Personal reflections on the early development of the EPDS

2014 ◽  
Author(s):  
John Cox
Keyword(s):  
Postnatal Depression ◽  
Mental Health Problems ◽  
Depression Scale ◽  
Self Report ◽  
African Women ◽  
Child Psychiatrist ◽  
London Hospital ◽  
Research Programmes ◽  
Team Player ◽  
Personal Reflections

Shortly after returning to the London Hospital from Uganda in 1974, and still jet-lagged and culture-shocked, I had an unexpected call from a Dr Kumar at the Maudsley Hospital whose name was then unfamiliar to me. Stephen Wolkind (Child Psychiatrist at the London Hospital working with Professor Pond) had informed him that I had completed a study of postnatal depression in East Africa and had used Goldberg’s Standardised Psychiatric Interview (SPI) translated into Luganda. Could we meet, and could I advise him on the use of the SPI? I was surprised, flattered and motivated by this request. We met in Turner St, London E1. This was the beginning of a friendly and mutually respectful collaboration, which facilitated the later development of the Edinburgh Postnatal Depression Scale (EPDS) (Cox et al. 1987), helped launch the 1980 meeting in Manchester, when the Marcé Society was founded, and motivated Phase One of the International Transcultural Postnatal Depression Study. Channi Kumar was a fine team player, and as a leader had that knack of making you feel respected and at ease. His greeting ‘Come in dear boy and have a seat’ when he ushered you to a chair piled high with research papers, was characteristic of his style and productivity. We would then talk, not only about screening scales, but about College matters and the Perinatal Special Interest Group (which later became a Specialty Section), as well as our ‘Blue Skies’ research programmes. My interest in perinatal psychiatry began when, as an impressionable medical student, I first met Brice Pitt at Claybury Hospital. He was carrying out a study of ‘atypical’ postnatal depression and was devising a self-report questionnaire to detect increases in depression scores after birth. This early experience, together with a postgraduate seminar some years later, must surely have been on my mind when I was asked by Allen German on my arrival in Uganda, what research I was planning to do. I replied that I wished to replicate Assael’s finding (1972) that a quarter of pregnant women at Kasangati had mental health problems, and I was curious to know whether African women experienced depression as described by Pitt (1968)—and if not, what were the differences.

scholarly journals Adapting a Revised Child Anxiety and Depression Scale for rural India: a pilot, amenable to scale up.

2016 ◽  
Author(s):  
Kasturi Haldar
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Child Anxiety ◽  
Scale Up ◽  
Depression Scale ◽  
Population Level ◽  
National Language ◽  
Self Report ◽  
Anxiety And Depression ◽  
Field Workers

*Abstract. *Education is an important cornerstone of economic developmentin India. Mental health critically impacts education but its comprehensiveassessment at a population level, especially in children in rural areaspresents significant challenges. Mental health problems areunder-recognized in the community and the clinic. Assessment by clinicalpractitioners requires specialized expertise which (for both logistical andcost reasons) are not amenable to scale-up. Diversity in languages,cultures and variation in levels of literacy further compounds the problem.Consequently, despite universal recognition that mental health isimportant, tools to measure its overall prevalence at scale are limited.Here we report adaptation of a robust, internationally validated, mentalhealth assessment scale, the Revised Child Anxiety and Depression Scale(RCADS) into Hindi, the national language, spoken by the largest number ofIndians. First RCADS in Urdu1 was translated to Hindi (since spoken Urdu isclose to Hindi). In addition, iterative steps of field adaptation andtraining enabled conversion from self-report to a questionnaire-survey(qaRCADS-H) to facilitate inclusion of illiterate respondents and improvethe overall accuracy and acceptance of the tool. Pratham EducationalFoundation-ASER Center field workers administered qaRCADS-H as a homeinterview/survey in a largely agrarian village where in 2011 the Censusreported 35% illiteracy2. Over a period of three weeks, fourcollege-educated field workers with prior survey experience, targeted 115households with children of which 110 agreed, resulting in participation of130 children 10-17 years of age. Our findings are discussed in context ofscaling and sensitization needed to effectively assess mental healthprevalence in a vulnerable group in large regions of India.

scholarly journals Can the Edinburgh Postnatal Depression Scale be used to screen for anxiety in the perinatal period? A factor analysis of high-risk and community samples

2020 ◽  
Author(s):  
Alexandra Lautarescu ◽  
Suresh Victor ◽  
Alex Lau-Zhu ◽  
Serena J. Counsell ◽  
Anthony David Edwards ◽  
...  
Keyword(s):  
Mental Health ◽  
Factor Analysis ◽  
Postnatal Depression ◽  
Edinburgh Postnatal Depression Scale ◽  
Mental Health Problems ◽  
Community Sample ◽  
Depression Scale ◽  
Maternal History ◽  
History Of ◽  
The Relationship

