Screening for postnatal depression using the double-test strategy

Objective: Postnatal depression affects 10% to 15% of women after childbirt h. Self-report rating instruments, such as the Edinburgh Postnatal Depressi on Scale (EPDS), have been developed and administered to postpartum women t o facilitate early detection. Most postnatal depression screening scales, h owever, focus solely on depressive symptomatology. We hypothesized that app lying two complementary rating scales of symptoms and functioning as a doub le test would significantly enhance the positive predictive value of screen ing. Methods: A prospective cohort study was conducted at the postnatal cli nic of a university teaching hospital. One hundred forty-five Chinese women completed the EPDS and 12-item General Health questionnaire (GHQ) 6 weeks after delivery. They were then interviewed by a psychiatrist, who used the Structured Clinical Interview for third revised edition of the Diagnostic a nd Statistical Manual of Menial Disorders, nonpatient version (SCID-NP), to validate the diagnoses. Results: The positive predictive Value of the EPDS and GHQ, when administered independently, was 44% and 52%, respectively, a t their respective optimal cutoff scores. When the EPDS-GHQ double test was administered, the positive predictive value was significantly increased to 78%. Conclusions: Simultaneous administration of the EPDS and GHQ can subs tantially improve-identification of women with postnatal depression. This c all potentially reduce unnecessary referrals to general practitioners and p sychiatrists and may enhance the overall cost-effectiveness of population-w ide screening.