(669) Utility of the Edinburgh Postnatal Depression Scale for Identifying Prenatal Psychological Distress in Black Women

Exposure to stress during pregnancy, including depression, is a significant concern due to its harmful effects on maternal health and infant developmental outcomes. Black populations face other stress-related experiences that contribute to risk factors in pregnancy outcomes in addition to depression. The Edinburgh Postnatal Depression Scale (EPDS) is one of many screeners of perinatal depression and its use is recommended by the American College of Obstetricians and Gynecologists. However, screening pregnant women for depression has been deployed without a comprehensive examination of its utility for capturing an individual’s stress. In the present study, we examine the overlap between a positive screen on the EPDS and other sources of emotional stressors in Black pregnant women living in a low-resourced, urban environment.

Study Design:

Data were gathered from an ongoing RCT study examining the effects of stress on prenatal health and infant developmental outcomes. The EPDS was used to measure levels of depression during pregnancy. Other measures of stress include the Perceived Stress Scale, the Difficult Life Circumstances scale, and the Everyday Discrimination Scale. Partner abuse was assessed using items from the DLC. The final sample included 45 women. We tested the overlap between the EPDS and other stress indices using crosstabs of dichotomized variables.

Results:

Using a common threshold for a positive screen on the EPDS (≥13) revealed a significant proportion of women who experienced partner abuse (53.3%), high levels of negative life events (58.8%), discrimination stress (58.3%), and perceived stress (36.6%) but who would not have been identified as needing further clinical assessment.

Conclusion:

A large proportion of Black women experiencing high levels of prenatal stress may not be identified as being at risk for poor obstetric outcomes if the EPDS is the only measure used to screen for referral. The singular use of the EPDS should be re-considered to better serve all obstetric patients as an intermediate step toward equity for pregnancy health and assessment of perinatal mental health.