Skip to main content
Springer Nature Link
Log in

The EPDS-Lifetime: assessment of lifetime prevalence and risk factors for perinatal depression in a large cohort of depressed women

  • Original Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Abstract

Perinatal depression (PND) is a common complication of pregnancy and postpartum associated with significant morbidity. We had three goals: (1) to explore the performance of a new lifetime version of the Edinburgh Postnatal Depression Scale (EPDS-Lifetime) to assess lifetime prevalence of PND; (2) to assess prevalence of lifetime PND in women with prior histories of major depressive episode (MDE); and (3) to evaluate risk factors for PND. Subjects were from the Netherlands Study of Depression and Anxiety (NESDA). The EPDS was modified by adding lifetime PND screening questions, assessing worst episode, and symptom timing of onset. Of 682 women with lifetime MDD and a live birth, 276 (40.4 %) had a positive EPDS score of ≥12 consistent with PND. Women with PND more often sought professional help (p < 0.001) and received treatment (p = 0.001). Independent risk indicators for PND included younger age, higher education, high neuroticism, childhood trauma, and sexual abuse. We found that two in five parous women with a history of MDD had lifetime PND and that the PND episodes were more severe than MDD occurring outside of the perinatal period. The EPDS-Lifetime shows promise as a tool for assessing lifetime histories of PND in clinical and research settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

References

  • Beck CT (2001) Predictors of postpartum depression: an update. Nurs Res 50(5):275–285

    Article  PubMed  CAS  Google Scholar 

  • Beesdo K, Bittner A et al (2007) Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Arch Gen Psychiatry 64(8):903–912

    Article  PubMed  Google Scholar 

  • Bergman K, Sarkar P et al (2010) Maternal prenatal cortisol and infant cognitive development: moderation by infant-mother attachment. Biol Psychiatry 67(11):1026–1032

    Article  PubMed  CAS  Google Scholar 

  • Bijl RV, van Zessen G et al (1998) The Netherlands Mental Health Survey and Incidence Study (NEMESIS): objectives and design. Soc Psychiatry Psychiatr Epidemiol 33(12):581–586

    Article  PubMed  CAS  Google Scholar 

  • Bland JM, Altman DG (1997) Cronbach's alpha. BMJ 314(7080):572

    Article  PubMed  CAS  Google Scholar 

  • Bloch M, Schmidt PJ et al (2000) Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry 157(6):924–930

    Article  PubMed  CAS  Google Scholar 

  • Boschloo L, Vogelzangs N et al (2011) Comorbidity and risk indicators for alcohol use disorders among persons with anxiety and/or depressive disorders: findings from the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord 131(1–3):233–242

    Article  PubMed  Google Scholar 

  • Boyd RC, Le HN et al (2005) Review of screening instruments for postpartum depression. Arch Womens Ment Health 8(3):141–153

    PubMed  CAS  Google Scholar 

  • Brugha T, Bebington P, Tennant C, Hurry J (1985) The list of threatening experiences: a subset of 12 life event categories with considerable long-term contextual treat. Psychol Med 15:189–194

    Article  PubMed  CAS  Google Scholar 

  • Brugha T, Sharp H et al (1998) The Leicester 500 Project. Social support and the development of postnatal depressive symptoms, a prospective cohort survey. Psychol Med 28(01):63–79

    Article  PubMed  CAS  Google Scholar 

  • Buist A (1998) Childhood abuse, parenting and postpartum depression. Aust N Z J Psychiatry 32(4):479–487

    Article  PubMed  CAS  Google Scholar 

  • Campbell SB, Brownell CA et al (2004) The course of maternal depressive symptoms and maternal sensitivity as predictors of attachment security at 36 months. Dev Psychopathol 16(2):231–252

    Article  PubMed  Google Scholar 

  • Costa PT Jr, McCrae RR (1995) Domains and facets: hierarchical personality assessment using the revised NEO personality inventory. J Pers Assess 64(1):21

    Article  PubMed  Google Scholar 

  • Cox JL, Rooney A, Thomas PF, Wrate RW (1984) How accurately do mothers recall postnatal depression? Further data from a 3 year follow-up study. J Psychosom Obstet Gynecol 3(3–4):185–189

