Brief reportScreening for postnatal depression: Validation of the Norwegian version of the Edinburgh Postnatal Depression Scale, and assessment of risk factors for postnatal depression
Introduction
In the postpartum period, women show an increased vulnerability for major depressive episodes (Cox et al., 1987; O’Hara and Swain, 1996). Untreated postpartum depression can have a detrimental effect on mother–child interaction and negative influence on child development (Murray and Cooper, 1997). The Edinburgh Postnatal Depression Scale (EPDS) is a questionnaire with 10 items that are specifically designed for detecting depression in the postpartum period (Cox et al., 1987). It has been used extensively in various languages. The use of the EPDS as a screening tool is particularly important among women who are at risk for postpartum depression (Nielsen et al., 2000).
Since its introduction, the EPDS has been used extensively in both clinical settings and in epidemiological studies. The EPDS has shown good psychometric properties in the postpartum population, is well accepted by women, and has also, in recent years, been used for pregnant and non-puerperal women (Cox et al., 1996).
The EPDS was designed as a one-dimensional instrument for depression, yet the suggestion of a two-factor model exists (Pop et al., 1992; Guedeney and Fermanian, 1998).
In the first EPDS studies, a cut off score of 10 was recommended for community surveys and screening (Cox et al., 1987), while a cut-off score of 13 was seen as more appropriate for a clinical setting.
The aim of the present study was to validate a Norwegian translation of the EPDS and to assess risk factors for postnatal depression.
Section snippets
Translation
A translation of the EPDS into Norwegian was followed by a back-translation into English. This procedure was done twice.
Sampling
Women attending routine post-natal visits, 6–12 weeks post partum, were screened using the EPDS. A majority of them also filled in the Beck Depression Inventory (BDI) (Beck et al., 1961) and the Hospital Anxiety and Depression Rating Scale (HADS) (Zigmond and Snaith, 1983).
Procedure
All women with an EPDS sum score of 8 or higher, and every tenth woman who scored below this threshold
Results
Items 1–9 correlated between 0.55 and 0.72 with the EPDS total score. Item 10 (suicidal ideation) correlated lowest (0.30). The internal consistency of EPDS assessed by Cronbach’s α was 0.87.
Interrater reliability had a κ of 0.82, 0.84 and 0.78 between rater pairs. Diagnosis was concurred upon for 25 of the 30 women who had had their videotaped interview rated. Disagreement on five cases was between major and minor depression.
According to DSM-IV, 27 women (6.6%) filled the criteria for major
Discussion
A point prevalence of 10% for postpartum major and minor depression using the Norwegian translation of the EPDS was found. This prevalence is in accordance with other studies.
In research, a cut-off score of 12 to detect women with major depression and a cut-off of 11 to detect both major and minor depression is recommended according to ROC (Fig. 1). In a clinical setting, a cut-off of 8 should detect both women at risk for developing depression and identify those who have minor depression. In
Acknowledgements
This research was supported by a grant from the Gerda Nyquist Trust in Bergen. We wish to thank the staff at the children’s health clinics in Bergen and at the gynaecologist’s specialist practice of Nyland and Johannessen in Bergen for their assistance in this study.
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2020, Journal of Affective DisordersCitation Excerpt :The Edinburgh Postnatal Depression Scale (EPDS) is a commonly used self-report questionnaire (Cox et al., 1987) developed to screen for postpartum depressive symptoms (Gibson et al., 2009). The construct validity of EPDS has been documented in many countries and in clinical as well as population-based samples (Berle et al., 2003; Glaze and Cox, 1991; Murray and Carothers, 1990; Rubertsson et al., 2011; Small et al., 2007; Vivilaki et al., 2009; Wickberg and Hwang, 1996; Zubaran et al., 2010). The EPDS was originally believed to measure one single construct (or factor) of postnatal depression (Cox et al., 1987).
The psychometric properties of the Icelandic version of the Edinburgh Postnatal Depression Scale (EPDS) when used prenatal
2019, MidwiferyCitation Excerpt :Although Cox et al. (1987) originally described EPDS as unidimensional, several studies have looked at its factor structure, reporting either two factors (depression and anxiety) or three factors (depression, anxiety and anhedonia), but with large variation in item-factor structures. This refers both to the postnatal (Astbury et al., 1994; Berle et al., 2003; Matthey, 2008; Phillips et al., 2009; Pop et al., 1992; Ross et al., 2003; Swalm et al., 2010; Tuohy and McVey, 2008) and prenatal periods (Adouard et al., 2005; Agampodi and Agampodi, 2013; Bowen et al., 2008; Brouwers et al., 2001; Jomeen and Martin 2005; Jomeen and Martin 2007; Montazeri et al., 2007; Ross et al., 2003; Swalm et al., 2010; Töreki et al., 2013; Zhong et al., 2014). Many studies reporting more than one factor have advocated the use of the EPDS as a multidimensional screening instrument for both depression and anxiety (Bina and Harrington, 2016; Matthey, 2008).