Self-Identification Questions May Be Effective Additions to Clinician-Rated Postnatal Depression Measures

Stresses of raising children.
Study findings highlight the need for broader assessment and understanding of psychological symptoms in the perinatal period.

Asking about depression in more than one way can identify symptoms in different groups of postnatal women, according to study data published in the Journal of Affective Disorders.

Investigators conducted a secondary analysis of 2 cross-sectional datasets from the United Kingdom: the National Survey of Women’s Experience of Maternity Care 2014 and the Northern Ireland Survey of Women’s Experience of Maternity Care 2014. Participants were identified through birth registrations in England and Northern Ireland and were supplied questionnaires via mail at 3 months postpartum. Each survey contained both a direct question about self-identified postnatal depression and the 10-item Edinburgh Postnatal Depression Scale (EDPS). In this study, EDPS scores ≥13 were used to indicate major depression to maximize consistency with other studies. The proportion of women reporting postnatal depression and the proportion of women with EDPS scores ≥13 were compared to assess agreement between the 2 terms.

The final study cohort comprised 7300 women, among whom 4578 were from England and 2722 were from Northern Ireland. More than half (56.5%) of respondents were aged from 30 to 39 years, most (85.9%) had completed 17 or more years of education, and 10.9% were of a minority ethnicity. Of the 6752 participants who completed all 10 items of the EPDS and the additional research question, 6.1% self-identified as having depression and 9.1% scored EDPS ≥13, with an overlap of 2.8% for both.

Women with self-identified depression had a significantly higher median EPDS score compared with women with no self-identified depression (P <.001): 68.0% had an EPDS score ≥10, 45.7% scored ≥13, 32.0% scored ≥15, and 22.7% scored ≥17. Women with self-identified depression were more likely to be aged >40 years (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.8). Among women with an EPDS score ≥13, 30.6% had self-identified depression; this proportion increased with increasing EPDS score. EPDS ≥13 was associated with <16 years of education (OR, 1.4; 95% CI, 1.1-1.8), minority ethnicity (OR, 1.4; 95% CI, 1.1-1.9), living without a partner (OR. 1.7; 95% CI 1.3-2.2), and a less than happy reaction to the pregnancy (OR 1.7; 95% CI, 1.4-2.1). Cohen’s kappa values suggested “minimal” agreement between self-identified depression and elevated EPDS scores (0.317 for EPDS ≥13).

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The researchers noted that low overall survey response rates limit the representational accuracy of the findings.

“Exploring the use of a direct question is important as women’s own views on their psychological wellbeing, even if they do not meet the screening threshold on measures such as EPDS, are important to ensure women are gaining appropriate support during a vulnerable period,” the researchers wrote.

“Our findings highlight the need for broader assessment and understanding of psychological symptoms in the perinatal period to ensure we are meeting the needs of women,” they concluded.


Fellmeth G, Opondo C, Henderson J, et al. Identifying postnatal depression: comparison of a self-reported depression item with Edinburgh Postnatal Depression Scale scores at three months postpartum. J Affect Disord. 2019;251:8-14.