A cross-cultural analysis of the use of the Edinburgh Post-Natal Depression Scale (EPDS) in health visiting practice

Healthcare professionals' views on the accessibility and acceptability of perinatal mental health services for South Asian and Black women: a qualitative study

BACKGROUND

Perinatal mental illness affects one third of new and expectant mothers. Individuals from ethnic minority groups experience higher rates of mental health problems and higher suicide rates. Despite this, women from ethnic minorities-Black and South Asian women in particular-are less likely to receive support from mental health services in the perinatal period. Healthcare professionals (HCPs) who have contact with women during this period have a unique perspective, and their views may provide insights to understand and remedy this health inequality. This study aimed to identify healthcare professionals' views on the current accessibility and acceptability of perinatal mental health services, and ways of improving services by addressing the barriers for these women.

METHODS

Semi-structured interviews were conducted with twenty-four healthcare professionals who work with patients in the perinatal period. Purposive sampling was used to select HCPs from a range of different professions (including mental health staff, midwifery, primary care, social care). The data were analysed using Framework Analysis.

RESULTS

Three main themes were identified from the data: (1) lack of awareness and understanding of perinatal mental illness and service structure in both healthcare professionals and patients; (2) patients' relationships with family, friends and healthcare professionals can both hinder and facilitate access to services; (3) healthcare professionals encourage raising awareness, flexibility, developing shared understandings and questioning assumptions to improve the accessibility and acceptability of services.

CONCLUSION

Key insights into explaining and remedying the health inequalities observed between ethnic groups were proposed by healthcare professionals. Recommendations included sharing information; taking steps to ensure each woman was considered as an individual in her relationship with her culture, ethnicity and childrearing practices; and healthcare professionals addressing their possible unconscious biases through engaging in personal reflexive practices. Reasons these are currently not being implemented deserve further research, and the potential of novel roles such as peer support workers in bridging the space between ideals and practice needs further investigation.

'Those whom I have to talk to, I can't talk to': Perceived social isolation in the context of anxiety symptoms among pregnant women in Pakistan

Anxiety during pregnancy is highly prevalent in low- and middle-income countries. The relative importance of different sources and types of perceived support in the Pakistani context is unknown. We explored social support during pregnancy and the role of social isolation in Pakistani women's experiences of antenatal anxiety. We conducted semi-structured interviews with 19 pregnant women with symptoms of anxiety and 10 female healthcare providers at a public urban hospital. We used inductive and deductive thematic coding to analyse the data. Many pregnant women reported feelings of physical and social isolation, even when living in joint families with larger social networks. Often fearing censure by their in-laws and peers for sharing or seeking help with pregnancy-related anxieties, women reported relying on husbands or natal family members. Normative expectations around pregnancy such as male gender preference, perceived immutability of wives' domestic responsibilities and expectations of accompanied travel by women may serve as sources of disconnectedness in the antenatal period. Providers viewed social isolation and deficits in social support during pregnancy as contributing to worse anxiety symptoms, reduced access to care and poorer health behaviours. One limitation is that the hospital setting for this study may have resulted in underreporting of abuse or neglect and limited inclusion of pregnant women who do not utilise facility-based antenatal care. In conclusion, husbands and natal families were key in reducing social isolation in pregnancy and mitigating anxiety, while in-laws did not always confer support. Targeted strategies should enhance existing support and strengthen in-law family relationships in pregnancy.

Perinatal depression screening and prevention: Descriptive findings from a multicentric program in the South of Italy

INTRODUCTION

Perinatal depression (PD) is a cluster of clinical depressive symptoms occurring globally during pregnancy or after childbirth, with a prevalence of 11.9%. Risk factors for PD among pregnant women may include personality traits of neuroticism, low personal resilience, higher anxiety, avoidance in close relationships, as well as dysfunctional coping strategies.

