Article

A systemic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women

National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
Acta Psychiatrica Scandinavica (Impact Factor: 5.61). 06/2009; 119(5):350-64. DOI: 10.1111/j.1600-0447.2009.01363.x
Source: PubMed

ABSTRACT

The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening tool for postpartum depression (PPD). We systematically reviewed the published evidence on its validity in detecting PPD and antepartum depression (APD) up to July 2008.
Systematic review of validation studies of the EPDS included 1987-2008. Cut-off points of 9/10 for possible PPD, 12/13 for probable PPD and 14/15 for APD were used.
Thirty-seven studies met the inclusion criteria. Sensitivity and specificity of cut-off points showed marked heterogeneity between different studies. Sensitivity results ranged from 34 to 100% and specificity from 44 to 100%. Positive likelihood ratios ranged from 1.61 to 78.
Heterogeneity among study findings may be due to differences in study methodology, language and diagnostic interview/criteria used. Therefore, the results of different studies may not be directly comparable and the EPDS may not be an equally valid screening tool across all settings and contexts.

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Available from: Kirstie McKenzie-McHarg, Jan 10, 2014
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    • "The final sample included 216 urban women and 215 rural women. The EPDS cut-offs for PND suggested by Gibson et al.,[22]yielded prevalence estimates of 37.1 % for possible depression (n = 431, 95 % CI 32.5–41.9) and 18.1 % (n = 431, 95 % CI 14.6 – 22.1) for probable depression. "
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    ABSTRACT: Background This study investigated the prevalence and socio-cultural correlates of postnatal mood disturbance amongst women 18–45 years old in Central Vietnam. Son preference and traditional confinement practices were explored as well as factors such as poverty, parity, family and intimate partner relationships and infant health. Methods A cross-sectional study was conducted in twelve randomly selected Commune Health Centres from urban and rural districts of Thua Thien Hue Province, Vietnam. Mother-infant dyads one to six months postpartum were invited to participate. Questionnaires from 431 mothers (urban n = 216; rural n = 215) assessed demographic and family characteristics, traditional confinement practices, son preference, infant health and social capital. The Edinburgh Postnatal Depression Scale (EPDS) and WHO5 Wellbeing Index indicated depressive symptoms and emotional wellbeing. Data were analysed using general linear models. Results Using an EPDS cut-off of 12/13, 18.1 % (n = 78, 95 % CI 14.6 - 22.1) of women had depressive symptoms (20.4 % urban; 15.8 % rural). Contrary to predictions, infant gender and traditional confinement were unrelated to depressive symptoms. Poverty, food insecurity, being frightened of family members, and intimate partner violence increased both depressive symptoms and lowered wellbeing. The first model accounted for 30.2 % of the variance in EPDS score and found being frightened of one’s husband, husband’s unemployment, breastfeeding difficulties, infant diarrhoea, and cognitive social capital were associated with higher EPDS scores. The second model had accounted for 22 % of the variance in WHO5 score. Living in Hue city, low education, poor maternal competence and a negative family response to the baby lowered maternal wellbeing. Conclusions Traditional confinement practices and son preference were not linked to depressive symptoms among mothers, but were correlates of family relationships and wellbeing. Poverty, food insecurity, violence, infant ill health, and discordant intimate and family relationships were linked with depressive symptoms in Central Vietnam.
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    • "Although designed for postnatal women it is commonly used and is well validated for use in pregnant women to screen for depression (Gibson et al., 2009). The EPDS is validated for use as a continuous measure of depressive symptoms (Gibson et al., 2009) with an acceptable Chronbach's alpha of .80 (Brouwers et al., 2001b). Possible total scores range from 0 to 30. "
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    • "Our results indicated that cutoffs Z11 for the EPDS, Z15 for the BDI and Z9 for the HAM-D would be the optimal values for determining whether an individual should be referred to a professional for diagnostic confirmation. Differences in the prevalence, methodology, language, culture, diagnostic interviews and decision-making criteria used across study samples could be responsible for the variability in recommended cut-off scores (Halbreich and Karkun, 2006; Gibson et al., 2009). Our results may apply only to the second trimester of pregnancy in Brazil and must be interpreted in consideration of certain limitations. "
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