    Article  Google Scholar 

  • Cox JL, Holden JM et al (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry J Ment Sci 150:782–786

    Article  CAS  Google Scholar 

  • Cox JL, Murray D et al (1993) A controlled study of the onset, duration and prevalence of postnatal depression. Br J psychiatry J Ment sci 163:27–31

    Article  CAS  Google Scholar 

  • Donker T, Comijs H et al (2010) The validity of the Dutch K10 and extended K10 screening scales for depressive and anxiety disorders. Psychiatry Res 176(1):45–50

    Article  PubMed  Google Scholar 

  • Dott M, Rasmussen S et al (2010) Association between pregnancy intention and reproductive-health related behaviors before and after pregnancy recognition, National Birth Defects Prevention Study, 1997–2002. Matern Child Health J 14(3):373–381

    Article  PubMed  Google Scholar 

  • DSM-IV, Ed (1994) Diagnostic and statistical manual of mental disorders (DSM-IV), 4th edn. American Psychiatric Association, Washington

    Google Scholar 

  • Elliott S (2000) Report on the satra bruk workshop on classification of postnatal mental disorders on November 7–10, 1999. Convened by Birgitta Wickberg, Philip Hwang and John Cox. Arch Womens Ment Health 3:27–33

    Google Scholar 

  • Feldman R, Granat A et al (2009) Maternal depression and anxiety across the postpartum year and infant social engagement, fear regulation, and stress reactivity. J Am Acad Child Adolesc Psychiatry 48(9):919–927

    Article  PubMed  Google Scholar 

  • Field T (2010) Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Behav Dev 33(1):1–6

    Article  PubMed  Google Scholar 

  • First MB, Spitzer RL, Gibbon M, Williams JBW (1995) Structured clinical interview for DSM-IV (SCID). American Psychiatric Association, Washington

    Google Scholar 

  • Fleming AS, Corter C (1988) Factors influencing maternal responsiveness in humans: usefulness of an animal model. Psychoneuroendocrinology 13(1–2):189–212

    Article  PubMed  CAS  Google Scholar 

  • Flynn HA, Davis M et al (2004) Rates of maternal depression in pediatric emergency department and relationship to child service utilization. Gen Hosp Psychiatry 26(4):316–322

    Article  PubMed  Google Scholar 

  • Flynn HA, Sexton M et al (2011) Comparative performance of the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9 in pregnant and postpartum women seeking psychiatric services. Psychiatry Res 187(1–2):130–134

    Article  PubMed  Google Scholar 

  • Fyer AJ, Weissman MM (1999) Genetic linkage study of panic: clinical methodology and description of pedigrees. Am J Med Genet 88(2):173–181

    Article  PubMed  CAS  Google Scholar 

  • Gavin NI, Gaynes BN et al (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106(5 Pt 1):1071–1083

    Article  PubMed  Google Scholar 

  • Gaynes BN, Gavin N et al (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ) 119:1–8

    Google Scholar 

  • Gigantesco A, Morosini P (2008) Development, reliability and factor analysis of a self-administered questionnaire which originates from the World Health Organization's Composite International Diagnostic Interview-Short Form (CIDI-SF) for assessing mental disorders. Clin Pract Epidemiol Ment Health CP & EMH 4:8

    Article  Google Scholar 

  • Grimstad H, Backe B et al (1998) Abuse history and health risk behaviors in pregnancy. Acta Obstet Gynecol Scand 77(9):893–897

    Article  PubMed  CAS  Google Scholar 

  • Wittchen HU (1994) Reliability and validity studies of the WHO—Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res 28(1):57–84

    Article  PubMed  CAS  Google Scholar 

  • Hewitt CE, Gilbody SM (2009) Is it clinically and cost effective to screen for postnatal depression: a systematic review of controlled clinical trials and economic evidence. BJOG 116(8):1019–1027