METHODS

We report on descriptive findings of a screening/prevention program aimed to detect depressive symptoms and associated risk factors in a large sample of women (N = 1,664) accessing the gynecological departments of the Regione Puglia (South of Italy) from July to November 2020. Pregnant women were assessed in their third trimester of pregnancy (T0), after childbirth (T1), and those at risk for PD within 1 year from delivery (T2-T4); The Edinburgh Postnatal Depression Scale (EPDS) has been employed for the screening of PD over time as well as other standardized measures for neuroticism, resilience, coping strategies, and quality of life.

RESULTS

Of 1,664, n = 1,541 were tested at T1, and 131 scored ≥ 12 at EPDS (14.6 ± 2.95), showing a higher risk for PD. They were followed over time at 1, 6, and 12 months after childbirth (T2-T4), and 15 of them scored ≥ 12 (EPDS) at T4. Women with a higher risk of PD also reported higher levels of neuroticism, lower levels of personal resilience, more anxiety and avoidance in close relationships, higher employment of dysfunctional coping strategies (e.g., denial, self-blame, etc.), and lower quality of life (0.0008 < all p < 0.0001).

CONCLUSION

This study confirmed the benefit of screening programs for the early detection of PD among pregnant women. We may suggest a set of risk factors to be considered in the clinical assessment of PD risk as well as the promotion of similar programs to improve depressive outcomes and pathways to care for PD on the basis of a more accurate assessment and referral.

"A Woman Is a Puppet." Women's Disempowerment and Prenatal Anxiety in Pakistan: A Qualitative Study of Sources, Mitigators, and Coping Strategies for Anxiety in Pregnancy

Common mental disorders are highly prevalent among pregnant women in low- and middle-income countries, yet prenatal anxiety remains poorly understood, particularly in the sociocultural context of South Asia. Our study explored sources, mitigators, and coping strategies for anxiety among symptomatic pregnant women in Pakistan, particularly in relation to autonomy in decision-making and social support. We interviewed 19 pregnant married women aged 18-37 years recruited from 2017-2018 at a public hospital in Rawalpindi who screened positive for anxiety. Thematic analysis was based on both inductive emergent codes and deductive a priori constructs of pregnancy-related empowerment. Gender norms emerged as an important dimension of Pakistani women's social environment in both constraining pregnancy-related agency and contributing to prenatal anxiety. Women's avenues of self-advocacy were largely limited to indirect means such as appeals to the husband for intercession or return to her natal home. The levels of autonomy during pregnancy depended on the area of decision-making, and peer/family support was a critical protective factor and enabling resource for maternal mental health. Women's disempowerment is a key contextual factor in the sociocultural experience of prenatal maternal anxiety in South Asia, and further examination of the intersections between empowerment and perinatal mental illness might help inform the development of more context-specific preventive approaches.

Validation of hindi version of Edinburgh postnatal depression scale as a screening tool for antenatal depression

BACKGROUND

Antenatal depression is recognized as one of the strongest predictors of postnatal depression, which itself is a strong predictor of mental disorders. The detection of antenatal depression is important and requires an accurate and valid screening tool. The Edinburgh Postnatal Depression Scale (EPDS) is one of the most extensively studied screening instruments for assessing postnatal depression.

AIM

To validate a linguistically and contextually appropriate Hindi version of the EPDS for use in women attending antenatal care in Sehore, Madhya Pradesh.

METHODS AND MATERIAL

A rigorously translated and modified Hindi version of the EPDS was developed and validated using the Hindi version of the PHQ-9 as a gold standard. A consecutive sample of women (n = 100) attending antenatal check-ups in healthcare facilities in Sehore district were interviewed.

RESULTS

The validity measure of Receiver Operator Characteristic curve was plotted for different cutoffs of EPDS. The optimal cutoff score for the Hindi validation of the EPDS was 9/10 for antenatal depression with sensitivity, specificity, positive and negative predictive value of 65.38%, 79.73%, 53.13%, and 86.76% respectively and area under the curve 0.7346. The internal consistency using Cronbach's alpha was 0.86 indicating good homogeneity.

CONCLUSION

Findings of this study suggest that the Hindi version of the EPDS can be used as a valid measure to screen antenatal depression in India.

