Symptomatology in 1,112 women screened positive and negative using the Edinburgh postnatal depression scale (EPDS): longitudinal observations from the first trimester to 6 weeks postpartum of a Chinese cohort

Abstract

Purpose

To compare the characteristics of depression-related symptoms identified by individual EPDS items in women who screened positive and negative, and to describe the occurrence of thoughts of self-harm in these women.

Methods

Based on a Chinese cohort of 1,112 women, scores on each EPDS item were analyzed at 7 time points from the first trimester to 6 weeks postpartum. Scores greater than 0 indicated the presence of symptoms, and higher scores indicated more severe symptoms. We defined the most frequent, serious and important symptoms for screening-positive and screening-negative groups as the item with the highest proportion of respondents scoring 1 or higher, highest proportion scoring 3, and highest average score, respectively.

Results

In screened positive women the most frequent symptom was feeling sad or miserable, and the most serious and important symptoms were both sleeping problems. Among those screened negative, self-blame was the most frequent, serious and important item. For women who screened positive in the first trimester, only self-blame and feeling overwhelmed showed stability over time. Symptoms in women screened negative were relatively stable. Four in ten women who had self-harm thoughts were screened negative.

Conclusion

Women who screened positive in EPDS differed from those screened negative in the characteristics in depressive symptoms. Intervention strategies focusing on the most frequent, serious and important symptoms (such as sadness and insomnia) may be worthwhile. Health practitioners should be trained to respond to a positive response to thoughts of self-harm, regardless of whether the women are screened positive or negative.

Keywords:

• EPDS
• depression screening
• maternal mental health
• symptomatology
• perinatal depression

Acknowledgements

We thank all women participated in this project; K.K. Cheng for his critical comments on the manuscript; Daniel Loebell for his comments on the language of manuscript; Hunan Provincial Maternal and Child Health Hospital, Maternal and Child Health Hospital in Ziyang district of Yiyang city (Fengyun Tian) for coordinating and assisting in our recruiting and survey; Yushi Mo, Weina Zhang and Min Yu, for recruiting, data collecting and supervision; Jing Deng and Peiyuan Qiu for advice on statistical methods.

Ethics approval

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. This study was approved by the institutional review board of the institute of clinical pharmacology of Central South University in China (No. ChiCTR-ROC-16009255).

Patient consent statement

Informed consent was obtained from all individual participants included in the study.

Disclosure statement

All authors declare no conflict of interests.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 81973059) and China Medical Board (CMB) Open Competition Program (Grant No. 20-368). The funder had no role in study design, data collection, data analysis, data interpretation or writing of this article.