Postnatal depression and child outcome at 11 years: the importance of accurate diagnosis.

BACKGROUND One in ten women suffers from postnatal depression (PND) and their children have elevated rates of psychopathology. We compared caseness of PND using the Edinburgh Postnatal Depression Scale (EPDS), the most commonly used research tool for the detection of PND, and the Clinical Interview Schedule (CIS) in terms of their relative abilities to identify infants at risk of psychopathology in middle childhood. METHOD In a prospective longitudinal primary care study, 147 randomly selected women were administered both the CIS and the EPDS at three months postpartum. Childhood psychopathology was identified by face-to-face interview at 11 years. RESULTS The risk for psychiatric disorder at 11 years was four times greater among children whose mothers were cases of PND on the CIS, compared to children whose mothers were not depressed. Using the EPDS to identify PND, there was no significant difference in the risk for children whose mothers scored above and below a conventional cut-off score. LIMITATIONS This study was retrospectively designed and was not part of the original study plan. CONCLUSIONS These data support the evidence that accurate detection of PND is better achieved by face-to-face clinical interview than through the use of the EPDS. They provide novel evidence that a simple diagnostic clinical interview for PND, in contrast to the EPDS, can identify mothers whose children will be at an increased risk of developing psychiatric disorder in later childhood.