Threatened miscarriage and depressive and anxiety symptoms among women and partners in early pregnancy

BACKGROUND

Antenatal depression has been associated with poor maternal and fetal outcomes, and threatened miscarriage is often seen clinically to impact adversely on maternal wellbeing, notwithstanding the limited research evidence. Our study aims to examine the link between threatened miscarriage and antenatal depression and anxiety in an Asian obstetric population.

METHODS

We recruited 121 women and 68 partners facing threatened miscarriage, and 241 women and 180 partners experiencing uncomplicated pregnancies from a tertiary maternity hospital in Singapore. All participants completed a Patient Information Questionnaire and the Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

The proportion of women with major depressive and anxiety symptomatology was significantly higher among women facing threatened miscarriage compared to those with stable pregnancies (depressive: 33.1% vs. 17.0%, p = 0.008; anxiety: 48.8% vs. 23.7%, p < 0.0001). Amongst their partners, there was a non-significant trend towards a similar finding (depressive: 10.3% vs. 7.2%, p = 0.439; anxiety: 23.5% vs. 18.9%, p = 0.478). Threatened miscarriage remained significantly associated with major depressive symptomatology after adjusting for potential confounders among women (OR 2.70; 95% CI 1.55, 4.71; p < 0.0001) but not among their partners (OR 1.47; 95% CI 0.56, 3.87; p = 0.430).

LIMITATIONS

This study is limited by its cross-sectional design and relatively small sample size for male partners.

CONCLUSION

Antenatal depressive and anxiety symptomatology affects one in four women in their first trimester, with even higher prevalence among women facing threatened miscarriage. Targeted depression and anxiety screening that includes women facing threatened miscarriages may facilitate early and efficient detection and management of mental health problems among pregnant women.

The experience of postnatal depression in West African mothers living in the United Kingdom: a qualitative study

OBJECTIVE

to explore the lived experience of postnatal depression (PND) in West African mothers living in the United Kingdom (UK).

DESIGN

using a qualitative design, semi-structured interviews were undertaken. Interpretative Phenomenological Analysis (IPA) was used to explore and analyse the data.

SETTING

community health services within inner-city suburbs in Manchester, England.

PARTICIPANTS

six West African mothers (Nigeria=3; Ghana=3), who were experiencing low mood in the postnatal period.

FINDINGS

five overarching themes emerged: (1) conceptualising PND, (2) isolation, (3) loss of identity, (4) issues of trust and (5) relationships as a protective factor. Women exhibited symptoms of PND but did not regard it as an illness. In their view, postnatal depression and distress resulted from social stress. Participants stated that their cultural background made it difficult to disclose feelings of depression thus adversely influencing their help-seeking behaviour.

KEY CONCLUSIONS

this is the first study to investigate the experiences of West African mothers with PND who live in the UK, and how they perceive and make sense of their experiences. The themes generated add to the body of existing research on PND in Black and ethnic minority populations and offer insight into the lived experience of West African women residing in England. Such insights are vital in order to deliver effective, culturally sensitive care.

IMPLICATIONS FOR PRACTICE

these findings have implications on how services should be designed to increase their accessibility to African women, by using a community psychology approach alongside systemic and group interventions. Challenges to help seeking and language used to describe experiences are considered.

Postpartum depression screening in yemeni and punjabi immigrant women

This article describes strategies for using a postpartum depression screening tool with women from two immigrant minority populations (from Yemen and from the Punjab region of India). Techniques to maximize success while working with interpreters and with women's unique cultural considerations are presented. Two case studies provide examples of challenges presented and overcome by women from each of these populations.

