BACKGROUND: Screening for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS), in combination with counselling sessions with a public health nurse (the Edinburgh method), has been introduced at many child health centres in Norway. In this article we provide a summary of the existing knowledge of how postnatal depression should be handled, with a particular emphasis on the benefits of screening. MATERIAL AND METHOD: A literature search was conducted in PubMed, PsychInfo and Cochrane. National and international guidelines and related reports were downloaded from the websites of the respective health authorities. RESULTS: Depressive symptoms occur in 10-15% of all new mothers. Several international studies have demonstrated a positive effect of the Edinburgh method, and screening for postnatal depression is recommended in a number of countries. In Norway no studies have yet been conducted to assess efficacy and resource use. The EPDS scale has been validated in several countries, and in a Norwegian validation study various threshold values for EPDS scores were compared with DSM-IV criteria for «major depression». Total score on the EPDS scale varies from 0 to 30. A threshold value of 10 yielded a sensitivity of 100% and a specificity of 87%, which resulted in many false positives. Higher threshold values yielded significantly lower sensitivity (67%). Two EPDS measurements plus an interview have been recommended, but have as yet been insufficiently tested. INTERPRETATION: Screening for postnatal depression may be an appropriate measure. However, further knowledge is needed about the efficacy in Norway of the Edinburgh method and other models for follow-up, as well as agreement on the cut-off point for a positive test.
BACKGROUND: Screening for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS), in combination with counselling sessions with a public health nurse (the Edinburgh method), has been introduced at many child health centres in Norway. In this article we provide a summary of the existing knowledge of how postnatal depression should be handled, with a particular emphasis on the benefits of screening. MATERIAL AND METHOD: A literature search was conducted in PubMed, PsychInfo and Cochrane. National and international guidelines and related reports were downloaded from the websites of the respective health authorities. RESULTS:Depressive symptoms occur in 10-15% of all new mothers. Several international studies have demonstrated a positive effect of the Edinburgh method, and screening for postnatal depression is recommended in a number of countries. In Norway no studies have yet been conducted to assess efficacy and resource use. The EPDS scale has been validated in several countries, and in a Norwegian validation study various threshold values for EPDS scores were compared with DSM-IV criteria for «major depression». Total score on the EPDS scale varies from 0 to 30. A threshold value of 10 yielded a sensitivity of 100% and a specificity of 87%, which resulted in many false positives. Higher threshold values yielded significantly lower sensitivity (67%). Two EPDS measurements plus an interview have been recommended, but have as yet been insufficiently tested. INTERPRETATION: Screening for postnatal depression may be an appropriate measure. However, further knowledge is needed about the efficacy in Norway of the Edinburgh method and other models for follow-up, as well as agreement on the cut-off point for a positive test.