Development of a Prenatal Psychosocial Screening Tool for
Post-Partum Depression and Anxiety
Sheila McDonalda, Jennifer Walle, Kaitlin Forbesa, Dawn Kingstond, Heather Kehlerc, Monica Vekveda,c and Suzanne Tougha,b Departments of aPaediatrics and bCommunity Health Sciences, Faculty of Medicine, University of Calgary, cPublic Health Innovation and Decision Support, Population and Public Health, Alberta Health Services, Calgary, dFaculty of Nursing, University of Alberta, Edmonton, Alberta, and eFaculty of Law, University of Toronto, Toronto, Ontario, Canada
Sheila McDonald, Child
Development Centre, Alberta
Children’s Hospital, c/o 2888
Shaganappi Trail, NW,
Calgary, Alberta, Canada T3B
McDonald S, Wall J, Forbes K, Kingston D, Kehler H, Vekved M, Tough S. Development of a prenatal psychosocial screening tool for post-partum depression and anxiety. Paediatric and Perinatal Epidemiology 2012; 26: 316–327.
Background: Post-partum depression (PPD) is the most common complication of pregnancy in developed countries, affecting 10–15% of new mothers. There has been a shift in thinking less in terms of PPD per se to a broader consideration of poor mental health, including anxiety after giving birth. Some risk factors for poor mental health in the post-partum period can be identiﬁed prenatally; however prenatal screening tools developed to date have had poor sensitivity and speciﬁcity. The objective of this study was to develop a screening tool that identiﬁes women at risk of distress, operationalized by elevated symptoms of depression and anxiety in the post-partum period using information collected in the prenatal period.
Methods: Using data from the All Our Babies Study, a prospective cohort study of pregnant women living in Calgary, Alberta (N = 1578), we developed an integer scorebased prediction rule for the prevalence of PPD, as deﬁned as scoring 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS) at 4-months postpartum. Results: The best ﬁt model included known risk factors for PPD: depression and stress in late pregnancy, history of abuse, and poor relationship quality with partner. Comparison of the screening tool with the EPDS in late pregnancy showed that our tool had signiﬁcantly better performance for sensitivity. Further validation of our tool was seen in its utility for identifying elevated symptoms of postpartum anxiety. Conclusion: This research heeds the call for further development and validation work using psychosocial factors identiﬁed prenatally for identifying poor mental health in the post-partum period.
Keywords: screening, psychosocial, prenatal, post-partum depression, post-partum anxiety.
Post-partum depression (PPD) is a non-psychotic
depressive disorder occurring in women during the
post-partum period. The Diagnostic and Statistical
Manual1 classiﬁes post-partum-onset depression as
beginning within 4 weeks of childbirth; however, most
researchers classify PPD as beginning within the ﬁrst 6
months or the ﬁrst year post partum.2 Populationbased studies examining PPD in the ﬁrst 6 months after birth report a prevalence of 10–18% using a
variety of standardised and validated assessment
tools.3 However, recent Canadian data from the Mater-
nity Experiences Survey report a prevalence of 13 on the Edinburgh Postnatal Depression Scale (EPDS).4 Differences across studies in
methodology, diagnostic criteria, period vs. point
prevalence estimates, and timing of assessment exist,
yielding wide ranges in prevalence rates5 and rendering it difﬁcult to make comparisons across populations. Other issues concern timing of onset of symptoms; for
example, a recent study found that among women presenting with PPD within the ﬁrst post-partum year, 11.5%, 66.5% and 22% had symptom onset during
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