The Edinburgh Postpartum Depression Scale: Stable structure but subscale of limited value to detect anxiety

English version

Autoři: Angarath I. van der Zee-van den Berg ^aff001; Magda M. Boere-Boonekamp ^aff001; Catharina G. M. Groothuis-Oudshoorn ^aff001; Sijmen A. Reijneveld ^aff002
Působiště autorů: Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands ^aff001; Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands ^aff002
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0221894

Souhrn

Purpose

The Edinburgh Postnatal Depression Scale (EPDS) aims at detecting postpartum depression. It has been hypothesized that a subscale (items 3, 4, 5) may detect anxiety. The aim of this study is to assess whether this EPDS anxiety subscale is present in a community-based dataset, and if so, to assess its validity and stability during the first six months postpartum.

Methods

We obtained EPDS data of a community sample of 1612 women at 1 month, with follow-up at 3 and 6 months, postpartum (Post-Up study). We performed an exploratory factor analysis on the EPDS forcing two- and three-factor solutions. We assessed the correlations of the extracted factor subscales and the total EPDS with the short-form of the STAI (STAI-6). We examined the stability of the identified factors by means of a confirmatory factor analysis (CFA), using the EPDS data collected at 3 and 6 months postpartum.

Results

Both the two- and three-factor solutions contained a hypothesized anxiety subscale of items 3,4,5,10, and fitted well with the 3- and 6-months EPDS data, with CFI and TLI values >.99 and RMSEA and SRMR values < .035 and < .45. The subscale’s Pearson correlations with the STAI-6 were moderate: .516, compared to .643 for the total EPDS.

Conclusions

The factor structure of the EPDS is stable across the first six months postpartum, and includes the subscale assumed to represent anxiety. However, this subscale as well as the total EPDS correlate only moderately with anxiety criteria. Using the EPDS thus does not imply adequate screening for anxiety.

Klíčová slova:

Biology and life sciences – Physical sciences – Research and analysis methods – Psychology – Social sciences – People and places – Population groupings – Mathematics – Medicine and health sciences – Women's health – Maternal health – Birth – Obstetrics and gynecology – Pregnancy – Statistics – Mathematical and statistical techniques – Statistical methods – Metaanalysis – Mental health and psychiatry – Emotions – Anxiety – Mood disorders – Depression – Ethnicities – European people – Factor analysis – Algebra – Linear algebra – Eigenvalues – Dutch people

Zdroje

1. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106(5 Pt 1):1071–83. Epub 2005/11/02. doi: 10.1097/01.AOG.0000183597.31630.db. 16260528.

2. Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry. 2017;210(5):315–23. Epub 2017/03/18. doi: 10.1192/bjp.bp.116.187179. 28302701.

3. Falah-Hassani K, Shiri R, Dennis CL. The prevalence of antenatal and postnatal co-morbid anxiety and depression: a meta-analysis. Psychological medicine. 2017;47(12):2041–53. Epub 2017/04/18. doi: 10.1017/S0033291717000617. 28414017.

4. Prenoveau J, Craske M, Counsell N, West V, Davies B, Cooper P, et al. Postpartum GAD is a risk factor for postpartum MDD: the course and longitudinal relationships of postpartum GAD and MDD. Depress Anxiety. 2013;30(6):506–14. Epub 2013/01/05. doi: 10.1002/da.22040. 23288653; PubMed Central PMCID: PMC3738937.

5. van der Waerden J, Galera C, Saurel-Cubizolles MJ, Sutter-Dallay AL, Melchior M. Predictors of persistent maternal depression trajectories in early childhood: results from the EDEN mother-child cohort study in France. Psychological medicine. 2015;45(9):1999–2012. Epub 2015/02/14. doi: 10.1017/S003329171500015X. 25678201.

6. van der Waerden J, Galera C, Larroque B, Saurel-Cubizolles MJ, Sutter-Dallay AL, Melchior M. Maternal Depression Trajectories and Children's Behavior at Age 5 Years. The Journal of pediatrics. 2015;166(6):1440–8.e1. Epub 2015/04/14. doi: 10.1016/j.jpeds.2015.03.002. 25866387.

7. Netsi E, Pearson RM, Murray L, Cooper P, Craske MG, Stein A. Association of Persistent and Severe Postnatal Depression With Child Outcomes. JAMA psychiatry. 2018;75(3):247–53. Epub 2018/02/02. doi: 10.1001/jamapsychiatry.2017.4363. 29387878; PubMed Central PMCID: PMC5885957.

8. Milgrom J, Gemmill AW. Identifying perinatal depression and anxiety: Evidence-based practice in screening, psychosocial assessment and management: John Wiley & Sons; 2015.

9. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–6. Epub 1987/06/01. doi: 10.1192/bjp.150.6.782 3651732.

