BACKGROUND The Edinburgh Postnatal Depression Scale (EPDS) is widely used in many countries to screen women for depression in the perinatal period. However, across studies the psychometric properties and cutoff scores of the EPDS have varied considerably; potentially due to different depression criteria and diagnostic systems being used. Therefore, we validated the Danish EPDS against a depression diagnosis according to both DSM-5 and ICD-10. Furthermore, we examined whether the Danish EPDS is multidimensional, as it has previously been suggested. METHODS Women (N = 324) were recruited after routine screenings with the EPDS between 2 and 10 months postpartum (T1). At a subsequent home visit (T2), the EPDS and the Structured Clinical Interview for DSM-5 were administered. Diagnostic interviews were audio recorded to enable subsequent coding for ICD-10 diagnoses and inter-rater reliability analysis. A two-phase stratified sampling strategy with three sampling categories (EPDS-score at T1) was used. Using the distribution of 4931 T1 EPDS-scores from the same population from which we sampled the participants, we used sampling weighing to reweight the sample. The calculation of weights was based upon the mother's sampling category at T1 (i.e. the probability of being sampled) and the weights were applied when assessing the receiver operation characteristics (ROCs) of the EPDS. Sensitivity, specificity, positive predictive value, negative predictive value and area under the ROC curve were computed from the reweighted data for all relevant cutoff values. CIs were computed by embedding the calculations in a weighted logistic regression. Exploratory factor analysis was done using oblique rotation. Parallel analysis was used to assess the number of factors. RESULTS A score of 11 or more was found to be the optimal cutoff for depression according to both DSM-5 and ICD-10 criteria. Factor analysis suggested that the Danish EPDS consists of three factors, including an 'anxiety factor'. CONCLUSIONS The Danish EPDS has reasonable sensitivity and specificity at a cutoff score of 11 or more. There are no notable differences with respect to using ICD-10 or DSM-5 criteria for depression in terms of optimal cutoff. The variation in cutoff scores is likely to be due to cultural variations in the expression of depressive symptoms.

中文翻译：

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根据 DSM-5 和 ICD-10 抑郁症诊断标准验证爱丁堡产后抑郁量表。


背景爱丁堡产后抑郁量表（EPDS）在许多国家广泛用于筛查女性围产期抑郁症。然而，在不同的研究中，EPDS 的心理测量特性和截止分数差异很大；可能是由于使用了不同的抑郁标准和诊断系统。因此，我们根据 DSM-5 和 ICD-10 验证了丹麦 EPDS 与抑郁症诊断的关系。此外，我们还研究了丹麦 EPDS 是否如之前所建议的那样是多维的。方法 产后 2 至 10 个月 (T1) 期间使用 EPDS 进行常规筛查后招募女性 (N = 324)。在随后的家访 (T2) 中，进行了 EPDS 和 DSM-5 结构化临床访谈。诊断访谈被录音，以便随后对 ICD-10 诊断进行编码和评估者间可靠性分析。使用具有三个采样类别（T1 时的 EPDS 分数）的两阶段分层采样策略。使用来自我们对参与者进行抽样的同一群体的 4931 个 T1 EPDS 分数的分布，我们使用抽样权重来重新加权样本。权重的计算基于母亲在T1 时的采样类别（即被采样的概率），并且在评估EPDS 的接收者操作特征（ROC）时应用权重。根据所有相关截止值的重新加权数据计算灵敏度、特异性、阳性预测值、阴性预测值和 ROC 曲线下面积。 CI 是通过将计算嵌入加权逻辑回归来计算的。使用倾斜旋转进行探索性因素分析。使用平行分析来评估因素的数量。 结果 根据 DSM-5 和 ICD-10 标准，11 分或以上是抑郁症的最佳分界值。因素分析表明，丹麦 EPDS 由三个因素组成，其中包括“焦虑因素”。结论 丹麦 EPDS 具有合理的敏感性和特异性，截止分数为 11 或更高。在最佳截止点方面，使用 ICD-10 或 DSM-5 抑郁症标准没有显着差异。截止分数的变化可能是由于抑郁症状表达的文化差异造成的。