    Article  PubMed  CAS  Google Scholar 

  • Kendall-Tackett KA (2007) Violence against women and the perinatal period: the impact of lifetime violence and abuse on pregnancy, postpartum, and breastfeeding. Trauma Violence Abuse 8(3):344–353

    Article  PubMed  Google Scholar 

  • Kendler KS, Bulik CM et al (2000) Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. Arch Gen Psychiatry 57(10):953–959

    Article  PubMed  CAS  Google Scholar 

  • Kessler RC, Andrews G et al (2002) Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 32(6):959–976

    Article  PubMed  CAS  Google Scholar 

  • Kumar R, Robson KM (1984) A prospective study of emotional disorders in childbearing women. Br J psychiatry J Ment sci 144:35–47

    Article  CAS  Google Scholar 

  • Kupfer DJ, Frank E et al (2011) Major depressive disorder: new clinical, neurobiological, and treatment perspectives. Lancet 379(9820):1045–1055

    Article  PubMed  Google Scholar 

  • Landman-Peeters KM, Hartman CA et al (2005) Gender differences in the relation between social support, problems in parent-offspring communication, and depression and anxiety. Soc Sci Med 60(11):2549–2559

    Article  PubMed  Google Scholar 

  • Leeners B, Richter-Appelt H et al (2006) Influence of childhood sexual abuse on pregnancy, delivery, and the early postpartum period in adult women. J Psychosom Res 61(2):139–151

    Article  PubMed  Google Scholar 

  • Leeners B, Stiller R et al (2010) Pregnancy complications in women with childhood sexual abuse experiences. J Psychosom Res 69(5):503–510

    Article  PubMed  Google Scholar 

  • Leserman J (2005) Sexual abuse history: prevalence, health effects, mediators, and psychological treatment. Psychosom Med 67(6):906–915

    Article  PubMed  Google Scholar 

  • Leserman J, Drossman DA et al (1996) Sexual and physical abuse history in gastroenterology practice: how types of abuse impact health status. Psychosom Med 58(1):4–15

    PubMed  CAS  Google Scholar 

  • Lindahl V, Pearson JL et al (2005) Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health 8(2):77–87

    Article  PubMed  CAS  Google Scholar 

  • Lukasse M, Vangen S et al (2011) Fear of childbirth, women's preference for cesarean section and childhood abuse: a longitudinal study. Acta Obstet Gynecol Scand 90(1):33–40

    Article  PubMed  Google Scholar 

  • Marmorstein NR, Malone SM et al (2004) Psychiatric disorders among offspring of depressed mothers: associations with paternal psychopathology. Am J Psychiatry 161(9):1588–1594

    Article  PubMed  Google Scholar 

  • McCauley J, Kern DE et al (1997) Clinical characteristics of women with a history of childhood abuse: unhealed wounds. JAMA 277(17):1362–1368

    Article  PubMed  CAS  Google Scholar 

  • Meltzer-Brody S, Zerwas S et al (2011) Eating disorders and trauma history in women with perinatal depression. J Womens Health (Larchmt) 20(6):863–870

    Article  Google Scholar 

  • Micali N, Simonoff E et al (2011) Pregnancy and post-partum depression and anxiety in a longitudinal general population cohort: the effect of eating disorders and past depression. J Affect Disord 131(1–3):150–157

    Article  PubMed  Google Scholar 

  • Milgrom J, Gemmill AW et al (2008) Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord 108(1–2):147–157

    Article  PubMed  Google Scholar 

  • Moffitt TE, Harrington H et al (2007) Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Arch Gen Psychiatry 64(6):651–660

    Article  PubMed  Google Scholar 

  • Munk-Olsen T, Laursen TM et al (2006) New parents and mental disorders: a population-based register study. JAMA 296(21):2582–2589

    Article  PubMed  CAS  Google Scholar 

  • Munk-Olsen T, Laursen TM et al (2011) Psychiatric disorders with postpartum onset: possible early manifestations of bipolar affective disorders. Arch Gen Psychiatry 69(4):428–434

    PubMed  Google Scholar 

  • Murray L, Cooper P (1997) Effects of postnatal depression on infant development. Arch Dis Child 77(2):99–101

