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Archives of Women's Mental Health
Published in: Archives of Women's Mental Health 2/2017

01-04-2017 | Original Article

Using the Edinburgh Postnatal Depression Scale for women and men—some cautionary thoughts

Authors: Stephen Matthey, Francesca Agostini

Published in: Archives of Women's Mental Health | Issue 2/2017

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Abstract

The objective of the study was to critically consider some of the possible limitations in the Edinburgh Depression Scale (EDS), given that great emphasis is put on the results of this measure within both clinical and research fields. Using findings and discussion points from other studies, as well as from a critical analysis of issues by the authors based upon their clinical and research experience, possible limitations with the scale in nine areas are discussed. Possible limitations include the following: (1) ambiguous items, (2) exclusion of certain types of distress, (3) scoring difficulties, (4) low positive predictive value, (5) frequent use of incorrect cut-off scores, (6) a vast array of validated cut-off scores, (7) validation against a questionable gold-standard, (8) limited anxiety detection and of depressive symptoms in men, and (9) many screen positive women only have transient distress. While the EDS has unquestionably been an extremely valuable instrument in aiding in the recognition of the importance of perinatal mental health, users of the scale should be aware that it, like other measures, has limitations. We discuss possible strategies to overcome these limitations and describe a recent scale that has been developed to surmount these shortcomings more effectively.
Literature
Abramowitz JS, Meltzer-Brody S, Leserman J, Killenberg S, Rinaldi K, Mahaffey BL, Pedersen C (2010) Obsessional thoughts and compulsive behaviours in a sample of women with postpartum mood symptoms. Arch Womens Ment Health 13:523–530CrossRefPubMed
Adewuya A, Ola BA, Dada A, Fasoto O (2006) Validation of the Edinburgh Postnatal Depression Scale as a screening tool for depression in late pregnancy among Nigerian woman. J Psychosom Obstet Gynecol 27:267–272CrossRef
Adouard F, Glangeaud-Freudenthal NM, Golse B (2005) Validation of the Edinburgh postnatal depression scale (EPDS) in a sample of woman with high-risk pregnancies in France. Arch Womens Ment Health 8:89–95CrossRefPubMed
Alderdice F, Ayers S, Darwin Z, Green J, Jomeen J, Kenyon S et al (2013) Measuring psychological health in the perinatal period: workshop consensus statement, 19 March 2013. J Reprod Inf Psychol 31:431–438CrossRef
Allison KC, Wenzel A, Kleiman K, Sarwer DB (2011) Development of a brief measure of postpartum distress. J Women’s Health 20:617–623CrossRef
American Psychiatric Association (1995) Diagnostic and statistical manual of mental disorders (4th Ed.). American Psychiatric Publishing, Washington, DC
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders: DSM-5 (5th Ed.). American Psychiatric Publishing, Washington, DCCrossRef
Austin M-PV, Hadzi-Pavlovic D, Priest SR, Reilly N, Wilhelm K, Saint K (2010) Depressive and anxiety disorders in the postpartum period: how prevalent are they and can we improve their detection. Arch Womens Ment Health 13:395–401CrossRefPubMed
beyondblue (2011) Clinical practice guidelines for depression and related disorders—anxiety, bipolar disorder and puerperal psychosis—in the perinatal period. A guideline for primary care health professionals. Melbourne: beyondblue: the national depression initiative
Ballestrem C-L, Straub M, Kachele H (2005) Contribution to the epidemiology of postnatal depression in Germany—implications for the utilization of treatment. Arch Womens Ment Health 8:29–35CrossRef
