Clinical Research
Further Development of the Postpartum Depression Predictors Inventory‐Revised

https://doi.org/10.1111/j.1552-6909.2006.00094.xGet rights and content

Objectives

To describe the newly developed item coding and computation of the total score for the Postpartum Depression Predictors Inventory‐Revised along with recommended cutoff points.

Design

Methodologic research.

Setting

Obstetrician and gynecologist offices in the Pacific Northwest.

Participants

This longitudinal study included 139 women; the study began in the participant’s third trimester of pregnancy and ended at 8 months after childbirth.

Methods

The participants completed the Postpartum Depression Predictors Inventory‐Revised in their third trimester of pregnancy and again at 2 and 6 months after childbirth. Postpartum depression symptoms were measured by the Edinburgh Postnatal Depression Scale and psychiatric nurse practitioner interview at 2 and 6 months after childbirth.

Main Outcome Measures

Sensitivity and specificity of the Postpartum Depression Predictors Inventory‐Revised at three points: prenatal and 2 and 6 months after childbirth.

Results

The receiver operating characteristic curve analysis indicated that the Prenatal Postpartum Depression Predictors Inventory‐Revised performed well and explained 67% of the variance of postpartum depressive symptomatology as measured by Edinburgh Postnatal Depression Scale scores. The Prenatal Postpartum Depression Predictors Inventory‐Revised yielded a sensitivity of .76 and a specificity of .54 at a cutoff score of 10.5.

Conclusions

A cutoff score of 10.5 is recommended when using the Postpartum Depression Predictors Inventory‐Revised during pregnancy. Further research needs to be conducted on recommended cutoff scores for use of the Postpartum Depression Predictors Inventory‐Revised during the postpartum period. JOGNN,35, 735‐745; 2006. DOI: 10.1111/J.1552‐6909.2006.00094.x

Section snippets

Postpartum Depression

Postpartum depression is a thief that steals motherhood (Beck, 1993). The basic problem women with this mood disorder have to contend with is loss of control over their emotions, thought processes, and actions. Women attempt to cope with this problem through a four‐stage process labeled teetering on the edge, which refers to walking a fine line between sanity and insanity. The four stages consist of (a) encountering terror as the symptoms hit unexpectedly and suddenly, (b) dying of self as

Postpartum Depression Predictors Inventory‐Revised

The PDPI‐R was developed from Beck’s (2001)updated meta‐analysis and includes 13 risk factors reported to be significantly related to the development of postpartum depression. Guide questions are provided for each risk factor, which clinicians can use during the interview process (Beck, 2002a). These questions are provided to help in determining whether a predictor is present or not in a woman being interviewed.

The first 10 predictors comprise the Prenatal Version of the PDPI‐R. The last three

Screening Instruments for Risk of Postpartum Depression

In addition to the PDPI‐R, there are 11 instruments designed to identify women during pregnancy who are at risk for developing postpartum depression. Six of these instruments have been described in a previous study (Beck, 2002a). These instruments include one developed by Braverman and Roux (1978), Petrick’s checklist (1984), a checklist compiled by Boyer (1990), the Antenatal Screening Questionnaire (Appleby, Gregoire, Platz, Prince, & Kumar, 1994), the Modified Antenatal Screening

Scoring Directions

A summary of the scoring directions is described first for the Prenatal Version of the PDPI‐R and then for the Postpartum Version. After delivery, the Full Version is used, which includes both the Prenatal and the Postpartum Versions.

Sensitivity and Specificity

Sensitivity is the ability of the PDPI‐R to correctly identify all screened women who actually go on to be depressed after the birth of the baby (i.e., true positive rate). Specificity is the ability of the PDPI‐R to correctly identify all screened women who do not become depressed after delivery (i.e., true negative rate). There is a trade‐off between the sensitivity and the specificity of a screening instrument. Sensitivity is increased only at the expense of specificity. A screening

Nursing Implications and Future Research

With the newly developed coding and scoring scheme for the PDPI‐R, its screening capability is expanded. For the first time since the PDPI was originally developed in 1998, researchers and clinicians can choose the implementation method that best fits their needs. Clinicians can administer the inventory as a means to dialogue with women, as originally proposed. The option is also available to use the inventory as a self‐report measure that can be a vehicle for clinician‐patient discussions. A

Acknowledgments

Dr. Kathie Records was supported by the National Institute of Nursing Research (NR05311‐01A2).

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