We recommend that i) the validated score of 13 or more is used when reporting on probable major depression in postnatal English-speaking women, and 15 or more when reporting on antenatal English-speaking women; ii) that the wording used is "13 or more" (or equivalent), and not other terms that may cause confusion (e.g., '>12'; 'more than 12'; '13' etc), iii) if a different cut-off score to the validated one is used, a clear explanation is given as to why this has been done; and iv) that the scale should be worded and formatted as originally described by its authors.

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This paper reviews the range of symptoms, timing and measurement of mood disturbance in the early puerperium. The prevalence and risk factors for postpartum blues and elation are discussed. The most convincing relationships are between blues and dysphoria during pregnancy, a past history of depression, neuroticism and premenstrual depression. Biological research is inconclusive. Blues and elation are predictors of subsequent postpartum depression and appear to be an index of affective vulnerability.

BackgroundInsecure attachment style relates to major depression in women, but its relationship to depression associated with childbirth is largely unknown. A new UK-designed measure, the Attachment Style Interview (ASI), has potential for cross-cultural use as a risk marker for maternal disorder.AimsTo establish the reliability of the ASI across centres, its stability over a 9-month period, and its associations with social context and majoror minor depression.MethodThe ASI was used by nine centres antenatally on 204 women, with 174 followed up 6 months postnatally. Interrater reliability was tested and the ASI was repeated on a subset of 96 women. Affective disorder was assessed by means of the Structured Clinical Interview for DSM–IV.ResultsSatisfactory interrater reliability was achieved with relatively high stability rates at follow-up. Insecure attachment related to lower social class position and more negative social context. Specific associations of avoidant attachment style (angry–dismissive or withdrawn) with antenatal disorder, and anxious style (enmeshed or fearful) with postnatal disorder were found.ConclusionsThe ASI can be used reliably in European and US centres as a measure for risk associated with childbirth. Its use will contribute to theoretically underpinned preventive action for disorders associated with childbirth.