Screening for antenatal maternal depression: comparative performance of the Edinburgh postnatal depression scale and patient health questionnaire

Abstract Background: Maternal antenatal depression affects 21-28% of expectants globally and negatively impacts both maternal and child health in the short and long term. Objective: To compare the psychometric properties and clinical utility of the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) in pregnant individuals. Methods: In this cross-sectional study, 953 third-trimester pregnant Italian individuals completed both the EPDS and the PHQ-9. Results: Both scales demonstrated good internal consistency (EPDS ω=.83, PHQ-9 ω=.80) and a moderate correlation between their scores (r=.59). Concordance at recommended cut-off points (≥14 for both) was moderate (k=.55). Factor analyses indicated a bifactor solution for the EPDS (dimensions: 'Depression' and 'Anxiety') and for the PHQ-9 (dimensions: 'Depression,' 'Pregnancy Symptoms,' 'Somatic'). Benchmarks for clinical change were also established. Conclusion: The EPDS and PHQ-9 capture distinct aspects of perinatal depressive symptomatology. Clinically, these findings recommend using both scales in obstetric and gynaecologic settings to minimize false positives and negatives.