ArticleActa psychiatrica Scandinavica2026
Postpartum Depression: Overlap Between Symptom-Based and Register-Based Measures.
Article in Acta psychiatrica Scandinavica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionPostpartum depression (PPD) can be measured in various ways, including questionnaire-based symptom scores or through administrative health databases. We examined the overlap between symptom-based and register-based PPD definitions and assessed the consistency in exposure-outcome associations.
methodsWe linked Danish nationwide health registers to PPD screening records (Edinburgh Postnatal Depression Scale, EPDS) at 2 months postpartum from women screened between January 1, 2015, and December 31, 2021. We defined symptom-based PPD as an EPDS ≥ 11, and register-based PPD as an antidepressant prescription or hospital depression diagnosis within 1 year postpartum. We estimated the overlap between women with register-based and symptom-based PPD, as well as between continuous EPDS scores and register-based treatment indicators. We evaluated consistency between the two definitions using logistic regression analyses for socioeconomic, obstetric, demographic- and health-related exposures from which we obtained odds ratios (ORs) for each PPD definition and calculated ratio of odds ratios (ROR).
resultsAmong 157,193 mothers (132,593 unique), 11,193 (7.1%) had symptom-based PPD and 2409 (1.5%) had register-based PPD. Of those with symptom-based PPD, 8.8% also had register-based PPD, while 40.8% of those with register-based PPD had symptom-based PPD. We observed a higher overlap with higher EPDS scores. Consistency was highest for obstetric variables but varying for demographic- and health-related exposures (ROR register-based vs. symptom-based 1.84 [95% CI 1.67-2.03] for psychiatric history and 0.75 [95% CI 0.68-0.83] for primiparity).
conclusionWe observed substantial differences and limited overlap between symptom-based and register-based PPD. Register-based measures capture hospital-based diagnoses and pharmacological treatment only, but not all treatment within the healthcare system, and differences may reflect a combination of severity, symptom transience, misclassification, and timing of measurement. Consistency in exposure-outcome associations varied, particularly for certain exposures. Our findings underline the importance of considering both the nature and implications of PPD definitions in epidemiological research.
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