10. Myers ER, Aubuchon-Endsley N, Bastian LA, Gierisch JM, Kemper AR, Swamy GK, et al. Efficacy and Safety of Screening for Postpartum Depression. AHRQ Comparative Effectiveness Reviews. Rockville (MD)2013.

11. Kozinszky Z, Toreki A, Hompoth EA, Dudas RB, Nemeth G. A more rational, theory-driven approach to analysing the factor structure of the Edinburgh Postnatal Depression Scale. Psychiatry Res. 2017;250:234–43. Epub 2017/02/09. doi: 10.1016/j.psychres.2017.01.059. 28167438.

12. Coates R, Ayers S, de Visser R. Factor structure of the Edinburgh Postnatal Depression Scale in a population-based sample. Psychol Assess. 2017;29(8):1016–27. Epub 2016/10/28. doi: 10.1037/pas0000397. 27736124.

13. Matthey S. Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders. Depress Anxiety. 2008;25(11):926–31. Epub 2007/11/28. doi: 10.1002/da.20415. 18041072.

14. Phillips J, Charles M, Sharpe L, Matthey S. Validation of the subscales of the Edinburgh Postnatal Depression Scale in a sample of women with unsettled infants. J Affect Disord. 2009;118(1–3):101–12. Epub 2009/03/12. doi: 10.1016/j.jad.2009.02.004. 19275960.

15. Rowe HJ, Fisher JR, Loh WM. The Edinburgh Postnatal Depression Scale detects but does not distinguish anxiety disorders from depression in mothers of infants. Arch Womens Ment Health. 2008;11(2):103–8. Epub 2008/05/09. doi: 10.1007/s00737-008-0003-z. 18463939.

16. van der Zee-van den Berg AI, Boere-Boonekamp MM, Groothuis-Oudshoorn CGM, MJ IJ, Haasnoot-Smallegange RME, Reijneveld SA. Post-Up Study: Postpartum Depression Screening in Well-Child Care and Maternal Outcomes. Pediatrics. 2017;140(4). doi: 10.1542/peds.2017-0110. 28882876.

17. Pop VJ, Komproe IH, van Son MJ. Characteristics of the Edinburgh Post Natal Depression Scale in The Netherlands. J Affect Disord. 1992;26(2):105–10. Epub 1992/10/01. 1447427.

18. Marteau TM, Bekker H. The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). The British journal of clinical psychology / the British Psychological Society. 1992;31 (Pt 3):301–6. Epub 1992/09/01. 1393159.

19. van der Bij AK, de Weerd S, Cikot RJ, Steegers EA, Braspenning JC. Validation of the dutch short form of the state scale of the Spielberger State-Trait Anxiety Inventory: considerations for usage in screening outcomes. Community genetics. 2003;6(2):84–7. Epub 2003/10/16. doi: 10.1159/000073003. 14560068.

20. Costello AB, Osborne JW. Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. practical assessment, research & evaluation [Internet]. 2005; 10(7):[1–9 pp.].

21. Osborne JW. Best practices in exloratory factor analysis. [Louisville, Ky.]: [CreateSpace Independent Publishing Platform]; 2014.

22. van der Ploeg HM. Handleiding bij de Zelf-Beoordelings Vragenlijst, een Nederlandse bewerking van de Spielberger Stait-Trait Anxiety Inventory, STAI-DY, ed 2. Lisse, Swets en Zeitlinger. 2000.

23. de Jong-Potjer LC, Elsinga J, le Cessie S, van der Pal-de Bruin KM, Neven AK, Buitendijk SE, et al. GP-initiated preconception counselling in a randomised controlled trial does not induce anxiety. BMC family practice. 2006;7:66-. doi: 10.1186/1471-2296-7-66. 17083722.

24. Lt Hu, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal. 1999;6(1):1–55. doi: 10.1080/10705519909540118

25. Jackson DL, Gillaspy JA, Purc-Stephenson R. Reporting practices in confirmatory factor analysis: an overview and some recommendations. Psychological methods. 2009;14(1):6–23. Epub 2009/03/11. doi: 10.1037/a0014694. 19271845.

26. Rosseel Y. lavaan: An R Package for Structural Equation Modeling. 2012. 2012;48(2):36. Epub 2012-05-24. doi: 10.18637/jss.v048.i02

27. Netherlands S. Childbirth: key figures 2013.

28. UNESCO_Institute_for_Statistics. International Standard Classification of Education (ISCED 2011). 2012.

29. Bina R, Harrington D. The Edinburgh Postnatal Depression Scale: Screening Tool for Postpartum Anxiety as Well? Findings from a Confirmatory Factor Analysis of the Hebrew Version. Matern Child Health J. 2016;20(4):904–14. Epub 2015/12/10. doi: 10.1007/s10995-015-1879-7. 26649883.

