Predictive validity of the Japanese version of Postpartum Depression Predictors Inventory-Revised (PDPI-R) during pregnancy and the postpartum period

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目的:産後うつ病(Postpartum Depression:PPD)は本人の自殺,パートナーや子供のメンタルヘルス,認知機能, 社会的・情緒的発達,虐待とも関連する。PPD 関連の自殺者は産科出血による死亡数より多いとする報告もある。故に妊娠中,産褥早期にリスク因子を見つけてケアすることが重要である。今回米国で開発された Postpartum Depression Predictors Inventory-Revised ( PDPI-R ) を産褥期だけでなく妊娠中にも検査し,PPD を妊娠期に予測出来るか否かを検討した。方法:2012 年12 月から2015 年2 月までに,鹿児島県内産婦人科に通院中,または入院中の妊婦で精神科疾患の既往がなく研究同意が得られた者を対象とした。PDPI-R は日本語に翻訳した後に逆翻訳し,原尺度と比較検討し日本語,英語について整合性の得られたもので日本語翻訳を完成させた。妊娠10-23 週にPDPI-R ( 自己評価票) 産前版(social support の欠如,life stress などのリスク因子10 項目,0-32 点満点)と産褥1ヶ月にPDPI-R 産後版(産前版10 項目 + 育児ストレス,子どもの気質,maternity blues のリスク因子3 項目,合計13 項目,0-39 点満点)を実施し産前と産後の2 時点で完全に解答し終えた120 人を対象とした。PPD のスクリーニングはエジンバラ産後うつ病自己評価票9 点以上とした。Receiver operating characteristic curve を用いて,PDPI-R の妥当なcut-off 値を決め, PPD のハイリスク群が予測出来るか否かを検討した。結果:1)PPD は12 人(10%)であった。2)妊娠中PDPI-R のcut-off 値を7.0 に決定したとき,PPD 予測の感度は50.0%(6/12),特異度は87.0%(94/108)であり,cut-off 値6.0, 8.0 のそれらに比較して優れていた。陽性, 陰性的中率も7.0 が優れていた。3)産褥期PDPI-R のcut-off 値を8.0 にしたとき,感度は66.7%(8/12),特異度88.0%(95/108)であり,cut-off 値7.0 と9.0 のそれらに比較して優れていた。陽性, 陰性的中率も8.0 が優れていた。結論:PDPI-R 日本語版は産褥期だけでなく妊娠中から産後うつ病のハイリスク群を予測できる有用な方法である。本研究でのPDPI-R のcut-off 値は妊娠中で7.0,産褥1 ヶ月で8.0 が妥当であると思われた。我々の設定したcut-off 値は本邦の他の報告と類似するが,欧米の報告よりcut-off 値が高かった。

Aim: To identify the risk factors for postpartum depression (PPD) during pregnancy and the early postpartum period is considered important for preventing the development of PPD. Postpartum Depression Predictors Inventory-Revised (PDPI-R, self-report questionnaires) was developed from Beck's updated meta-analysis and correlated with the development of PPD. The purpose of the present study was to investigate the predictive validity of the Japanese version of PDPI-R during pregnancy and one month after delivery.Materials and methods: Pregnant Japanese women (n=192) participated in this study between December 2012 and February 2015 at the Department of Obstetrics and Gynecology, Kagoshima University Hospital and three practitioners in Kagoshima prefecture, all of which are located in the southern part of Japan. Subjects were 120 pregnant Japanese women who completed PDPI-R during 10-23 weeks of gestation and one month postpartum. All subjects delivered full-term healthy babies. PPD symptoms were measured by the Edinburgh Postnatal Depression Scale (EPDS) one month after delivery. The predictive validity of the Japanese version of PDPI-R was investigated. After identifying appropriate cut-off values by carrying out a receiver operating characteristic (ROC) curve, sensitivity, specificity, positive and negative predictive values, and the accuracy of PDPI-R were determined in both versions.Results: Twelve (10%) out of 120 mothers met the PPD criteria with EPDS scores of 9 or higher. With a prenatal cut-off value of 7.0 after carrying out a ROC curve, the sensitivity and specificity of PDPI-R were 50.0% (6/12) and 87.0% (94/108), respectively. The positive and negative predictive values of PDPI-R were 30.0% (6/20) and 94.0% (94/100), respectively. The cut-off value of 7.0 was superior to 6.0 and 8.0. With a postpartum appropriate cut-off value of 8.0, sensitivity and specificity were 66.7% (8/12) and 88.0% (95/108), respectively. The positive and negative predictive values were 38.1% (8/21) and 96.0% (95/99), respectively. The cut-off value of 8.0 was superior to 7.0 and 9.0.Conclusions: The Japanese version of PDPI-R is a useful instrument for predicting PPD in not only the postpartum period, but also the prenatal period. An appropriate cut-off value of PDPI-R may be 7.0 in the prenatal version and 8.0 in the postpartum version.


  • 鹿児島大学医学雑誌 = Medical journal of Kagoshima University

    鹿児島大学医学雑誌 = Medical journal of Kagoshima University 68(1-3), 9-19, 2016-12



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