Prospective testing of the Brisbane Postnatal Depression Index

Abstract

Background: Over 50 percent of women have one or more risk factors for postnatal depression during pregnancy or in the perinatal period but only 10 to 15 percent become clinically depressed. Identifying the women with risks, who will also develop depression remains elusive and has been the focus of considerable research. The objective of this study was to prospectively test the Brisbane Postnatal Depression Index, to validate a theoretical index which was developed in an earlier study, and to establish whether the Index could be introduced as an administratively simple and clinically useful method for the detection of women who may be at risk for developing postnatal depression. Methods: Antenatally, women were asked about social support and about personal and family history of mental illness, including postnatal depression. Responses were scored according to pre-defined ratings on the Brisbane Postnatal Depression Index. In the postnatal wards, 353 women were recruited and their scores for ‘blues’, social support, feelings about the baby, and satisfaction with the birth process were added. Sixteen weeks after hospital discharge, women were asked to complete the Edinburgh Postnatal Depression Scale. The Brisbane Postnatal Depression Index was validated by the number of women scoring >12 on the Edinburgh Postnatal Depression Scale at 16 weeks postpartum who were correctly predicted by a score of > 6 on the Brisbane Postnatal Depression Index. Sensitivity, specificity, positive predictive value and negative predictive value for the Brisbane Postnatal Depression Index using > 6 as a cut off point were calculated. ‘Ease of use’ was assessed informally through discussions with women who completed the questionnaire and with staff responsible for administration and scoring the instrument. Results: Compared with results from the derivation study, prospective testing of the index showed an improvement in sensitivity from 36.3 to 47.5 percent and a small decrease in specificity but there was no improvement on the positive predictive value 39.8 to 39.6 percent. Conclusion: The Brisbane Postnatal Depression Index has been validated in a prospective sample but the sensitivity and specificity of the instrument requires improvement before introduction as a measure of prediction

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