(300) Elevated Edinburgh Postnatal Depression Scale (EPDS) Scores in Caregivers of Infants with Cystic Fibrosis

Background: Cystic fibrosis (CF) is usually diagnosed soon after birth. Families of infants with CF must adjust to managing general newborn care along with the physical and mental stress of caring for CF. CF caregivers have increased rates of depression and anxiety compared with the general population [1,2]. The Edinburgh Postnatal Depression Scale (EPDS) is a validated tool, used to screen for post-partum depression [3]. In the general population, persistent and severe post-partum depression, defined by elevated EPDS scores, is associated with adverse outcomes for the child including increased behavioral problems and higher rates of depression [4]. The prevalence of elevated EPDS scores for caregivers of infants diagnosed with CF has not been well reported.

Methods: This prospective study was conducted at a large tertiary pediatric hospital infant CF clinic between August 2019 and February 2022. Parents of infants with CF or CFTR-related metabolic syndrome (CRMS) completed the EPDS survey at visit 1 (generally age 1-2 mo) and visit 3 (6-9 mo). EPDS scores for the control group were obtained retrospectively from 2 mo and 6 mo well-child visits at primary care clinics in the same geographic area. Comparisons between the CF and control cohorts were conducted for presence of elevated EPDS score (≥10) and total EPDS scores at visits 1 and 3 using Fisher’s exact and two sample t-tests. The percentage of positive scores for question 10 (“The thought of harming myself has occurred to me”) was compared between cohorts at visits 1 and 3 using Fisher’s exact test.

Results: A total 36 infants were enrolled at time of this analysis. The prevalence of elevated EPDS score and mean total EPDS scores for CF and control cohorts are displayed in Table 1. CF/CRMS caregivers had significantly higher prevalence of a positive score for EPDS question 10 at visit 1 compared to the control cohort [4/36 (11%) and 11/883 (1.2%), respectively (p=0.002)]. The prevalence of a positive score for EPDS question 10 at visit 3 was not significant [2/27 (7.4%) for CF/CRMS caregivers; 9/535 (1.7%) for the control cohort (p=0.094)].

Conclusions: Caregivers of infants with CF or CRMS had significantly elevated EPDS scores compared to the controls at around 2 and 6 mo of age. During the first months of life, caregivers of infants with CF or CRMS were also more likely to disclose thoughts of self-harm, compared with controls. The increased prevalence of elevated scores among caregivers for post-partum depression requires close attention. CF care teams should be aware of this increased risk and consider screening for post-partum depression as a part of routine infant CF care.

Acknowledgements:

References: [1] Gillespie, Michelle L., et al. Mental health history and social barriers impacting caregivers of infants with cystic fibrosis. Pediatr Pulmonol. 2020;56(2):457–464., https://doi.org/10.1002/ppul.25213.

[2] Quittner, Alexandra L, et al. Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: Results of the international depression epidemiological study across nine countries. Thorax. 2014;69(12):1090–1097., https://doi.org/10.1136/thoraxjnl-2014-205983.

[3] Cox, J. L., et al. Detection of postnatal depression. Br J Psychiatry. 1987;150(6):782–786., https://doi.org/10.1192/bjp.150.6.782.

[4] Netsi, Elena, et al. Association of persistent and severe postnatal depression with child outcomes. JAMA Psychiatry. 2018;75(3):247-253., https://doi.org/10.1001/jamapsychiatry.2017.4363.