screen at 6 weeks. The mean age of mothers was 26.8 years (SD 5.8) and 72% were Caucasian. Forty-one percent of mothers had experienced depression prior to this pregnancy and 36% had felt depressed during this pregnancy. There were 24 (15%) new mothers that scored high risk on the inpatient EPDS of which 18 had a diagnostic interview. At 6 weeks there were 18 mothers, which scored as high risk for postpartum depression. The inpatient EPDS was significantly correlated to the 6-week (r=0.60, p<0.0001) EPDS. Immediate postpartum EPDS and past history of depression were significant predictors of postpartum depression at 6 weeks (p=<0.0001 and p=0.003, respectively). Mothers that had an inpatient EPDS ³10 were 9.6 times more likely to score high risk at 6 weeks (95% CI 3.3 – 28.6). The inpatient EPDS was significantly correlated with the 2-question HRSA-UIC screen (r=0.52, p<0.0001).  Fifty-nine percent of the patients receiving a diagnostics interview (EPDS ³10) had positive diagnosis of depression.

Conclusions:The inpatient EPDS screen in the immediate postpartum period was a significant predictor of maternal mood at the 6 week interval. The 2-question HRSA-UIC screen had a significant correlation with the EPDS and would be a reliable, more concise screen that could be efficiently incorporated into an intake history. Health care professionals can use the EPDS in the immediate postpartum period to evaluate new mothers for depression so that interventions and referral can be integrated into inpatient postpartum care.