Despite the prevalence of postpartum depression and anxiety, current screening recommendations are limited to depression symptoms. Screening using the Edinburgh Postnatal Depression Scale–Anxiety subscale (EPDS-A) may enhance ability to detect distress in postpartum women. We aimed to replicate the EPDS-A in 200 mothers with infants hospitalized in the neonatal intensive care unit (NICU) and examine its incremental utility in identifying emotional distress. Presence of the EPDS-A was identified using exploratory factor analysis. Women experiencing elevated anxiety were identified using a previously established cutoff score. Results replicated the EPDS-A for the first time in mothers with infants hospitalized in the NICU. In all, 21.9% of these women had elevated anxiety symptoms and nearly one quarter of them would have been missed in routine depression screening. Use of the EPDS-A, in addition to the total EPDS score, is a promising approach to identifying anxious women in need of further evaluation, treatment, or support.
AdouardF.Glangeaud-FreudenthalN. M. C.GolseB. (2005). Validation of the Edinburgh Postnatal Depression Scale (EPDS) in a sample of women with high-risk pregnancies in France. Archives of Women’s Mental Health, 8, 89-95. doi:10.1007/s00737-005-0077-9
2.
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., Rev.). Washington, DC: Author.
3.
BowenA.BowenR.MaslanyG.MuhajarineN. (2008). Anxiety in a socially high-risk sample of pregnant women in Canada. The Canadian Journal of Psychiatry, 53, 435-440.
4.
BoydR. C.LeH. N.SombergR. (2005). Review of screening instruments for postpartum depression. Archives of Women’s Mental Health, 8, 141-153. doi:10.1007/s00737-005-0096-6
5.
BrealeyS. D.HewittC.GreenJ. M.MorrellJ.GilbodyS. (2010). Screening for postnatal depression: Is it acceptable to women and healthcare professionals? A systematic review and meta-synthesis. Journal of Reproductive and Infant Psychology, 28, 328-344. doi:10.1080/02646838.2010.513045
6.
BrouwersE. P. M.van BaarA. L.PopV. J. M. (2001). Does the Edinburgh Postnatal Depression Scale measure anxiety?Journal of Psychosomatic Research, 51, 659-663. doi:10.1016/S0022-3999(01)00245-8
7.
BrownT. A.ChorpitaB. F.BarlowD. H. (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology, 107, 179-192. doi:10.1037/0021-843X.107.2.179
8.
BuistA.CondonJ.BrooksJ.SpeelmanC.MilgromJ.HayesB.. . . BilsztaJ. (2006). Acceptability of routine screening for perinatal depression. Journal of Affective Disorders, 93, 233-237. doi:10.1016/j.jad.2006.02.019
9.
CarterJ. D.MulderR. T.BartramA. F.DarlowB. A. (2005). Infants in a neonatal intensive care unit: Parental response. Archives of Disease in Childhood—Fetal & Neonatal Edition, 90, F109-F113. doi:10.1136/adc.2003.031641
10.
CattellR. B. (1978). The scientific use of factor analysis. New York, NY: Plenum Press.
11.
CostelloA. B.OsborneJ. W. (2005). Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment, Research & Evaluation, 10, 1-9.
12.
CoxJ. L.ChapmanG.MurrayD.JonesP. (1996). Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women. Journal of Affective Disorders, 39, 185-189. doi:10.1016/0165-0327(96)00008-0
13.
CoxJ. L.HoldenJ. (2003). Perinatal mental health: A guide to the Edinburgh Postnatal Depression Scale (EPDS). London, England: Royal College of Psychiatrists.
14.
HartleyC. M.BarrosoN.ReyY.PettitJ. W.BagnerD. M. (2014). Factor structure and psychometric properties of English and Spanish versions of the Edinburgh Postnatal Depression Scale among Hispanic women in a primary care setting. Journal of Clinical Psychology, 70, 1240-1250. doi:10.1002/jclp.22101
15.
HeronJ.O’ConnorT. G.EvansJ.GoldingJ.GloverV. (2004). The course of anxiety and depression through pregnancy and the postpartum in a community sample. Journal of Affective Disorders, 80, 65-73. doi:10.1016/j.jad.2003.08.004
16.
JomeenJ.MartinC. R. (2005). Confirmation of an occluded anxiety component within the Edinburgh Postnatal Depression Scale (EPDS) during early pregnancy. Journal of Reproductive and Infant Psychology, 23, 143-154. doi:10.1080/02646830500129297
17.
JomeenJ.MartinC. R. (2007). Replicability and stability of the multidimensional model of the Edinburgh Postnatal Depression Scale in late pregnancy. Journal of Psychiatric and Mental Health Nursing, 14, 319-324. doi:10.1111/j.1365-2850.2007.01084.x
18.
KesslerR. C.ChiuW. T.DemlerO.WaltersE. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 617-627. doi:10.1001/archpsyc.62.6.617
19.
KesslerR. C.SonnegaA.BrometE.HughesM.NelsonC. B. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048-1060. doi:10.1001/archpsyc.1995.03950240066012
20.
