Screening Beyond Postpartum Depression: Occluded Anxiety Component in the EPDS (EPDS-3A) in French Mothers

Abstract

Introduction.According to many studies, anxiety in the perinatal period is widespread and has many detrimental effects. Thus, screening measures should not be limited to assessing depression symptoms. The widely used Edinburgh Postnatal Depression Scale (EPDS) might assess depression but also anxiety symptoms. This study explores whether an anxiety dimension (EPDS-3A) was found and valid in French women during pregnancy and the postpartum period.Methods. French women were followed-up at late pregnancy and 2 and 4 months postpartum (N = 144, 138 and 129). They completed the EPDS and the Hospital Anxiety and Depression Scale (HADS-A). Exploratory factor analyses were performed. Then to test its validity, the EPDS-3A was correlated with anxiety (HADS-A) and depression (EPDS-D) scores. Finally, prevalence estimates were computed according to recommended cut off.Results. The anxiety dimension assessed through the EPDS-3A was observed during the postpartum period but not during pregnancy. A two-factor structure (depression and anxiety) increases the variance explained at 2 and 4 months postpartum (respectively 6 and 12%). The EPDS-3A shows good internal consistency (≥.70) and was more strongly associated with anxiety scores (HADS-A) (.48-.57) than with depression scores (EPDS-D) (.30-.39). Nearly 28% of mothers had scores that exceeded the EPDS-3A cut off (≥ 4) but not the full EPDS cut off (≥ 13 or more).Discussion: The EPDS contains an anxiety component (EPDS-3A) that can be found in French women during the postnatal period but not during pregnancy. It shows signs of internal consistency and validity. The EPDS-3A could be considered when screening for postpartum anxiety.

Profiles of women with postpartum depressive symptoms: A latent profile analysis using the Edinburgh Postnatal Depression Scale factors

“…Sun et al (2019) described different subtypes of perinatal depressive symptoms, considering anhedonia as a distinctive feature between groups. Several authors have also found an anxiety subscale within the EPDS (e.g., Loyal et al, 2020), and indeed, comorbidity between anxiety and depressive symptoms during the postpartum period has been reported in the literature (Falah-Hassani et al, 2016). Thus, heterogeneity in PPD symptoms should also be understood in light of both anhedonia and anxiety symptoms, in addition to depressive symptoms (Sun et al, 2019).…”

Perinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China

“…The accumulative score from the items 3, 4, and 5 in EPDS (EPDS-3A) represents the anxiety dimension. 15,16…”

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

“…The EPDS is a 10-item depression scale, primarily developed to detect depression in the postpartum period, but it is also validated and widely used during pregnancy [21]. It is also used to measure anxiety [5,22,43] and its items address depressive and anxiety symptoms concerning the past seven days. Depending on the trimester, the cut-off score varies worldwide from 6.5 to 14.5, and in the Netherlands, it varies from 10 to 11 [21].…”