A controlled study of postpartum depression among Nepalese
women: validation of the Edinburgh Postpartum Depression
Scale in Kathmandu
Shishir Regmi1, Wendy Sligl2, Diana Carter3, William Grut4and Michael Seear5
1 Mental Health Resource Centre, Tribhuvan University, Kathmandu, Nepal
2 Medical Student at University of British Columbia, Vancouver, Canada
3 Department of Psychiatry, University of British Columbia, Vancouver, Canada
4 Association of Medical Doctors in Asia, Kathmandu, Nepal
5 Centre for International Health, University of British Columbia, Vancouver, Canada
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 ‡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.
To measure the prevalence of depression amongst postpartum and non-postpartum
keywords depression, postpartum depression, Nepal, Edinburgh Postpartum Depression Scale,
correspondence Dr Michael Seear, Children’s and Women’s Health Centre of British Columbia, 4480
Oak Street, Room 1C42, Vancouver, British Columbia V6H 3V4, Canada. Fax: +1 604 875 3293;
Although the mortality from avoidable diseases amongst
the developing world’s women and children is still shock-
ingly high, steady improvements over the last two decades
have been reflected by a slow shift in research emphasis
towards non-lethal conditions such as children’s rights and
adult mental illness. A recent World Health Organization
(WHO) report, predicting disease patterns for developing
countries in 2020, also warned of the increasing impact of
non-communicable diseases, including mental ill health
(WHO 1996). While epidemiological information is avail-
able for mental illness in a few developing countries (Bahar
et al. 1992; Abbas & Broadhead 1997), this area deserves
more research attention (Desjarlais et al. 1996; Blue &
Postpartum depression (PPD) is a mental illness with
particular relevance for health planners in the developing
world, both from maternal and child health viewpoints.
Literature from developed (O’Hara et al. 1990) and
Tropical Medicine and International Health
volume 7 no 4 pp 378–382 april 2002
ª 2002 Blackwell Science Ltd