The Edinburgh Postnatal Depression Scale (EPDS) is a validated screening tool for peripartum depression. We seek to characterize a subset of questions most predictive of peripartum depression in patients with a history of anxiolytic/antidepressant or substance use.METHODS:
We performed a case-control study of pregnant women who received prenatal care in an academic center. Pregnancy records were reviewed for patient demographics, medical and social history. The EPDS scores of subjects with a history of mood disorder (anxiolytic/antidepressant use, untreated depression) or substance use (ethanol, illicit drug use) were compared to controls to determine likelihood of probable depression (score >12) using a chi square test. Principal component analysis (PCA) was used to identify the individual EPDS survey items and question themes that were commonly associated with depressive symptoms.RESULTS:
297 subjects were reviewed. Subjects in the mood disorder and substance use groups were more likely to have EPDS scores >12 than controls in both the antepartum (P=.001, P=.030, respectively) and postpartum (P=.016, P=.008). PCA of EPDS scores for the mood disorders group identified 3 themes (anhedonia, anxiety, sadness) that accounted for 59% and 67% of variance in the antepartum and postpartum scores, respectively. PCA of EPDS scores in the substance use group identified 2 themes that accounted for 58% variance in the antepartum and 66% in the postpartum scores.CONCLUSION:
Patients with a history of mood disorder or substance use are at increased risk of peripartum depression and may have characteristic symptom complexes. Recognition of patterns in at-risk populations may facilitate early intervention.