Does the Edinburgh Postnatal Depression Scale (EPDS) identify antenatal depression and antenatal anxiety disorders? A validation study in Singapore.

OBJECTIVE

Research on the usage of the Edinburgh Postnatal Depression Scale (EPDS) to detect common antenatal mental disorders in pregnant women attending outpatient clinics in Singapore is limited. This study aimed to investigate the psychometric properties of the EPDS in screening for antenatal depression (AND) and anxiety disorders.

METHOD: 250 pregnant women from two national public obstetric clinics were included. The EPDS and EPDS-3A were validated against the Mini International Neuropsychiatric Interview (MINI) by analyzing key parameters at different cutoffs and obtaining the receiver operating characteristic analysis. Multivariable analysis was used to identify possible risk factors of AND.

RESULTS

The prevalence of AND and anxiety disorders was 4.4 % and 3.3 %, respectively. The EPDS demonstrated strong psychometric performance in screening for both conditions, with an Area Under the Curve (AUC) of 0.927 for depression and 0.829 for anxiety. In contrast, the EPDS-3A was not recommended as a screening tool due to its relatively poor psychometric properties. For clinical applicability of AND screening using EPDS in a busy outpatient clinic, a cutoff >11 is recommended, followed by further assessment and tiered care based on needs. Being a member of minority ethnic group was the only risk factor identified for AND in our study population.

CONCLUSION

EPDS performs well in screening for antenatal depression and anxiety disorders; however, further assessment is important.