2026 ECNP Congress

EP02-2029

Multilevel diagnostic framework using EPDS and PDSS for perinatal mental disorders

Boronin Larisa — N. Igor · Nicolae Testemitanu State University of Medicine and Pharmacy- Chisinau- Moldova, Department of Mental Health- Medical Psychology and Psychotherapy “Alexandru Nacu”- Mental Health Research Laboratory- Nicolae Testemitanu State University of Medicine and Pharmacy- Chisinau- Moldova, Chisinau, Moldova

2026 ECNP Congress

Background

Perinatal mental disorders, particularly depression and anxiety, are among the most prevalent complications associated with pregnancy and the postpartum period. Early identification relies on screening instruments; however, the use of single tools may limit diagnostic accuracy and fail to capture complex or comorbid conditions. Variability in cut-off thresholds and differences in psychometric properties across instruments further complicate clinical interpretation. The Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Depression Screening Scale (PDSS) are widely used in clinical practice, yet their diagnostic behaviour and complementary roles within structured assessment frameworks remain insufficiently characterized.

Aim

To evaluate the diagnostic performance of EPDS and PDSS and to propose a multilevel framework for perinatal mental health assessment.

Methods

This theoretical study integrates international psychometric data with secondary statistical analysis of EPDS and PDSS performance across multiple cut-off values. Correlation analyses (Pearson, Spearman, and Kendall) and linear regression modelling were used to examine relationships between sensitivity and specificity for each instrument, and to assess the consistency of diagnostic performance across thresholds. The analysis specifically aimed to determine whether diagnostic parameters demonstrate systematic trade-offs or operate as independent metrics. A multilevel diagnostic framework was conceptualized, combining screening tools with structured clinical interviews (SCID, MINI) to improve diagnostic precision.

Results

EPDS demonstrated stable psychometric performance, with no statistically significant relationship between sensitivity and specificity (R² ≈ 0.005, p > 0.05), indicating relative independence of psychometric parameters across thresholds. Similarly, PDSS showed no significant correlation between sensitivity and specificity (Pearson r ≈ –0.11, p > 0.05; R² ≈ 0.011), confirming stability and relative independence of diagnostic indicators. These findings indicate that sensitivity and specificity function as largely independent psychometric parameters rather than strictly competing metrics within these instruments, suggesting that variations in cut-off values do not produce systematic diagnostic trade-offs. Despite the absence of a linear association, both instruments demonstrated consistently robust diagnostic performance across a wide range of values. PDSS showed broader clinical coverage and high internal consistency (Cronbach’s α ≈ 0.95). Combined approaches integrating EPDS or PDSS with structured clinical interviews (e.g. SCID, MINI) substantially improved diagnostic accuracy, with sensitivity up to 94% and specificity up to 98%. These findings further indicate that both instruments maintain consistent performance across diverse clinical and population settings, supporting their applicability in routine perinatal care.

Conclusions

EPDS and PDSS demonstrate stable and complementary diagnostic properties but should not be used independently for definitive diagnosis. The absence of a systematic trade-off between sensitivity and specificity suggests that these parameters may reflect distinct and non-interchangeable aspects of diagnostic performance. A multilevel approach integrating screening instruments with structured clinical interviews provides a more accurate and clinically meaningful assessment, enabling identification of comorbid and complex perinatal mental disorders. This framework may further improve early detection, optimize resource allocation, support more effective clinical decision-making in perinatal mental health care, and contribute to the development of standardized multilevel screening strategies.

References

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