30. Gollan JK, Wisniewski SR, Luther JF, Eng HF, Dills JL, Sit D, et al. Generating an efficient version of the Edinburgh Postnatal Depression Scale in an urban obstetrical population. J Affect Disord. 2017;208:615–20. Epub 2016/11/09. doi: 10.1016/j.jad.2016.10.013. 27823853; PubMed Central PMCID: PMC5697759.

31. Kubota C, Okada T, Aleksic B, Nakamura Y, Kunimoto S, Morikawa M, et al. Factor structure of the Japanese version of the Edinburgh Postnatal Depression Scale in the postpartum period. PLoS One. 2014;9(8):e103941. Epub 2014/08/05. doi: 10.1371/journal.pone.0103941. 25089523; PubMed Central PMCID: PMC4121230.

32. Downe SM, Butler E, Hinder S. Screening tools for depressed mood after childbirth in UK-based South Asian women: A systematic review. Journal of Advanced Nursing. 2007;57(6):565–83. doi: 10.1111/j.1365-2648.2006.04028.x 17346316

33. Astbury J, Brown S, Lumley J, Small R. Birth events, birth experiences and social differences in postnatal depression. Australian journal of public health. 1994;18(2):176–84. Epub 1994/06/01. 7948335.

34. Cunningham NK, Brown PM, Page AC. Does the Edinburgh Postnatal Depression Scale measure the same constructs across time? Arch Womens Ment Health. 2015;18(6):793–804. Epub 2014/12/17. doi: 10.1007/s00737-014-0485-9. 25510935.

35. Brouwers EP, van Baar AL, Pop VJ. Does the Edinburgh Postnatal Depression Scale measure anxiety? Journal of psychosomatic research. 2001;51(5):659–63. Epub 2001/12/01. PubMed PMID: 11728506. doi: 10.1016/s0022-3999(01)00245-8 11728506

36. Green JM. Postnatal depression or perinatal dysphoria? Findings from a longitudinal community-based study using the Edinburgh Postnatal Depression Scale. J Reprod Infant Psyc. 1998;16(2–3):143–55. doi: 10.1080/02646839808404565

37. Stuart S, Couser G, Schilder K, O'Hara MW, Gorman L. Postpartum anxiety and depression: onset and comorbidity in a community sample. J Nerv Ment Dis. 1998;186(7):420–4. Epub 1998/07/29. doi: 10.1097/00005053-199807000-00006 9680043.

38. Navarro P, Ascaso C, Garcia-Esteve L, Aguado J, Torres A, Martin-Santos R. Postnatal psychiatric morbidity: a validation study of the GHQ-12 and the EPDS as screening tools. Gen Hosp Psychiatry. 2007;29(1):1–7. Epub 2006/12/27. doi: 10.1016/j.genhosppsych.2006.10.004. 17189737.

39. Stasik-O'Brien SM, McCabe-Beane JE, Segre LS. Using the EPDS to Identify Anxiety in Mothers of Infants on the Neonatal Intensive Care Unit. Clinical nursing research. 2017:1054773817740532. Epub 2017/11/07. doi: 10.1177/1054773817740532. 29103314.

40. Bowen A, Bowen R, Maslany G, Muhajarine N. Anxiety in a socially high-risk sample of pregnant women in Canada. Canadian journal of psychiatry Revue canadienne de psychiatrie. 2008;53(7):435–40. doi: 10.1177/070674370805300708 18674401

41. Holgado–Tello FP, Chacón–Moscoso S, Barbero–García I, Vila–Abad E. Polychoric versus Pearson correlations in exploratory and confirmatory factor analysis of ordinal variables. Quality & Quantity. 2010;44(1):153–66. doi: 10.1007/s11135-008-9190-y

42. Elwood LS, Wolitzky-Taylor K, Olatunji BO. Measurement of anxious traits: a contemporary review and synthesis. Anxiety, stress, and coping. 2012;25(6):647–66. Epub 2011/06/07. doi: 10.1080/10615806.2011.582949. 21644113.

43. Gros DF, Antony MM, Simms LJ, McCabe RE. Psychometric properties of the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA): comparison to the State-Trait Anxiety Inventory (STAI). Psychol Assess. 2007;19(4):369–81. Epub 2007/12/19. doi: 10.1037/1040-3590.19.4.369. 18085930.

44. Richerson JE, Simon GR, Abularrage JJ, Boudreau ADA, Baker CN, Barden GA, et al. 2017 Recommendations for Preventive Pediatric Health Care. Pediatrics. 2017;139(4). doi: 10.1542/peds.2017-0254 28213605

45. Siu AL, Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, et al. Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. Jama. 2016;315(4):380–7. Epub 2016/01/28. doi: 10.1001/jama.2015.18392. 26813211.