Daily and cultural issues of postnatal depression in african women immigrants in South East london: tips for health professionals

Postnatal depression has profound effects on the quality of life, social functioning, and economic productivity of women and families. This paper presents the findings of an earlier exploration of the perception of postnatal depression in African women immigrants in South East London. The aims of this research were twofold: firstly, to establish cultural elements related to postnatal depression through women's narratives regarding their daily life situations, including the nuances and complexities present in postnatal depression, and secondly, to help health professionals understand and acknowledge postnatal depression signs in these immigrant women and some of the cultural ambiguities surrounding them. The study used a qualitative approach mainly through the implementation of two focus groups. Thematic analysis of the women's narratives suggested that almost half of the participants in the study struggle with some signs of postnatal depression. The women did not perceive the signs as related to illness but as something else in their daily lives, that is, the notion "that you have to get on with it." The study also highlights the fact that the signs were not identified by health visitors, despite prolonged contact with the women, due to the lack of acknowledgement of women's silence regarding their emotional struggle, household and family politics, and intercultural communication in health services.

Postnatal depression: A global public health perspective

The aim of this paper is to discuss whether or not postnatal depression is a global public health concern. Public health is the study of the morbidity, mortality and the cause and course of disease, at a population rather than an individual level. Public health is also concerned with examining factors that cause health inequalities. Postnatal depression is a mental and emotional condition that can affect women during the first postnatal year. Since the effects of postnatal depression are known to go beyond the mother in that it also affects the partner and the child, it can be deemed a public health problem. Additionally, severe postnatal depression can lead to infanticide as well as maternal death, often by suicide. Furthermore, evidence demonstrates that all countries are faced with the challenge of postnatal depression, but low- to middle-income countries face the greatest burden. The literature revealed various treatment options for this complex condition. However, it also uncovered that not all women are assessed for postnatal depression, nor do all women receive treatment. The emerging picture is that postnatal depression is indeed a public health problem, particularly as the incidence is much higher than the quoted rate of 10%—15%. This paper recommends direction for public health-orientated perinatal mental health research and suggests that service providers should consider the routine assessment of all postnatal women.

The health and life experiences of mothers with rheumatoid arthritis: a phenomenological study

BACKGROUND

In our varied roles as health care professionals and researchers, many women with rheumatoid arthritis (RA) have commented to us about their feelings of inability to cope with everyday tasks, especially within their role as mothers.

AIMS

This study explored the health and life experiences of mothers with RA in order to increase knowledge about this group of women and inform health care professionals who provide them with support before and after becoming a mother.

METHODS

A phenomenological approach was adopted, and individual face-to-face semi-structured interviews were carried out with a sample of seven women, aged 21-41 years, who had lived with RA for 3-11 years and had one or more children under five years of age (total range of ages being 1-7 years). The data were analysed using Colaizzi's procedural steps.

RESULTS

The five major themes that emerged were inner strength, depression, labelling, failure, and pre- and post-natal education. Sub-themes included issues such as putting on a brave face, spirituality, guilt, burden, feeling 'robbed of motherhood', isolation, coping methods and lack of information.

CONCLUSIONS

This in-depth study informs health care professionals for their role as support provider for mothers with RA. Further research needs to be carried out to include multicultural experiences, which may or may not differ. As a step forward, we have implemented a local support group for mothers with RA, which will hopefully add benefit to existing rheumatology, midwifery and health visiting services.

Screening tools for depressed mood after childbirth in UK-based South Asian women: a systematic review

AIM

This paper is a report of a systematic review to answer the question: what is the relevance, acceptability, validity and effectiveness of tools designed to screen for postnatal depressed mood for South Asian women living in the UK?

BACKGROUND

Standard methods to screen women for postnatal depressed mood were developed with Caucasian populations. This study reviews postnatal screening tools adapted or developed for United Kingdom-based South Asian women.

METHOD

A structured systematic review of English language studies initially was completed between 1980 and May 2003, and later updated to January 2005. The review was based on an a priori search strategy with inclusion and exclusion criteria and analysis included a quality assessment tool. Findings were tabulated against criteria for acceptability and effectiveness of diagnostic tools.