Background: Timely and accurate detection of perinatal mental health problems is essential for the wellbeing of both mother and child. Growing evidence has suggested that the Edinburgh Postnatal Depression Scale (EPDS) is not a unidimensional measure of perinatal depression, but can be used to screen for anxiety disorders.Methods: We aimed to assess the factor structure of the EPDS in 3 different groups of women: n=266 pregnant women at high-risk of depression (“Perinatal Stress Study”), n=471 pregnant women from a community sample, and n=637 early postnatal women from a community sample (“developing Human Connectome Project”). Exploratory factor analysis (40% of each sample) and confirmatory factor analysis (60% of each sample) were performed. The relationship between EPDS scores and history of mental health was investigated. Results: Results suggested that a 3-factor model (depression, anxiety, and anhedonia) is the most appropriate across groups. The anxiety subscale (EPDS 3A) emerged consistently and was related to maternal history of anxiety disorders. Total EPDS score was related to history of mental health problems. Limitations: Although data were collected on maternal history of mental health, there was no standardized diagnostic interview administered to assess the relationship between EPDS 3A and a current diagnosis of anxiety disorder. Conclusions: A better understanding of the multi-factorial structure of the EPDS can inform diagnosis and management of women in the prenatal and postnatal period. The EPDS 3A could be used to provide initial screening information for anxiety in situations where a validated anxiety questionnaire is not administered.

scholarly journals The factor structure of the Edinburgh Postnatal Depression Scale among perinatal high-risk and community samples in London

2021 ◽  
Author(s):  
Alexandra Lautarescu ◽  
Suresh Victor ◽  
Alex Lau-Zhu ◽  
Serena J. Counsell ◽  
A. David Edwards ◽  
...  
Keyword(s):  
Mental Health ◽  
Factor Analysis ◽  
High Risk ◽  
Factor Structure ◽  
Postnatal Depression ◽  
Edinburgh Postnatal Depression Scale ◽  
Mental Health Problems ◽  
Community Sample ◽  
Depression Scale ◽  
History Of

AbstractTimely and accurate detection of perinatal mental health problems is essential for the wellbeing of both mother and child. Growing evidence has suggested that the Edinburgh Postnatal Depression Scale (EPDS) is not a unidimensional measure of perinatal depression, but can be used to screen for anxiety disorders. We aimed to assess the factor structure of the EPDS in 3 different groups of women: n = 266 pregnant women at high-risk of depression (“Perinatal Stress Study”), n = 471 pregnant women from a community sample, and n = 637 early postnatal women from a community sample (“developing Human Connectome Project”). Exploratory factor analysis (40% of each sample) and confirmatory factor analysis (60% of each sample) were performed. The relationship between EPDS scores and history of mental health concerns was investigated. Results suggested that a 3-factor model (depression, anxiety, and anhedonia) is the most appropriate across groups. The anxiety subscale (EPDS-3A) emerged consistently and was related to maternal history of anxiety disorders in the prenatal sample (W = 6861, p < 0.001). EPDS total score was related to history of mental health problems in both the prenatal (W = 12,185, p < 0.001) and postnatal samples (W = 30,044, p < 0.001). In both high-risk and community samples in the perinatal period, the EPDS appears to consist of depression, anxiety, and anhedonia subscales. A better understanding of the multifactorial structure of the EPDS can inform diagnosis and management of women in the prenatal and postnatal period. Further research is required to validate the EPDS-3A as a screening tool for anxiety.

Retrospective and concurrent self-report of behavioral inhibition and their relation to adult mental health

1992 ◽  
Vol 4 (2) ◽  
pp. 301-321 ◽  
Author(s):  
J. Steven Reznick ◽  
Irene M. Hegeman ◽  
Emily R. Kaufman ◽  
Scott W. Woods ◽  
Marlene Jacobs
Keyword(s):  
Mental Health ◽  
Behavioral Inhibition ◽  
Mental Health Problems ◽  
Depression Scale ◽  
Health Problems ◽  
Epidemiologic Studies ◽  
The State ◽  
Self Report ◽  
Unique Variance ◽  
Adult Mental Health

AbstractFour studies are reported in which an interview or questionnaire is used to measure the relation between behavioral inhibition, defined as consistent restraint in response to unfamiliar social or nonsocial stimuli, and adult mental health. In Study 1, undergraduates were tested using a retrospective self-report questionnaire. Those who reported more behaviors suggesting childhood inhibition also reported more mental health problems. Study 2 was an attempt to establish the postdictive validity of the measurement of childhood inhibition. College students and their parents completed the questionnaire independently and were in extremely strong agreement regarding the student's inhibited behaviors as a child. In Study 3, self-reported contemporary behaviors suggesting inhibition correlated with the retrospective self-report of inhibition. Both measures correlated with the State Anxiety Subscale of the State-Trait Anxiety Inventory and the Center for Epidemiologic Studies Depression Scale, and both accounted for unique variance in anxiety, but only contemporary inhibition accounted for unique variance in depression. In Study 4, adults who had been treated for panic disorder or depression were interviewed and reported more behaviors indicative of inhibition during childhood than did control subjects. These four studies support the usefulness of retrospective self-report as a measure of childhood inhibition and are compatible with the hypothesis that a tendency toward inhibited behavior in childhood or adulthood may be a risk factor for mental health problems.