Banker JE, LaCoursiere DY (2014) Postpartum depression: risks, protective factors, and the couple’s relationship. Issues Ment Health Nurs 35:503–508CrossRefPubMed
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch General Psychiatry 4:561–571CrossRef
Bedford A, Foulds GA (1978) Delusions symptoms states. States of anxiety and depression. National Foundation for Educational Research: Windsor
Benvenuti P, Ferrara M, Niccolai C, Valoriani V, Cox JL (1999) The Edinburgh Postnatal Depression Scale: validation for an Italian sample. J Affect Disord 53:137–141CrossRefPubMed
Bergink V, Kooistra L, Lambreqtse-van den Berg MP, Wijnen H, Bunevicius R, van Baar A, Pop V (2011) Validation of the Edinburgh Depression Scale during pregnancy. J PsychosomRes 70:385–389CrossRef
Bowen A, Bowen R, Butt P, Rahman K, Muhajarine N (2012) Patterns of depression and treatment in pregnant and postpartum in women. Can J Psychiatr 57:161–167CrossRef
Boyce P, Stubbs J, Todd A (1993) Edinburgh Postnatal Depression Scale: validation for an Australian sample. Aust N Z J Psychiatry 27:472–476CrossRefPubMed
Brealey SD, Hewitt C, Green JM, Morrell J, Gilbody S (2010) Screening for postnatal depression—is it acceptable to women and healthcare professionals? A systematic review and meta-synthesis. J Reprod Infant Psychol 28:328–344CrossRef
Brodey B, Goodman SH, Baldasaro RE, Brooks-DeWeese A, Wilson M, Brodey ISB, Doyle NM (2016) Development of the Perinatal Depression Inventory (PDI)-14 using item response theory: a comparison of the BDI II, EPDS, PDI, and PHQ-9. Arch Womens Ment Health 19:307–316CrossRefPubMed
Brownhill S, Wilhelm K, Barclay L, Schmied V (2005) ‘Big build’: hidden depression in men. Aust N Z J Psychiatry 39:921–931PubMed
Buist AE, Austin M-PV, Hayes BA, Speelman C, Bilszta JLC, Gemmill AW, Brooks J, Ellwood D, Milgrom J (2008) Postnatal mental health of women giving birth in Australia 2002-2004: findings from the beyondblue National Postnatal Depression Program. Aust NZJ Psychiatry 42:66–73CrossRef
Bunevicius A, Kusminskas L, Pop V, Pedersen CA, Bunevicius R (2009) Screening for antenatal depression with the Edinburgh Depression Scale. Validation of the Lithuanian version of the Edinburgh Postnatal Depression Scale. J Psychosom Obst Gynecol 30:238–243CrossRef
Committee on Obstetric Practice (2015) Screening for perinatal depression. Committee opinion no. 630. American College of Obstetricians & Gynecologists. Obstet Gynecol 125:1268–1271CrossRef
Cox J, Holden JM (1994) Perinatal psychiatry: use and misuse of the Edinburgh postnatal. The Royal College of Psychiatrists. Gaskell, London
Cox J, Holden J (2003) Perinatal mental health: a guide to the Edinburgh Postnatal Depression Scale (EPDS). The Royal College of Psychiatrists. Gaskell, London
Cox J, Holden J, Sagovsky R (1987) Detection of postnatal depression: development of the 10 item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786CrossRefPubMed
Cox J, Chapman G, Murray D, Jones P (1996) Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women. J Affect Disord 39:185–189CrossRefPubMed
Darwin Z, McGowan L, Edozien LC (2016) Identification of women at risk of depression in pregnancy: using women’s accounts to understand the poor specificity of the Whooley and Arroll case finding questions in clinical practice. Arch Womens Ment Health 19:41–49CrossRefPubMed
Edmondson OJH, Psychogiou L, Vlachos H, Netsi E, Ramchandani PG (2010) Depression in fathers in the postnatal period: assessment of the Edinburgh Postnatal Depression Scale as a screening measure. J Affect Disord 125:365–368CrossRefPubMedPubMedCentral
Escriba-Aguir V, Artazcoz L (2011) Gender differences in postpartum depression: a longitudinal cohort study. J Epidemiol Community Health 65:320–326CrossRefPubMed
