Case-finding with the anxiety sub-scale of the Edinburgh Postnatal Depression Scale in an observational cohort: Sensitivity, specificity, and cost-effectiveness.

Camacho, Elizabeth M; Shields, Gemma E; Eisner, Emily; Littlewood, Elizabeth; Watson, Kylie; Chew-Graham, Carolyn A; McMillan, Dean; Gilbody, Simon

Abstract

The Edinburgh Postnatal Depression Scale (EPDS) is effective and cost-effective for identifying postnatal depression. Postnatal anxiety is also common and can be identified by three questions on the EPDS (anxiety sub-scale). We aimed to compare EPDS score alone with EPDS score and sub-scale score together (EPDS+) to identify common mental illness (depression or anxiety) in postnatal women. The sensitivity and specificity of the EPDS and sub-scale were explored. We developed a decision tree to compare costs and health outcomes associated with case-finding for postnatal depression or anxiety over one year. Model parameters were derived from secondary data analysis, published literature, and expert consultation. Costs included case-finding and treatment. Health benefit was measured as quality-adjusted life years (QALYs). We explored the cost-effectiveness of using EPDS alone and EPDS+ (versus no case-finding). The greatest number of true positive outcomes and smallest number of false negative outcomes were seen with EPDS+. However, the number of false positives is also higher for EPDS+. Compared with no case-finding, EPDS alone costs £3365/QALY gained and EPDS+ costs £6405/QALY gained. The additional health gain from EPDS+ (versus EPDS alone) costs £22,104/QALY. The model does not include long-term impacts of maternal mental illness or impacts on other family members. Case-finding for common mental illness in the postnatal period is cost-effective. Compared to no case-finding, EPDS alone is more cost-effective than EPDS+. If decision-makers want to maximise identification of cases, EPDS+ could be cost-effective depending on how much they are willing to pay. [Abstract copyright: Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.]

Citation

Camacho, E. M., Shields, G. E., Eisner, E., Littlewood, E., Watson, K., Chew-Graham, C. A., McMillan, D., & Gilbody, S. (in press). Case-finding with the anxiety sub-scale of the Edinburgh Postnatal Depression Scale in an observational cohort: Sensitivity, specificity, and cost-effectiveness. Journal of Affective Disorders, 381, 84-91. https://doi.org/10.1016/j.jad.2025.04.009

• Journal Article Type: Article
• Acceptance Date: Apr 1, 2025
• Online Publication Date: Apr 3, 2025
• Deposit Date: Apr 29, 2025
• Journal: Journal of affective disorders
• Print ISSN: 0165-0327
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 381
• Pages: 84-91
• DOI: https://doi.org/10.1016/j.jad.2025.04.009
• Keywords: Cost-effectiveness, Depression, Case-finding, Postnatal, Edinburgh Postnatal Depression Scale, Anxiety
• Public URL: https://keele-repository.worktribe.com/output/1201126
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0165032725005610?via%3Dihub