Objective To estimate the effect of an interpersonally-oriented intervention on reducing the risk of postpartum depression in primiparous adolescents. Study design Randomized controlled trial of 106 pregnant primiparous adolescents who were 17 years old or younger at their first prenatal visit. Participants were randomized to the intervention (n=54) or the attention and dose-matched control program (n=52). Each program included 5 sessions delivered during the prenatal period. To assess for the primary outcome, depression at 6-weeks, 3-months and 6-months after delivery, a structured diagnostic interview was administered. Results Participants included Hispanic (53%), non-Hispanic black (17%) and non-Hispanic white (16%) adolescents. The overall rate of depression in the intervention group (12.5%) was lower than the control group (25%) with a HR 0.44 (95% CI 0.17–1.15) at 6 months postpartum. Conclusion An intervention delivered during the prenatal period has the potential to reduce the risk for postpartum depression in primiparous adolescent mothers.

WHAT'S KNOWN ON THIS SUBJECT: Studies assessing the accuracy of brief screening tools for postpartum depression have been conducted among adult women; however, no similar validation studies have been conducted among adolescent mothers. Accurate and valid brief depression screening tools are needed for adolescent mothers. WHAT THIS STUDY ADDS:We found that the 10-item Edinburgh Postnatal Depression Scale (EPDS) and 2 subscales, the EPDS-7 and EPDS-2, are highly accurate at identifying postpartum depression among adolescent mothers. In pediatric settings with limited time and resources, these brief scales have potential to be used as effective depression screening tools. abstract OBJECTIVE: To evaluate the accuracy of the Edinburgh Postnatal Depression Scale (EPDS) and 3 subscales for identifying postpartum depression among primiparous adolescent mothers. METHODS:Mothers enrolled in a randomized controlled trial to prevent postpartum depression completed a psychiatric diagnostic interview and the 10-item EPDS at 6 weeks, 3 months, and 6 months postpartum. Three subscales of the EPDS were assessed as brief screening tools: 3-item anxiety subscale (EPDS-3), 7-item depressive symptoms subscale (EPDS-7), and 2-item subscale (EPDS-2) that resemble the Patient Health Questionnaire-2. Receiver operating characteristic curves and the areas under the curves for each tool were compared to assess accuracy. The sensitivities and specificities of each screening tool were calculated in comparison with diagnostic criteria for a major depressive disorder. Repeated-measures longitudinal analytical techniques were used. RESULTS:A total of 106 women contributed 289 postpartum visits; 18% of the women met criteria for incident postpartum depression by psychiatric diagnostic interview. When used as continuous measures, the full EPDS, EPDS-7, and EPDS-2 performed equally well (area under the curve .0.9). Optimal cutoff scores for a positive depression screen for the EPDS and EPDS-7 were lower ($9 and $7, respectively) than currently recommended cutoff scores ($10). At optimal cutoff scores, the EPDS and EPDS-7 both had sensitivities of 90% and specificities of .85%. CONCLUSIONS:The EPDS, EPDS-7, and EPDS-2 are highly accurate at identifying postpartum depression among adolescent mothers. In primary care pediatric settings, the EPDS and its shorter subscales have potential for use as effective depression screening tools.

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