RESULTS

Seven papers were included in the review. None addressed all preset quality criteria. Four papers among them reported on translations of two existing tools (Edinburgh Postnatal Depression Scale and General Household Questionnaire). Two new tools were reported between the remaining three papers (Punjabi Postnatal Depression Scale and 'Doop Chaon'. Doop Chaon is a visual tool. The other tools used either Bengali or Punjabi, based on written scales. The General Household Questionnaire did not appear to be appropriate for this population. None of the studies were rigorous enough to demonstrate generalizable sensitivity or specificity. Qualitative data indicated that women preferred face-to-face interviews to self-complete questionnaires.

CONCLUSIONS

None of the tools are currently sufficiently evaluated for clinical practice. Questions are raised specifically about use of language-based tools to measure postnatal depressed mood in this population and about the extent to which focused interviews could be used as an alternative for specific sub-sections of population groups.

Validation of the Punjabi version of the Edinburgh postnatal depression scale (EPDS)

This study reports a project to validate a Punjabi translation of the Edinburgh postnatal depression scale (EPDS). The study involved three points of data collection. Bilingual (Punjabi and English speaking) new mothers completed the English and Punjabi EPDS on two separate occasions and underwent a diagnostic interview. At a threshold of 12.5 the Punjabi scale yielded a sensitivity of 71.4 and specificity of 93.7. Analysis suggests criterion and conceptual equivalence between the two scales. A users' evaluation indicates that the tool was acceptable to the majority of mothers, however, the scale may be more applicable for mothers for whom Punjabi is their first language.

Evaluating “Starting Well,” the Scottish National Demonstration Project for Child Health: Outcomes at Six Months

This paper presents early findings from the evaluation of Starting Well, an intensive home visiting program aimed at improving the health of pre-school children in disadvantaged areas of Glasgow, Scotland. Using a quasi-experimental design, detailed survey, observation and interview data were collected on a cohort of 213 intervention and 146 comparison families over the first six months of the child's life. After controlling for relevant background characteristics, multivariate regression analysis revealed higher child dental registration rates and lower rates of maternal depressive symptoms in the intervention cohort. Findings are interpreted as positive evidence of early program impact. Implications, limitations and future plans for analysis are discussed. EDITORS' STRATEGIC IMPLICATIONS: Starting Well draws on elements of an Australian parent education program and an American home visitation model. The authors demonstrate how the program implementation, research questions, and measurement are designed to fit their Glasgow population and the Scottish public health system. Their quasi-experimental data suggest that this primary prevention program is a promising strategy for improving maternal and child health outcomes.

Instrument translation process: a methods review

BACKGROUND

Cross-cultural and international collaborative studies are needed in nursing research. Therefore, it is necessary to translate research instruments into the language of the culture being studied. In this methods review, different processes of instrument translation and evaluation of translation adequacy in published nursing research are described and classified into a hierarchy.

METHODS

Studies including translation of quantitative research instruments were reviewed. Forty-seven studies were included. These were classified into six categories.

RESULTS

Studies were classified into categories as follows: forward-only translation (2), forward-only translation with testing (7), back-translation (13), back-translation with monolingual test (18), back-translation with bilingual test (3), and back-translation with both monolingual and bilingual test (4). Strengths and weaknesses are analysed.

CONCLUSION

The studies reviewed used diverse methods of varying quality. There is need for consensus among researchers in how to achieve quality of instrument translation in cross-cultural research. Researchers should carefully attend to achieving and reporting evidence of the accuracy and validity of instrument translation. When back-translation fails to achieve semantic equivalence, the instrument development process should be replicated in the target language.

Improving services for disadvantaged childbearing women

BACKGROUND

Tackling health inequalities is high on the political agenda of the Labour government. The government wants to reduce inequalities through policies based on evidence, the health of childbearing women and their babies being priority areas for action. National Service Frameworks (NSFs) are being set up to ensure high quality services for all groups. The External Working Group looking into maternity services for the Children's NSF seeks evidence upon which to plan strategies for all women, while focusing attention on the most disadvantaged. Wide differentials are noted between high- and low-income groups in the outcomes of pregnancy and the health of babies. The worst outcomes appear to be concentrated in small subgroups of disadvantaged women.