Evans J, Heron J, Francombe H, Oke S, Golding J, and on behalf of the Avon Longitudinal Study of Parents and Children Study Team (2001) Cohort study of depressed mood during pregnancy and after childbirth. BMJ 323:257–260CrossRefPubMedPubMedCentral
Fisher JRW, Tran HTT, Tran T (2007) Relative socio-economic advantage and mood during advanced pregnancy in women in Vietnam. Int J Ment Health Syst 1:3CrossRefPubMedPubMedCentral
Gawlik S, Muller M, Hoffmann L, Dienes A, Wallwiener M, Sohn C (2014) Prevalence of paternal perinatal depressiveness and its link to partnership satisfaction and birth outcomes. Arch Womens Ment Health 17:49–56CrossRefPubMed
Glavin K, Smith L, Sorum R, Ellefsen B (2010) Redesigned community participation care to prevent and treat postpartum depression in women—a one-year follow-up study. J of Clinical Nursing 19:3051–3062CrossRef
Godderis R, Adair CE, Brager N (2009) Applying new techniques to an old ally: a qualitative validation study of the Edinburgh Postnatal Depression Scale. Women Birth 22:17–23CrossRefPubMed
Goldberg D (1972) The detection of psychiatric illness by questionnaire. Oxford University Press, Oxford
Goodman J, Tyer-Viola L (2010) Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. J Women’s Health 19:477–490CrossRef
Guedeney N, Fermanian J (1998) Validation study of the French version of the Edinburgh Postnatal Depression Scale (EPDS): new results about use and psychometric properties. Eur Psychiatry 13:83–89CrossRefPubMed
Halbreich U (2007) The phenomenology of depressions and anxieties in women across different cultures: guest editor’s introduction to the special edition. J Affect Dis 102:155–158CrossRefPubMed
Halbreich U, Alarcon RD, Calil H, Douki S, Gaszner P, Jadresic E et al (2007) Culturally-sensitive complaints of depressions and anxieties in women. J Affect Dis 102:159–176CrossRefPubMed
Harvey ST, Pun PKK (2007) Analysis of positive Edinburgh depression scale referrals to a consultation liaison psychiatry service in a two-year period. Int J Ment Health Nurs 16:161–167CrossRefPubMed
Howell EA, Balbierz A, Wang J, Parides M, Zlotnick C, Leventhal H (2012) Reducing postpartum depressive symptoms among black and Latina mothers: a randomized controlled trial. Obstet Gyn 119:942–949CrossRef
Huang YC, Mathers NJ (2008) Postnatal depression and the experience of South Asian marriage migrant women in Taiwan: survey and semi-structured interview study. Int J Nurs Studies 45:924–931CrossRef
Jomeen J (2004) The importance of assessing psychological status during pregnancy, after childbirth and the postnatal period as a multidimensional construct: a literature review. Clin Effect Nurs 8:143–155CrossRef
Kim JJ, La Porte LM, Saleh MP, Allweiss S, Adams MG, Zhou Y, Silver RK (2015) Suicide risk among perinatal women who report thoughts of self-harm on depression screens. Obstet Gyn 125:885–893CrossRef
Kozinszky Z, Dudas RB (2015) Validation studies of the Edinburgh Postnatal Depression Scale for the antenatal period. J Affect Disord 176:95–105CrossRefPubMed
Lai BPY, Tang AKL, Lee DTS, Yip ASK, Chung TKH (2010) Detecting postnatal depression in Chinese men: a comparison of three instruments. Psychiatry Res 180:80–85CrossRefPubMed
Lawrie TA, Hofmeyr GJ, de Jager M, Berk M (1998) Validation of the Edinburgh Postnatal Depression Scale on a cohort of South African women. S Afr Med J 88:1340–1344PubMed
Leigh B, Milgrom J (2007) Acceptability of antenatal screening for depression in routine antenatal care. Australian J Adv Nurs 24:14–18
Loscalzo Y, Giannini M, Contena B, Gori A, Benvenuti P (2015) The Edinburgh Postnatal Depression Scale for Fathers: a contribution to the validation for an Italian sample. Gen Hosp Psychiatry 37:251–256CrossRefPubMed
Lovibond PF Lovibond SH (1995) The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Therapy 33:335–343
