Screening Using the Edinburgh Postnatal Depression Scale at Delivery Discharge as a Predictor of Postpartum Depression

The objective of this study was to determine if Edinburgh Postnatal Depression Scale (EPDS) scores at delivery discharge are predictive of EPDS scores at 2-6 weeks postpartum.

This was a retrospective cohort study of all patients who delivered at an urban academic medical center from 6/2021 to 6/2022. Universal EPDS screening was implemented for all patients prior to discharge; a score of ≥ 9 was considered at risk for postpartum depression. Patients were re-screened at 2-6 weeks postpartum. The primary outcome was mean EPDS score at 2-6 weeks postpartum.

One thousand six hundred three patients were included; 219 (13.7%) scored ≥ 9 at delivery discharge and 37 (2.3%) endorsed self-harm at delivery discharge. Mean EPDS score at the postpartum visit was significantly higher for patients who had an elevated EPDS at delivery discharge compared to those with a low-risk score (7.9 vs. 2.7, p < 0.001). Of patients who had an EPDS ≥ 9 at delivery discharge, 42.0% (92/219) continued to score ≥ 9 postpartum. Most patients who scored < 9 at delivery discharge continued to score low at 2-6 weeks postpartum (1270/1384, negative predictive value 91.8%). A small proportion of patients who had a low score at delivery discharge scored ≥ 9 at the postpartum visit (114/1384, 8.2%).

EPDS screening at delivery discharge is feasible and identifies patients at risk of postpartum depression. Interventions should target patients with an elevated EPDS score at delivery discharge, as many patients will continue to score high at their postpartum visit. Rescreening at the postpartum visit remains important, as there are patients who will not be captured immediately postpartum.