Research Reports Sensitivity And Specificity Of Edinburgh Postnatal Depression Scale ( EPDS ) As A Method Of Screening Depression After Childbirth

In RSUP Sanglah Nelson Edwin Pratama, Tjokorda Gde Agung Suwardewa, I Gusti Ayu Endah Ardjana* Obstetrics And Gynecological Department Psychiatry Department* Medical Faculty, Udayana University RSUP Sanglah Bali Abstract Research purposes : To find out the sensitivity and specificity of EPDS in detecting depression after childbirth in RSUP Sanglah Research methods : This research employed diagnostic test design. The number of samples is 62 after delivery woman, consisted of 42 samples as a group EPDS > 10 and 20 samples as an EPDS group < 11, with depression case which involved 41 people and not depression case which involved 21 people. Kuisioner epds own done by the subject of research, examination psychiatry wrought by smf psychiatry. To find out the relationship EPDS with the examination results ICD and DSM 4 X TR Psychiatric MSF test used Chi-Square. Results : The results of analysis by using 2 x 2 table showed that Sensitivity = 92,7%; Specificity = has 81.0%; Guess positive value = 85,0%; A negative value for guess = 90,4%; The ratio of positive Possibilities = 4,87; The ratio of negative Possibilities = 0.09. Conclusions : From this research can be concluded that EPDS can be used as a method of screening depression after childbirth in RSUP Sanglah. Keywords: depression, after childbirth depression, edinburgh postnatal depression scale Correspondence: Edwin Nelson, Jln. Pratama Biomedical B 3 No. 22 North Jakarta, DKI Jakarta: 081236159611, Email: shin_supernelson@yahoo.com

INTRODUCTION

A mental disorder after childbirth is divided into three, namely : postpartum blues, depresi after childbirth , and psychosis after childbirth. Since these three mental disorders have symptoms that overlap each other, it is difficult to distinguish mental disorders separately, more easily understood if they are considered to be a continuous events. Depression disorders that occur in pregnancy can affect the antepartum and postpartum. The Diagnostic and Statistical Manual of Mental Disorders 2000 categorize the depression post childbirth as a major depression disorders due to maternity and lies of post signs that depression symptoms arise within 1 week after the childbirth. 1 Marce Society, an international organization dedicated to conduct research on psychiatric disorder after childbirth, defines psychiatric disorders after childbirth as an episode that takes place until one year after the birth of a baby. 2 Risk factors for the occurrence of depression after childbirth varies. Each area is distinctive since the cause of a particular disorder is influenced by demographics, socioeconomics, and culture of each area. In 2008 OHara and serge declare the need for screening during pregnancy especially for them who have the depression risk at least twice, first before childbirth and second after childbirth.3 Ideal screening methods is required to detect the presence of the ideal postpartum blues and depression after childbirth. Edinburgh postnatal depression scale (EPDS) is one of the methods for detecting depression after childbirth. This research is a study of the diagnostic test which aims to know the sensitivity and specificity of EPDS as a method of screening in detecting depression after childbirth in RSUP Sanglah.

METHOD

A research on diagnostic test with consecutive sampling method was carried out from March 2011 until February 2012 at the polyclinic and a parturition room that belongs to obstetrics and Gynecology department RSUP Sanglah, Denpasar, Bali, Indonesia. Population of the research is postmenopausal woman on the 2nd day until 42th day who gave birth to a baby at the RSUP Sanglah. The sample that meets the criteria of inclusion and exclusion, as well as agree to participate in the research are included in this research. There are 62 patients who become the sample of this research. Patients who are selected will undergo the procedure of this research namely: identity and clinical examination results that will be recorded in the data collection form, and then patients EPDS will fill out the quesioner given. After the calculation is performed on the value of kuisioner level of the EPDS, patients are divided into two groups, namely the Group of EPDS with value > 10 and with a value of EPDS < 11. The patients who have filled out the kuisioner will be consulted to Psychiatry department to perform psychiatric examination to diagnose depression symptoms. EPDS are completed by patients, unless they have difficulty in understanding the language in kuisioner. Demographic Data are recorded on data collection form. Statistical analysis employed SPSS for Windows version 16. While, homogeneity test used the Levene test. To find out the relationship between EPDS and ICD X and DSM 4 X TR . For Psychiatric SMF used Chi-Square.

RESULT The result of the research showed that 62 women meet the criteria of inclusion and exclusion that can be divided into two groups, namely 42 people as groups of EPDS > 10 and 20 people as a group of EPDS < 11. From the sample of this research, it is found out around 41 depression cases 21 of undepressed cases. The result of the analysis shows differences that is not statistically significant between the groups that involves the mother age, parity and education

length (p > 0.05) variables. Based on the results of analysis by using 2 x 2 cross table, it is obtained that Sensitivity = 92,7%; Specificity = 81.0%; Guess positive value = 85,0%; guess negative value = 90,4%; The ratio of positive Possibilities = 4,87; The ratio of negative Possibilities = 0.09. Table 1 The average of mothers age, parity, and education length on depressed group and undepressed group Depressed (MeanSD) 28,525,72 1,790,90 10,173,28 Undepressed (MeanSD) 26,455,97 2,001,03 8,504,78

Characteristics Mothers age (yo) Parity Education length (y)

p 0,193 0,405 0,114

Table 2 EPDS Diagnostic test on after child birth patients Result of Psychiatri Examination Group Depressed EPDS Undepressed 3 17 Depressed 38 Undepressed 4

DISCUSSION

The lowest age of participants is 17 years old and the highest is 42 years with the average age aroud 28,52 5,72 on the depressed group and 26,45 5,9 on the undepressed group, on the undepressed group, the difference is not statistically significant (P > 0,05). In line with some previous research, it is conluded that different maternal age is not statistically significant on depression after childbirth.4.5 The number of children in both groups does not mean statistically significant (P > 0.05), and it is similar to some previous studies.4,5,6,7 The variable of education length in this research is not statistically significant (P>0.05), this is in accordance with the earlier research. 8,9 Eventhough other studies have stated that education length is a risk factor that causes depression after childbirth.10 In its use, EPDS have cut off point between 7 to 12.
10,11

On the preliminary

research, the EPDS scores used is 12/13 with the sensitivity and specificity of each is 86% and 70%. Next, by using a cut off point 10/11 to get the sensitivity and specificity of each 64% and 85%. Some research in Asia that employ EPDS as a method of screening depression after childbirth use varied cut off point.10,11 Our data shows that the sensitivity and specificity of EPDS are high enough in detecting depression after childbirth i.e. each 92,7% and has 81.0%. Guess of positive and negative value is also high, 90,4% respectively and 85,0%. A research on depression after childbirth in China, using the cut off point 9, get the sensitivity, specificity, positive and negative value guess respectively of 82%, 86%, 44%, 97%.12 On the cut off point > 12 it is obtained sensitivity of 42% despite of specificity improvement to 95%. The similar result is resulted from a research in Japan, using cut off point 10/11 to get case sensitivity 82% and specificity 95%, and using the cut off 12/13 to obtain 55% sensitivity and 98%.13 Consistent with previous research conducted in Indonesia that involvesin 102 patients at three hospitals in Jakarta, our study get 86,5% sensitivity and 61,58 % specificity with the different way to assess the patients.14 Samples on these patients are grouped into 4 groups, includes:

1) Value 8: possible low occurrence of depression.

2) Value 9-12: problems with lifestyle changes because of the newborn or the case of postpartum blues. 3) Value 13-14: the occurence of the symptoms that lead to the possibility of postpartum depression. 4) Value 15: High Value of probability or experiencing postpartum depression.

CONCLUSION AND SUGGESTION

Employing the value 10/11, EPDS as depression screening methods after childbirth in RSUP Sanglah shows the value of sensitivity 92,7% and specificity of 81%. In terms of high sensitivity and specificity, EPDS can be used as a method of screening depression after childbirth in RSUP sanglah. Based on the research, the patients with EPDS value > 11 need to perform psychiatry examination. On the contrary, patients with EPDS value <10 do not need to perform psychiatric examination.

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