Clinical applications of anxiety, social support, stressors, and self-esteem measured during pregnancy and postpartum for screening postpartum depression in Thai women

Aim: To assess the clinical applications of anxiety, social support, stressors and self-esteem as well as the Postpartum Depression Risk Scale (PDRS), measured during pregnancy and postpartum, for screening postpartum depression. Methods: A questionnaire regarding anxiety, social support, stressors and self-esteem was administered to 400 women during 36-40 weeks of gestation and 6-8 weeks postpartum prospectively, using factor analysis. The enrolled women were interviewed 6-8 weeks postpartum by psychiatrists using a diagnostic system of the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), for diagnosis of postpartum depression. Multiple logistic regression was used to identify the significant predictors for postpartum depression and then developed to be the PDRS and tested for clinical benefit. Results: Of 400 enrolled women, 40 (10%) were diagnosed with minor or major postpartum depression. After factor analysis, 10 items of anxiety, 10 items of social support, four items of stressors and five items of self-esteem were identified, with a standardized reliability coefficient of 0.85, 0.82, 0.81 and 0.82 during pregnancy and of 0.84, 0.82, 0.85 and 0.84 during the postpartum period, respectively. During pregnancy, a significant predictor was anxiety about postpartum depression, but postpartum significant predictors were anxiety and social support, which were generated to be PDRS. The clinical benefit of PDRS as a measure was better postpartum than during pregnancy. Conclusions: Anxiety and social support were identified as the predictors of postpartum depression. The development of the PDRS is clinically beneficial and useful during pregnancy and postpartum for the screening of postpartum depression in Thai women.