AIM

To report on a review of studies of interventions improving perinatal outcomes for disadvantaged women, to inform policy and practice around the organization and delivery of statutory services in the UK.

METHOD

We searched six relevant databases for reviews, intervention studies, audits and descriptions of services reporting outcomes for disadvantaged groups of women, published between 1990 and 2003. Synthesis was performed around what works and what does not work. Gaps in the evidence base were identified.

RESULTS

We found limited evidence of effective and promising interventions for childbearing women from minority ethnic groups, women experiencing domestic violence, women with mental health illness and HIV infected women. Few studies were well-designed or powered to detect effectiveness. There were no studies of interventions for women prisoners, homeless women and travellers.

CONCLUSIONS

Searching for intervention studies primarily by participant subgroup has brought in evidence from few well-designed studies on which to plan policy. Combining this approach with searching for intervention studies addressing behaviour like smoking, and needs like social support, may provide further evidence to tackle inequalities in the perinatal period.

Translating and validating the Finnish version of the Manchester Clinical Supervision Scale

Evaluation research provides new perspectives for clinical supervision (CS), and international collaboration offers advantages to develop valid instruments for this purpose. Besides translation, an instrument developed and tested in another culture requires systematic validation. The study focuses on the translation process of the Manchester Clinical Supervision Scale for testing in Finland carried out collaboratively between the Universities of Tampere and Manchester. The instrument is a 45-item questionnaire with a Likert-type (1-5) scale comprising seven sub-scales: trust and rapport, supervisor advice and support, improved care and skills, importance and value of CS, finding time, personal issues and reflection and total score. At first, a licensed translator translated the instrument into Finnish. A native British language teacher at the University language centre performed the blind back-translation into English. The translations were compared by both collaborative parties and by three experienced Finnish supervisors. A pilot sample (n = 182) was collected to test the translated instrument. In this sample Cronbach's alpha value for the total score was 0.9227 and in the sub-scales 0.6393-0.8838. The mean values in the sub-scales were 14.2-29.3, SDs 3.02-3.88 and modes 14.0-30.0. The British test sample had almost similar values. Translating an instrument into another language not only requires expertise in language, but also in practice. The cultural validation is the most important phase in the process that can be accomplished with pilot testing and statistical methods. However, further expert evaluation is required for the validity of the instrument.

Early detection and treatment of postnatal depression in primary care

BACKGROUND

Postnatal depression has a relatively high incidence and gives rise to considerable morbidity. There is sound evidence supporting the use of the Edinburgh Postnatal Depression Scale as a screening tool for possible postnatal depression.

AIM

This paper reports on a project developed by two health visitors and a community mental health nurse working in the United Kingdom. The aim of the project was to improve the early detection and treatment of postnatal depression in the population of the general practice to which they were attached.

METHOD

The health visitors screened for postnatal depression in the course of routine visits on four occasions during the first postpartum year. Women identified as likely to be suffering from postnatal depression were offered 'listening visits' as a first-line intervention, with referral on to the general practitioner and/or community mental health nurse if indicated.

FINDINGS

Data collected over 3 years showed that the project succeeded in its aim of enhancing early detection and treatment of postnatal depression. These findings replicate those of other studies. The data also showed that a substantial number of women were identified for the first time as likely to be suffering from postnatal depression at 12 months postpartum. Women screened for the first time at 12 months were at greater risk than those who had been screened earlier than this.

CONCLUSIONS

Health visitors should screen for postnatal depression throughout the period of their contact with mothers, not solely in the immediate postnatal period. It is particularly important to screen women who, for whatever reason, were not screened when their child was younger. The knowledge and skills needed to use the Edinburgh Postnatal Depression Scale and provide first-line intervention and onward referral can be developed at practitioner level through close collaborative working.

