Construct Validity and Responsiveness of Instruments Measuring Depression and Anxiety in Pregnancy: A Comparison of EPDS, HADS-A and CES-D

Abstract

Depression and anxiety occur frequently in pregnancy and may have unfavourable consequences for mother and child. Therefore, adequate symptom measurement seems important. Commonly used instruments are the Center for Epidemiologic Studies Depression Scale (CES-D), the Edinburgh Postpartum Depression Scale (EPDS), and the Hospital Anxiety and Depression Scale, anxiety subscale (HADS-A). We compared the (1) structural and (2) longitudinal validity of these instruments. The data originated from a study on the effectiveness of an Internet intervention for pregnant women with affective symptoms. (1) A confirmatory factor analysis was used to estimate the construct validity. The theoretical factorial structure that was defined in earlier studies of the CES-D and the EPDS, but not the HADS-A, could be sufficiently replicated with acceptable CFI and RMSEA values. (2) Since there were two measurements in time, the hypotheses concerning plausible directions of the change scores of subscales that were (un)related to each other could be formulated and tested. In this way, longitudinal validity in the form of responsiveness was estimated. Ten of sixteen hypotheses were confirmed, corroborating the longitudinal validity of all constructs, except anhedonia, probably due to inconsistent conceptualization. The HADS-A seems less suitable to screen for anxiety in pregnancy. Anhedonia needs better conceptualisation to assess the change of symptoms over time with the CES-D and the EPDS.

A Psychometric Study of the Perinatal Assessment of Maternal Affectivity (PAMA) for the Screening of Perinatal Affective Disorders in Mothers

“…Specifically, PAMA scores strongly and positively correlated with scores on measures of depression, perceived stress and global severity of psychological symptoms. These results constitute an evidence of validity for the PAMA as they highlight, first of all, the association between a measure on perinatal symptomatology and a very well-known depression measure, the CES-D, as frequently reported by the literature [ 65 ]. Another interesting result was the association between higher perinatal maternal symptomatology and higher levels of perceived stress, which is consistent with the findings of previous studies [ 66 , 67 ].…”

Comparison of dolutegravir and efavirenz on depression, anxiety and sleep disorders in pregnant and postpartum women living with HIV

“…In our study, a different rate of depression symptoms was noted in the EPDS and HADS questionnaires. In a Dutch cohort of pregnant women the HADS-a, EPDS and other screening tools were assessed and showed a low performance of the HADS-a [ 18 ]. Moreover, psychometric analysis of the HADS score, showed poor test-retest reliability in a pregnant cohort.…”

Maternal per- and poly-fluoroalkyl substances exposures associated with higher depressive symptom scores among immigrant women in the Chemicals in Our Bodies cohort in San Francisco

“…Our study had several limitations. First, our indicator of depression was based on self-report and we do not have a clinical confirmed depression outcome measure; however, the CES-D is validated and has been widely used during pregnancy (Heller et al, 2022). Second, our study design was cross-sectional as serum samples and the CES-D were collected at the same second trimester visit, which raises potential temporality issues related to PFAS exposures and depressive symptom outcomes.…”