    Article  PubMed  CAS  Google Scholar 

  • Murray L, Stein A (1989) The effects of postnatal depression on the infant. Baillieres Clin Obstet Gynaecol 3(4):921–933

    Article  PubMed  CAS  Google Scholar 

  • Network NECCR (1999) Chronicity of maternal depressive symptoms, maternal sensitivity, and child functioning at 36 months. Dev Psychol 35(5):1297–1310

    Article  Google Scholar 

  • Nurnberger JI Jr, Blehar MC et al (1994) Diagnostic interview for genetic studies: rationale, unique features, and training. Arch Gen Psychiatry 51(11):849–859

    Article  PubMed  Google Scholar 

  • O'Connor TG, Zeanah CH (2003) Current perspectives on attachment disorders: rejoinder and synthesis. Attach Hum Dev 5(3):321–326

    Article  PubMed  Google Scholar 

  • O'Hara MW (2009) Postpartum depression: what we know. J Clin Psychol 65(12):1258–1269

    Article  PubMed  Google Scholar 

  • O'Hara MW, Swain AM (1996) Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatry 8(1):37–54

    Article  Google Scholar 

  • Onoye JM, Goebert D et al (2009) PTSD and postpartum mental health in a sample of Caucasian, Asian, and Pacific Islander women. Arch Womens Ment Health 12(6):393–400

    PubMed  Google Scholar 

  • Paulson JF, Dauber S et al (2006) Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics 118(2):659–668

    Article  PubMed  Google Scholar 

  • Penninx BW, Beekman AT et al (2008) The Netherlands Study of Depression and Anxiety (NESDA): rationale, objectives and methods. Int J Methods Psychiatr Res 17(3):121–140

    Article  PubMed  Google Scholar 

  • Penninx BW, Nolen WA et al (2011) Two-year course of depressive and anxiety disorders: results from the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord 133(1–2):76–85

    Article  PubMed  Google Scholar 

  • Rahman A, Iqbal Z et al (2004) Impact of maternal depression on infant nutritional status and illness: a cohort study. Arch Gen Psychiatry 61(9):946–952

    Article  PubMed  Google Scholar 

  • Records K, Rice MJ (2009) Lifetime physical and sexual abuse and the risk for depression symptoms in the first 8 months after birth. J Psychosom Obstet Gynaecol 30(3):181–190

    Article  PubMed  Google Scholar 

  • Robertson E, Grace S et al (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 26(4):289–295

    Article  PubMed  Google Scholar 

  • Romans S, Belaise C et al (2002) Childhood abuse and later medical disorders in women. An epidemiological study. Psychother Psychosom 71(3):141–150

    Article  PubMed  Google Scholar 

  • Rubertsson C, Waldenström U et al (2003) Depressive mood in early pregnancy: prevalence and women at risk in a national Swedish sample. J Reprod Infant Psychol 21(2):113–123

    Article  Google Scholar 

  • Rubinow DR (2005) Reproductive steroids in context. Arch Womens Ment Health 8:1–5

    Article  PubMed  CAS  Google Scholar 

  • Rubinow DR, Schmidt PJ (2006) Gonadal steroid regulation of mood: the lessons of premenstrual syndrome. Front Neuroendocrinol 27(2):210–216

    Article  PubMed  CAS  Google Scholar 

  • Schmidt PJ, Nieman LK et al (1998) Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med 338(4):209–216

    Article  PubMed  CAS  Google Scholar 

  • Silverman ME, Loudon H (2010) Antenatal reports of pre-pregnancy abuse is associated with symptoms of depression in the postpartum period. Arch Womens Ment Health 13(5):411–415

    Article  PubMed  Google Scholar 

  • Smith MV, Shao L et al (2010) Perinatal depression and birth outcomes in a Healthy Start project. Matern Child Health J 15(3):401–409

    Article  Google Scholar 

  • Suellentrop K, Morrow B, Williams L, D'Angelo D (2006) Monitoring progress toward achieving Maternal and Infant Healthy People 2010 objectives—19 states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000–2003. MMWR Surveill Summ 55(9):1–11

