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Cited by 140Maternal Mental Health During Pregnancy and PostpartumAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychometric Methodologies and Testing

Comparative performance of Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale for screening antepartum depression

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Zhong, Qiuyue, Gelaye, Bizu, Rondon, Marta, E. Sánchez, Sixto, J. García, Pedro, Sánchez, Elena, V. Barrios, Yasmin, E. Simon, Gregory +3 more·2014·Journal of Affective Disorders
DOI 10.1016/j.jad.2014.03.028PMC PMC4040145
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Abstract

Objective We sought to evaluate the psychometric properties of two widely used screening scales: the Patient Health Questionnaire (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) among pregnant Peruvian women. Methods This cross-sectional study included 1517 women receiving prenatal care from February 2012 to March 2013. A structured interview was used to collect data using PHQ-9 and EPDS. We examined reliability, construct and concurrent validity between two scales using internal consistency indices, factor structures, correlations, and Cohen׳s kappa. Results Both scales had good internal consistency (Cronbach׳s alpha>0.8). Correlation between PHQ-9 and EPDS scores was fair (rho=0.52). Based on exploratory factor analysis (EFA), both scales yielded a two-factor structure. EFA including all items from PHQ-9 and EPDS yielded four factors, namely, "somatization", "depression and suicidal ideation", "anxiety and depression", and "anhedonia". The agreement between the two scales was generally fair at different cutoff scores with the highest Cohen׳s kappa being 0.46. Conclusions Both the PHQ-9 and EPDS are reliable and valid scales for antepartum depression assessment. The PHQ-9 captures somatic symptoms, while EPDS detects depressive symptoms comorbid with anxiety during early pregnancy. Our findings suggest simultaneous administration of both scales may improve identification of antepartum depressive disorders in clinical settings.

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  • The PHQ-9 directly assesses DSM-5 criteria for major depressive disorder, including sleep, appetite, energy, concentration, and other symptoms, which all may be inflated during the postpartum period for non-psychiatric reasons.

    “The PHQ-9 directly assesses DSM-5 criteria for major depressive disorder, including sleep, appetite, energy, concentration, and other symptoms, which all may be inflated during the postpartum period for non-psychiatric reasons.73”

    From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [73]

    The Methods (section 2.3.1; page not provided) list sleep, appetite, energy, and concentration among the symptoms assessed by the PHQ-9, but say it is based on DSM-IV, not DSM-5, criteria. The Discussion (section 4; page not provided) says postpartum somatic symptoms can overlap with depressive symptoms and may cause false positives; it does not extend that concern to every listed symptom, including concentration. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Comparison across studies is limited by substantial heterogeneity in postpartum depression ascertainment, including different screening instruments, variable cutoff thresholds, inconsistent assessment windows, and differing definitions of depression.

    “Comparison across studies is limited by substantial heterogeneity in postpartum depression ascertainment, including use of different screening instruments (EPDS vs. PHQ-9), variable cutoff thresholds, inconsistent postpartum assessment windows, and differing definitions of depression based on screening scores versus structured diagnostic interviews.73”

    From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [73]

    The Background and Discussion (pages unavailable) discuss EPDS and PHQ-9 as different screening instruments, and the Discussion compares studies using different cutoffs and antenatal assessment times. But this paper studies antepartum depression; it does not establish inconsistent postpartum assessment windows or document cross-study differences between screening-score and diagnostic-interview definitions of postpartum depression. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • The Edinburgh Postnatal Depression Scale was designed specifically for the perinatal population and tends to focus on symptoms such as anxiety while minimizing somatic items that can overlap with normal postpartum recovery.

    “In contrast, the EDPS was designed specifically for the perinatal population and tends to focus on symptoms such as anxiety while minimizing somatic items that can overlap with normal postpartum recovery.73”

    From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [73]

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Authors
Zhong, Q., Gelaye, B., Rondon, M., E. Sánchez, S., J. García, P., Sánchez, E., V. Barrios, Y., E. Simon, G., C. Henderson, D., May Cripe, S., & A. Williams, M.
Affiliations
Harvard University (US)
Corresponding author
Gelaye, Bizu
ORCID
Gelaye, Bizu
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2014-06
Volume
162
Pages
1-7
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2014.03.028
PMC
PMC4040145
OpenAlex
W2138029104
Cited by
140
References
14
Citations by year
2026: 12 · 2025: 14 · 2024: 10 · 2023: 14 · 2022: 14 · 2021: 16 · 2020: 19 · 2019: 5 · 2018: 15 · 2017: 6 · 2016: 6 · 2015: 5 · 2014: 4
FWCI
6.44
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Affective Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-nd)
  • Universidad de San Martín de Porres – USMP
Funders
Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD059835)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Keywords
antenatal depression, PHQ-9, Edinburgh Postnatal Depression Scale, depression screening, psychometric properties, scale validity, scale reliability, factor structure, somatization, anxiety comorbidity, pregnant women, prenatal care
MeSH terms
Adolescent, Adult, Cross-Sectional Studies, Depressive Disorder, Female, Humans, Mass Screening, Middle Aged, Peru, Pregnancy, Pregnancy Complications, Prenatal Diagnosis, Surveys and Questionnaires, Reproducibility of Results, Depression, Postpartum, Young Adult, Suicidal Ideation

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