Rates and precipitating factors for postpartum depression following screening in consecutive births

Objective: To measure the recurrence rate and precipitating factors of postpartum depression (PPD) following universal screening using the Edinburgh Postnatal Depression Scale (EPDS) in consecutive births. Methods: EPDS questionnaires were administered to all postpartum women at our hospital beginning in June 2008. For this study, perinatal factors were examined in relation to EPDS scores during consecutive births to identify factors in the development of PPD. Outcomes of women previously screening negative and returning for another delivery were analyzed using univariable and multivariable analysis for associations with PPD. Results: Between June 2008 and March 2010, 17 613 women were screened using EPDS questionnaires, and 3842 (22%) women returned and subsequently delivered another infant. A prior negative EPDS score significantly reduced the risk of a subsequent positive EPDS when compared with index testing (3% versus 6%; p<0.01). Of those 3631 women previously screening negative and returning for a subsequent delivery, stillbirth and neonatal malformation were both associated with increased risk of PPD, p = 0.01 and p = 0.02, respectively. Following logistic regression, stillbirth remained significantly associated with symptoms of PPD (aOR 7.79, 95% CI 1.5-39.5). Conclusions: While prior negative screening portends a reduced risk for PPD, stillbirth in a subsequent pregnancy remains a powerful antecedent for PPD.