    PubMed  Google Scholar 

  • Tammentie T, Tarkka M-T et al (2002) Sociodemographic factors of families related to postnatal depressive symptoms of mothers. Int J Nurs Pract 8(5):240–246

    Article  PubMed  Google Scholar 

  • Viguera AC, Tondo L et al (2011) Episodes of mood disorders in 2,252 pregnancies and postpartum periods. Am J Psychiatry 168(11):1179–1185

    PubMed  Google Scholar 

  • Warner R, Appleby L et al (1996) Demographic and obstetric risk factors for postnatal psychiatric morbidity. Br J Psychiatry 168(5):607–611

    Article  PubMed  CAS  Google Scholar 

  • Wiersma J, Hovens JG, Oppen P, Giltay EJ, Schaik DV, Beekman AT, Penninx BW (2009) The importance of childhood trauma and childhood life events for chronicity of depression in adults. J Clin Psychiatry 70:983–989

    Article  PubMed  Google Scholar 

  • Wisner KL, Parry BL et al (2002) Clinical practice. Postpartum depression. N Engl J Med 347(3):194–199

    Article  PubMed  Google Scholar 

  • Wisner KL, Moses-Kolko EL et al (2010) Postpartum depression: a disorder in search of a definition. Arch Womens Ment Health 13(1):37–40

    Article  PubMed  Google Scholar 

  • Wittchen H-U, Burke JD et al (1989) Recall and dating of psychiatric symptoms: test-retest reliability of time-related symptom questions in a standardized psychiatric interview. Arch Gen Psychiatry 46(5):437–443

    Article  PubMed  CAS  Google Scholar 

  • Wittchen H, Robins L et al (1991) Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials. Br J Psychiatry 159(5):645–653 [published erratum appears in Br J Psychiatry 1992 Jan;160:136]

    Article  PubMed  CAS  Google Scholar 

  • Yonkers KA, Ramin SM et al (2001) Onset and persistence of postpartum depression in an inner-city maternal health clinic system. Am J Psychiatry 158(11):1856–1863

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The infrastructure of the NESDA study fully supported this project and provided the critical assistance to interview the subjects who generously gave their time to participate in this study. We thank Dr. John Cox, the creator of the Edinburgh Postnatal Depression Scale, for his thoughtful review of the manuscript and willingness to allow us to modify the original version of the EPDS to assess lifetime episodes of perinatal depression.

The infrastructure for the NESDA study (www.nesda.nl) is funded through the Geestkracht program of the Netherlands Organization for Health Research and Development (Zon-MW, grant number 10-000-1002) and is supported by participating universities and mental health care organizations (VU University Medical Center, GGZinGeest, Arkin, Leiden University Medical Center, GGZ Rivierduinen, University Medical Center Groningen, Lentis, GGZ Friesland, GGZ Drenthe, IQ Healthcare, Netherlands Institute for Health Services Research (NIVEL), and Netherlands Institute of Mental Health and Addiction (Trimbos)). Dr. Meltzer-Brody is funded by the National Institutes of Health grant # K23MH85165.

Conflict of interest

All authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Psychiatry, CB# 7160, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7160, USA

    Samantha Meltzer-Brody & Patrick F. Sullivan

  2. University Medical Center Groningen, Groningen, The Netherlands

    Lynn Boschloo

  3. Department of Psychiatry and EMGO Institute, VU University Medical Center Amsterdam, Amsterdam, The Netherlands

    Brenda W. Penninx

  4. Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK

    Ian Jones

  5. Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Patrick F. Sullivan

Authors
  1. Samantha Meltzer-Brody
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Lynn Boschloo
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Ian Jones
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Patrick F. Sullivan
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Brenda W. Penninx
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Samantha Meltzer-Brody.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Meltzer-Brody, S., Boschloo, L., Jones, I. et al. The EPDS-Lifetime: assessment of lifetime prevalence and risk factors for perinatal depression in a large cohort of depressed women. Arch Womens Ment Health 16, 465–473 (2013). https://doi.org/10.1007/s00737-013-0372-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-013-0372-9

Keywords

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy