Validation of the Edinburgh Postnatal Depression Scale and its 3-item anxiety subscale, and the Generalised Anxiety Disorder-7 item for screening of postpartum depression and anxiety in women in Malta.

Abstract

Background & aim: Perinatal mental health disorders are common complications of pregnancy and the postpartum period. The value of screening for their early detection is well-recognized, but to-date, research-validated mental health measures for postpartum women in Malta are lacking. In this prospective cross-sectional study, we assessed the validity of the Edinburgh Postnatal Depression Scale (EPDS), an EPDS subscale (EPDS-3A), and the Generalised Anxiety Disorder-7 item (GAD-7) as screening measures for postpartum depression and anxiety. The optimal cut points were calculated.

Methods: 243 randomly selected women from birth to 12 months postnatally self-completed the EPDS and the GAD-7. For women scoring ≥10 in at least one of the questionnaires, the Mini International Neuropsychiatric Interview (MINI) was applied to confirm or refute a diagnosis of depression and/or anxiety disorder based on DSM-5 criteria. Total EPDS, EPDS-3A and GAD-7 scores were analysed against MINI outcomes using receiver operator curve (ROC), and area under curves (AUCs) were determined. Sensitivity, specificity, positive and negative predictive values, likelihood ratios and Youden's indices were calculated across a range of cut-off values.

Findings: Both the EPDS and GAD-7 had significant AUCs (>0.8) and Youden's indices (>0.6), contrary to the EPDS-3A. When screening for postnatal depression with the EPDS, the optimal cut-off is 11/12 (sensitivity 75 %; specificity 87.6 %). For postnatal anxiety, the recommended GAD-7 cut-off is 8/9 (sensitivity 79.2 %; specificity 85.3 %).

Conclusion: Both the EPDS and GAD-7 are valid screening measures for postpartum depression and anxiety, respectively. These findings can inform the implementation of postpartum screening programs to improve maternal healthcare in Malta.