Martin LA, Neighbors HW, Griffith DM (2013) The experience of symptoms of depression in men vs women: analysis of the National Comorbidity Survey Replication. JAMA Psychiatry 10:1100–1106CrossRef
Martini J, Knappe S, Beesdo-Baum K, Lieb R, Wittchen HU (2010) Anxiety disorders before birth and self-perceived distress during pregnancy: associations with maternal depression and obstetric, neonatal and early childhood outcomes. Early Hum Dev 86:305–310CrossRefPubMed
Massoudi P, Hwang CP, Wickberg B (2013) How well does the Edinburgh Postnatal Depression Scale identify depression and anxiety in fathers? A validation study in a population based Swedish sample. J Affect Dis 149:67–74CrossRefPubMed
Matthey S (2008) Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders. Depress Anxiety 25:926–931CrossRefPubMed
Matthey S (2016) Differentiating between transient and enduring distress on the Edinburgh Depression Scale within screening contexts. J Affect Dis 196:252–258CrossRefPubMed
Matthey S, Ross-Hamid C (2011) The validity of DSM symptoms for depression and anxiety disorders during pregnancy. J Affect Dis 133:546–552CrossRefPubMed
Matthey S, Ross-Hamid C (2012) Repeat testing on the Edinburgh Depression Scale and the HADS-A in pregnancy: differentiating between transient and enduring distress. J Affect Disord 141:213–221CrossRefPubMed
Matthey S, Barnett BEW, Kavanagh DJ, Howie P (2001) Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners. J Affect Dis 64:175–183CrossRefPubMed
Matthey S, Phillips J, White T, Glossop P, Hopper U, Panasetis P, Petridis A, Larkin M, Barnett B (2004) Routine psychosocial assessment of women in the antenatal period: frequency of risk factors and implications for clinical services. Arch Womens Ment Health 7:223–229CrossRefPubMed
Matthey S, Henshaw C, Elliott S, Barnett B (2006) Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale—implications for clinical and research practice. Arch Womens Ment Health 9:309–315CrossRefPubMed
Matthey S, Fisher J, Rowe H (2013a) Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders: conceptual and methodological considerations. J Affect Dis 146:224–230CrossRefPubMed
Matthey S, Lee C, Crncec R, Trapolini T (2013b) Errors in scoring the Edinburgh Postnatal Depression Scale. Arch Womens Ment Health 16:117–122CrossRefPubMed
Matthey S, Valenti B, Souter K, Ross-Hamid C (2013c) Comparison of four self-report measures, and a generic mood question, to screen for anxiety during pregnancy in English-speaking women. J Affect Dis 148:347–351CrossRefPubMed
Mayberry LJ, Horowitz JA, Declercq E (2007) Depression symptom prevalence and demographic risk factors among U.S. women during the first 2 years postpartum. J Obstet Gynecol Neonatal Nurs 36:542–549CrossRefPubMed
Melrose S (2010) Paternal postpartum depression: how can nurses begin to help? Contemp Nurse 34:199–210CrossRefPubMed
Meltzer-Brody S, Boschloo L, Jones I, Sullivan PF, Penninx BW (2013) The EPDS-Lifetime: assessment of lifetime prevalence and risk factors for perinatal depression in a large cohort of depressed women. Arch Womens Ment Health 16:465–473CrossRefPubMed
Milgrom J, Mendelsohn J, Gemmill AW (2011) Does postnatal depression screening work? Throwing out the bathwater, keeping the baby. J Affect Dis 132:301–320CrossRefPubMed
Montazeri A, Torkan B, Omidvari S (2007) The Edinburgh Postnatal Depression Scale (EPDS): translation and validation study of the Iranian version. BMC Psychiatry 7:11CrossRefPubMedPubMedCentral
Murray D, Cox JL (1990) Screening for depression during pregnancy with the Edinburgh Postnatal Depression Scale (EPDS). J Reprod Infant Psychol 8:99–107CrossRef
Norhayati MN, Hazlina NHN, Asrenee AR, Emilin WMAW (2015) Magnitude and risk factors for postpartum symptoms. J Affect Dis 175:34–52CrossRefPubMed