KruegerR. F. (1999). The structure of common mental disorders. Archives of General Psychiatry, 56, 921-926. doi:10.1001/archpsyc.56.10.921
21.
KruegerR. F.McGueM.IaconoW. G. (2001). The higher-order structure of common DSM mental disorders: Internalization, externalization, and their connections to personality. Personality and Individual Differences, 30, 1245-1259. doi:10.1016/S0191-8869(00)00106-9
22.
LefkowitzD. S.BaxtC.EvansJ. R. (2010). Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the neonatal intensive care unit (NICU). Journal of Clinical Psychology in Medical Settings, 17, 230-237. doi:10.1007/s10880-010-9202-7
23.
MattheyS. (2008). Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders. Depression and Anxiety, 25, 926-931. doi:10.1002/da.20415
24.
MattheyS. (2016). Anxiety and stress during pregnancy and the postpartum period. In WenzelA. (Ed.), The Oxford handbook of perinatal psychology (pp. 132-149). New York, NY: Oxford University Press.
25.
MattheyS.HenshawC.ElliottS.BarnettB. (2006). Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale: Implications for clinical and research practice. Archives of Women’s Mental Health, 9, 309-315. doi:10.1007/s00737-006-0152-x
26.
MilesM. S.Holditch-DavisD.SchwartzT. A.ScherM. (2007). Depressive symptoms in mothers of prematurely born infants. Journal of Developmental & Behavioral Pediatrics, 28, 36-44. doi:10.1097/01.DBP.0000257517.52459.7a
27.
MinekaS.WatsonD.ClarkL. A. (1998). Comorbidity of anxiety and unipolar mood disorders. Annual Review of Psychology, 49, 377-412. doi:10.1146/annurev.psych.49.1.377
28.
O’ConnorB. P. (2000). SPSS and SAS programs for determining the number of components using parallel analysis and Velicer’s MAP test. Behavior Research Methods, Instruments & Computers, 32, 396-402. doi:10.3758/BF03200807
29.
O’ConnorE.RossomR. C.HennigerM.GroomH. C.BurdaB. U. (2016). Primary care screening for and treatment of depression in pregnant and postpartum women: Evidence report and systematic review for the US preventive services task force. Journal of the American Medical Association, 315, 388-406. doi:10.1001/jama.2015.18948
30.
PopV. J.KomproeI. H.Van SonM. J. (1992). Characteristics of the Edinburgh Post Natal Depression Scale in the Netherlands. Journal of Affective Disorders, 26, 105-110. doi:10.1016/0165-0327(92)90041-4
31.
SegreL. S.McCabeJ. E.Chuffo-SiewertR.O’HaraM. W. (2014). Depression and anxiety symptoms in mothers of newborns hospitalized on the neonatal intensive care unit. Nursing Research, 63, 320-332. doi:10.1097/nnr.0000000000000039
32.
SegreL. S.O’HaraM. W.ArndtS.BeckC. T. (2010a). Nursing care for postpartum depression, part 1: Do nurses think they should offer both screening and counseling?MCN: The American Journal of Maternal/Child Nursing, 35, 220-225. doi:10.1097/nmc.0b013e3181dd9d81
33.
SegreL. S.O’HaraM. W.ArndtS.BeckC. T. (2010b). Screening and counseling for postpartum depression by nurses: The women’s views. MCN: The American Journal of Maternal/Child Nursing, 35, 280-285. doi:10.1097/nmc.0b013e3181e62679
34.
SegreL. S.SiewertR.BrockR. L.O’HaraM. W. (2013). Emotional distress in mothers of preterm hospitalized infants: A feasibility trial of nurse-delivered treatment. Journal of Perinatology, 33, 924-928. doi:10.1038/jp.2013.93
35.
SingerL. T.FultonS.DavillierM.KoshyD.SalvatorA.BaleyJ. E. (2003). Effects of infant risk status and maternal psychological distress on maternal-infant interactions during the first year of life. Journal of Developmental & Behavioral Pediatrics, 24, 233-241. doi:10.1097/00004703-200308000-00003
36.
SingerL. T.SalvatorA.GuoS.CollinM.LilienL.BaleyJ. (1999). Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. Journal of the American Medical Association, 281, 799-805. doi:10.1001/jama.281.9.799
37.
StuartS.CouserG.SchilderK.O’HaraM.GormanL. (1998). Postpartum anxiety and depression: Onset and comorbidity in a community sample. Journal of Nervous and Mental Disease, 186, 420-424. doi:10.1097/00005053-199807000-00006
38.
WoolhouseH.BrownS.KrastevA.PerlenS.GunnJ. (2009). Seeking help for anxiety and depression after childbirth: Results of the maternal health study. Archives of Women’s Mental Health, 12, 75-83. doi:10.1007/s00737-009-0049-6
39.
ZelkowitzP.PapageorgiouA.BardinC.WangT. (2009). Persistent maternal anxiety affects the interaction between mothers and their very low birthweight children at 24 months. Early Human Development, 85, 51-58. doi:10.1016/j.earlhumdev.2008.06.010