A literature review of the public health roles of health visitors and school nurses

This paper describes a two-stage review relating to the family-centred public health role of health visitors and the child-centred public health role of school nurses. During the first stage, literature was searched using CINAHL and Medline databases and two models were used to frame the literature analysis. The findings of this analysis were, however, disappointing. Although many policy documents advocate development of the family-centred public health role of health visitors and the child-centred public health role of school nurses, there was no overwhelming evidence of reports of these approaches in health visiting and school nursing practice. The second stage of the review comprised a content analysis of West Midlands community trusts' strategic development plans. Seventeen plans were analysed. Of these, only two were 'formal' plans, the remainder being fragmented documentation related to plans for the development of health visiting and school nursing services. It may be concluded from the analysis that NHS trusts are beginning to adopt ideas from the rhetoric of national policy documents. Additionally, public health practice initiatives form an integrated part of most of the trust strategic development plans that the researchers examined.

Developing a culture-specific tool to assess postnatal depression in the Indian community

Postnatal depression is a serious and debilitating condition which affects, at a conservative estimate, 10% of postnatal mothers. It can be difficult to identify due to the reluctance of some women to acknowledge their feelings. The Edinburgh Postnatal Depression Scale was developed to facilitate the elicitation of negative mood, however, it does not translate adequately into other languages or cultures. To address this problem the dosha assessment tool for postnatal depression was developed. This tool is aimed at women who are more familiar with the concepts of Ayurvedic medicine, one of the key medical systems of the Indian subcontinent. Although not yet evaluated, the tool goes some way towards the development of a culturally specific screening tool for this condition.

Affective (depressive) morbidity in puerperal Nigerian women: validation of the Edinburgh Postnatal Depression Scale

OBJECTIVE

To determine the rate of depression in a group of postpartum Nigerian women and to validate the Edinburgh Postnatal Depression Scale (EPDS) in this group.

METHOD

Between April and August 2000, all postpartum women who remained in the maternity ward for up to 7 days, and those who attended the postnatal clinics of Nnamdi Azikiwe University Teaching Hospital were recruited. Translated local language versions of the EPDS and the Zung Self-Rating Depression Scale were used to screen the subjects. A structured interview schedule was adapted from the depression section of the Composite International Diagnostic Interview and affective module of the ICD-10 Symptom Check List to assess screened subjects.

RESULTS

The total rejection rate was 23%, with 225 women participating in the study. Twenty-four subjects (10.7%) had depression. At the optimal cut-off score of 9, the EPDS had a sensitivity of 0.75, and specificity of 0.97.

CONCLUSION

The EPDS clearly distinguished between depressed and non-depressed postpartum mothers (t = 7.63, P < 0.001, df = 222). Because of its brevity and acceptability, it is recommended that the EPDS be used in routine postnatal screening.

A cross-cultural analysis of the use of the Edinburgh Post-Natal Depression Scale (EPDS) in health visiting practice

This report describes a project that developed and undertook initial validation of a Punjabi version of the Edinburgh Post-Natal Depression Scale (EPDS). A multi-disciplinary and multi-ethnic project team translated the EPDS from English to Punjabi. A pilot study indicated a high level of correlation between the two scales opening the way for a larger study in which a total of 98 bi-lingual women completed both the English and Punjabi version of the scale 6-8 weeks after delivery of their child. Of these a further 52 completed the scales on a second occasion, 16-18 weeks post-partum. A small sub-group (n = 15) was subject to independent clinical assessment by a community psychiatric nurse (CPN) to determine their mental state, enabling the outcome of the assessment to be compared with the EPDS score. The scores of the English and Punjabi versions of the scale were analysed using Spearman correlation coefficient and the Bland Altman test. A high correlation was found between overall scores and most individual items on the scale. Furthermore, the independent assessment of mental health state indicated that a number of those women who scored 12 or above on the EPDS scale (the cut-off point for determining risk of post-natal depression (PND)) were diagnosed as having a post-natal depressive disorder by the CPN assessing them independently. Whilst the results to date are promising there is a need for further work to determine the validity, sensitivity and specificity of the Punjabi EPDS tool against international classification of depressive disorders and to establish optimal cut-off scores when using the Punjabi version of the EPDS.