NSW Department of Health (2009) NSW Health/Families NSW Supporting Families Early Package—SAFE START Strategic Policy, NSW Department of Health
Paul IM, Downs DS, Schaefer EW, Beiler JS, Weisman CS (2013) Postpartum anxiety and maternal-infant health outcomes. Pediatrics 131:e1218–e1224CrossRefPubMed
Phillips J, Charles M, Sharpe L, Matthey S (2009) Validation of the subscales of the Edinburgh Postnatal Depression Scale in a sample of women with unsettled infants. J Affect Dis 118:101–112CrossRefPubMed
Ramchandani P, Stein A, Evans J, O’Connor TG, and the ALSPAC study team (2005) Paternal depression in the postnatal period and child development: a prospective population study. Lancet 365:2201–2205CrossRefPubMed
Segre LS, Losch ME, O’Hara MW (2006) Race/ethnicity and perinatal depressed mood. J Reprod Infant Psychol 24:99–106CrossRef
Somerville S, Byrne SL, Dedman K, Hagan R, Coo S, Oxnam E, Doherty D, Cunningham N, Page AC (2015) Detecting the severity of perinatal anxiety with the Perinatal Anxiety Screening Scale (PASS). J Aff Dis 186:18–25CrossRef
Spitzer TL, Kroenke K, JBW W, and the Patient Health Questionnaire Primary Care Study Group (1999) Validation and utility of a self-report version of PRIME-MD. JAMA 282:1737–1744CrossRefPubMed
Spitzer RL, Kroenke K, Williams JBW, Lowe B (2006) A brief measure for assessing generalized anxiety disorder. Arch Intern Med 166:1092–1097CrossRefPubMed
Stewart RC, Umar E, Tomenson B, Creed F (2013) Validation of screening tools for antenatal depression in Malawi—a comparison of the Edinburgh Postnatal Depression Scale and Self Reporting Questionnaire. J Aff Dis 150:1041–1047CrossRef
Su KP, Chiu TH, Huang CL, Ho M, Lee CC, Wu PL et al (2007) Different cutoff points for different trimesters? The use of Edinburgh Postnatal Depression Scale and Beck Depression Inventory to screen for depression in pregnant Taiwanese women. Gen Hosp Psychiatry 29:436–441CrossRefPubMed
Swalm D, Brooks J, Doherty D, Nathan E, Jacques A (2010) Using the Edinburgh Postnatal Depression Scale to screen for perinatal anxiety. Arch Womens Ment Health 13:515–522CrossRefPubMed
Toreki A, Andò B, Kereszturi A, Sikovanyecz J, Dudas RB, Janka Z (2013) The Edinburgh Postnatal Depression Scale: translation and antepartum validation for a Hungarian sample. Midwifery 29:308–315CrossRefPubMed
Tran TD, Tran T, Fisher J (2012) Validation of three psychometric instruments for screening for perinatal common mental disorders in men in the north of Vietnam. J Affect Dis 136:104–109CrossRefPubMed
Venkatesh KK, Nadel H, Blewett D, Freeman MP, Kaimal AJ, Riley LE (2016) Implementation of universal screening for depression during pregnancy: feasibility and impact on obstetric care. Am J Obstet Gynecol 215:517.e1–517.e8CrossRef
Wang Y, Guo X, Lau Y, Chan KS, Yin L, Chen J (2009) Psychometric evaluation of the Mainland Chinese version of the Edinburgh Postnatal Depression Scale. Int J Nurs Stud 46:813–823CrossRefPubMed
Whooley MA, Avins AL, Miranda J, Browner WS (1997) Case finding instruments for depression: two questions as good as many. J Gen Intern Med 12:439–445CrossRefPubMedPubMedCentral
Wickberg B, Hwang CP (1996) The Edinburgh Postnatal Depression Scale: validation on a Swedish community sample. Acta Psychiatr Scand 94:181–184CrossRefPubMed
Wilhelm KA (2009) Men and depression. Aust Fam Physician 38:102–105PubMed
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370CrossRefPubMed
Metadata
Title
Using the Edinburgh Postnatal Depression Scale for women and men—some cautionary thoughts
Authors
Stephen Matthey
Francesca Agostini
Publication date
01-04-2017
Publisher
Springer Vienna
Published in
Archives of Women's Mental Health / Issue 2/2017
Print ISSN: 1434-1816
Electronic ISSN: 1435-1102
DOI
https://doi.org/10.1007/s00737-016-0710-9

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