A controlled study of postpartum depression among Nepalese women: Validation of the Edinburgh Postpartum Depression Scale in Kathmandu

Mental Health Resource Centre, Tribhuvan University, Kathmandu, Nepal.
Tropical Medicine & International Health (Impact Factor: 2.33). 04/2002; 7(4):378-82. DOI: 10.1046/j.1365-3156.2002.00866.x
Source: PubMed

ABSTRACT To measure the prevalence of depression amongst postpartum and non-postpartum Nepalese women in Kathmandu using the Edinburgh Postpartum Depression Scale (EPDS) and to assess the ease of use and validity of the scale compared with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for major depression.
We screened 100 women 2-3 months post-delivery and 40 control women using the EPDS. All those who screened positive for depression and 20% of the negatives also underwent a structured interview to assess depression by DSM-IV criteria.
Predictive errors were minimized by using an EPDS score > or =13 to define depression. Using this threshold, there was no difference in depression prevalence between postpartum women (12%) and the control group (12.5%) (Fisher's exact test, P > 0.05). Compared with DSM-IV, the sensitivity, specificity and positive predictive values were 100, 92.6 and 41.6%, respectively.
The prevalence of postpartum depression (PPD) in Nepalese women and the validity and ease of use of the EPDS in the setting of a postnatal clinic in Kathmandu are all surprisingly similar to the results of numerous studies in developed countries. Despite poor living conditions, PPD is no more common than the background depression rate amongst Nepalese women. It can be reliably detected by trained clinical nurses using the EPDS screening test. These results may have implications for the planning of mental health resources for women in other developing countries.

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    • "There is evidence of a high burden of maternal mental illness in Nepal: estimates of distress in the postnatal period range from 5 to 12%, and suicide is the leading cause of death among women of reproductive age [6-9]. Quantitative studies have shown that poor reproductive health, son preference, and socioeconomic disadvantage are important predictors of distress among Nepalese mothers [10,11]. "
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    BMC Psychiatry 03/2014; 14(1):60. DOI:10.1186/1471-244X-14-60 · 2.21 Impact Factor
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    • "Examination of the issue across 11 countries (10 HICs and 1 low income country (LIC) - Uganda), supported the " universality " of postpartum morbid unhappiness but raised concerns about the cross-cultural equivalence of PND as an illness requiring clinical intervention (Oates et al., 2004). There has been expansion in the testing of PND screening instruments in LLMICs, significantly improving the validity and reliability of evidence relating to PND from these settings (Baggaley et al., 2007; Banerjee et al., 2000; Gausia et al., 2007; Hanlon et al., 2008; Kaaya et al., 2008; Kazi et al., 2009; Pollock et al., 2006; Randhawa et al., 2009; Regmi et al., 2002; Spies et al., 2009; Stewart et al., 2009; Tesfaye et al., 2010; Weobong et al., 2009; Wulsin et al., 2002). In our mapping we take an inclusive approach and include studies that assessed depression in the postpartum period, for which we do not know the timing of the onset of depression, including maternal depression in the postpartum period. "
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    Health & Place 05/2012; 18(5):1188-97. DOI:10.1016/j.healthplace.2012.05.004 · 2.81 Impact Factor
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    • "However, in 6 of them women who had experienced physical abuse during pregnancy or in the previous year had a higher prevalence Fig. 2. Meta-analysis of individual study and overall prevalence of common perinatal mental disorders in women in low-and lowermiddle-income countries Study Health sector Pregnancy Limlomwongse 2006 Karmaliani 2007 Fisher 2007 Aderibigbe 1993 Abiodun 1993 Adewuya 2006 Cox 1979 Chandran 2002 Nhiwatiwa 1998 Fisher 2010 Fisher 2010 Hanlon 2009 Rahman 2003 Gausia 2009 Subtotal (l 2 = 95.5%, P < 0.001) Postpartum Pollock 2009 Uwakwe 2003 Pitanupong 2007 Piyasil 1998 Regmi 2002 Aderibigbe 1993 Wan 2009 Faisal-Cury 2004 Limlomwongse 2006 Xie 2007 Ebeigbe 2008 Adewuya 2005 Fisher 2004 Ho-Yen 2007 Gao 2009 Edwards 2006 Patel 2006 Owoeye 2006 Nakku 2006 Agoub 2005 Gausia 2007 Adewuya 2007 Montazeri 2007 Nhiwatiwa 1998 Abiodun 2006 Gausia 2009 Adewuya 2005 Stewart 2008 Fisher 2010 Affonso (India) 2000 Affonso (Guyana) 2000 Rahman 2003 Husain 2006 Black 2007 Nagpal 2008 Subtotal (l 2 = 97.2%, P < 0.001) "
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    Bulletin of the World Health Organisation 02/2012; 90(2):139G-149G. DOI:10.2471/BLT.11.091850 · 5.09 Impact Factor
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