(1051) EPDS Screening at Delivery Discharge as a Predictor of Postpartum Depression

To determine if screening with the Edinburgh Postpartum Depression Scale (EPDS) at delivery discharge (DC) is predictive of postpartum depression (PPD).

Study Design:

This was a retrospective cohort study of all patients who delivered at a single urban academic medical center from 6/2021-6/2022. Universal EPDS screening was implemented for all patients prior to DC; a score of ≥9 was considered at risk for PPD. Patients were re-screened at 2-6 weeks postpartum (PP). The primary outcome was mean EPDS score at 2-6 weeks PP. Secondary outcomes included the change in EPDS score from delivery DC to 2-6 weeks PP (paired t-test) and the positive and negative predictive value (PPV, NPV) of the DC score.

Results:

Of 4194 deliveries, 1603 (38.2%) completed EPDS screening at both timepoints. Patients were predominantly Black (64.2%) and publically insured (61.6%). 219 (13.7%) patients scored ≥9 at DC and 37 (2.3%) endorsed self-harm at DC. There was a moderate positive correlation between scores at delivery DC and PP (r=0.51, p< 0.001). Mean EPDS score at the PP visit was significantly higher for patients who had an elevated EPDS at delivery DC compared to those with a score < 9 (7.9 vs. 2.7, p< 0.001). Of patients who had an EPDS ≥ 9 at delivery DC, 42.0% (92/219) continued to score ≥ 9 PP, representing the PPV (Table 1). Most patients who scored < 9 at delivery DC continued to score low PP (1270/1384, NPV 91.8%). A small proportion of patients who had a low score at delivery DC scored ≥9 at the PP visit (114/1384, 8.2%). Patients who had a low-risk EPDS at DC and then scored high PP were more likely to be privately insured compared to those who continued to have a low risk score (OR=1.38, p=0.001). There was no difference by age, race, or mode of delivery.

Conclusion:

EPDS screening at delivery DC identifies patients at risk of PPD. Interventions should target patients with an elevated EPDS score at delivery DC, as many patients will continue to score high at their PPV. Further investigation is needed to determine which patients will develop symptoms of PPD despite a low-risk score at delivery DC.