scholarly journals The epidemiology of postnatal depression in Ethiopia: a systematic review and meta-analysis

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Bereket Duko ◽  
Dereje Wolde ◽  
Yonas Alemayehu
Keyword(s):  
Systematic Review ◽  
Sensitivity Analysis ◽  
Postnatal Depression ◽  
Mental Health Problems ◽  
Unplanned Pregnancy ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Depression Scale ◽  
Reproductive Health Services

Abstract Background Postnatal depression is among the common mental health problems that occur during the postnatal period. However, it is left undiagnosed in low- and middle-income countries including Ethiopia. Therefore, this systematic review and meta-analysis aimed to systematically summarize the available evidence on the epidemiology of postnatal depression in Ethiopia and suggest recommendations for future clinical practice. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to conduct this systematic review and meta-analysis. We searched PubMed, SCOPUS, EMBASE and Google Scholar databases for the relevant articles that assessed the prevalence of postnatal depression in Ethiopia. We used a random-effect model to conduct a meta-analysis. We conducted a subgroup and sensitivity analysis to explore the source of heterogeneity. Cochrane Q- and the I2-test were used to check the heterogeneity of the included studies. The presence of publication bias was also checked by visual inspection of symmetry and Egger's test. Results The pooled estimated prevalence of postnatal depression in Ethiopia was 20.1% (95% CI 12.7–30.2). The pooled prevalence of postnatal depression in the studies that were conducted in community settings and used the Patient Health Questionnaire to assess postnatal depression [16.6% (95% CI 8.90–28.99)] was lower than the prevalence in studies based in institutions and that used the Edinburgh Postnatal Depression Scale [23.2% (95% CI 14.50–28.5)]. Further, in a leave-one-out sensitivity analysis the prevalence of postnatal depression ranges between 15.4% and 25.4%. Unplanned pregnancy [AOR = 3.46, 95% CI (2.37–5.04)], age between 15–24 years [AOR = 1.72, 95% CI (1.11–2.68)], marital problems [AOR = 3.07, 95% CI (2.36–3.99)], experiencing the death of infant [AOR = 3.41, 95% CI (1.91–6.09)] and history of substance use [AOR = 3.47, 95% CI (2.17–5.56)] were associated with the increased odds of postnatal depression in Ethiopia. Conclusion The prevalence of postnatal depression in Ethiopia was high. Therefore, the concerned body should give due attention to improve reproductive health services through early detection of risk factors of postnatal depression.

scholarly journals Thirty years with the Edinburgh Postnatal Depression Scale: voices from the past and recommendations for the future

2019 ◽  
Vol 214 (3) ◽  
pp. 127-129 ◽  
Author(s):  
John Cox
Keyword(s):  
Postnatal Depression ◽  
Edinburgh Postnatal Depression Scale ◽  
Perinatal Depression ◽  
Depression Scale ◽  
Self Report ◽  
Future Studies ◽  
The Past ◽  
Financial Interest ◽  
Practical Usefulness ◽  
The World

SummaryThe Edinburgh Postnatal Depression Scale (EPDS) was published over 30 years ago as a ten-item self-report questionnaire to facilitate the detection of perinatal depression – and for use in research. It is widely used at the present time in many regions of the world and has been translated into over 60 languages. It is occasionally misused. In this editorial, updated recommendations for optimal use in primary and secondary care as well as research are provided. Future studies to evaluate its use and validity in naturalistic community populations are now required, and to determine the psychometric properties and practical usefulness of the EPDS when completed online.Declaration of interestJ.C. has no financial interest in the use of, or reproduction of, the EPDS.

Vietnamese and Arabic Women's Responses to the Diagnostic Interview Schedule (Depression) and Self-Report Questionnaires: Cause for Concern

1997 ◽  
Vol 31 (3) ◽  
pp. 360-369 ◽  
Author(s):  
Stephen Matthey ◽  
Bryanne E. W. Barnett ◽  
Amanda Elliott
Keyword(s):  
Postnatal Depression ◽  
General Health Questionnaire ◽  
Depression Scale ◽  
Diagnostic Interview ◽  
Self Report ◽  
Interview Schedule ◽  
Convenience Sample ◽  
Diagnostic Interview Schedule ◽  
Vietnamese Women ◽  
Specific Symptoms

Objective: The original study aimed to determine the best cut-off scores to screen for postnatal depression on translated versions of the Edinburgh Postnatal Depression Scale (EPDS) for Vietnamese and Arabic women. This research was conducted using the depression module of the Diagnostic Interview Schedule (DIS) to determine caseness. This paper reports on the suitability of this diagnostic interview as a criterion measure of depression in these women with a non-English speaking background. Method: Vietnamese and Arabic women in south-west Sydney completed the EPDS and a General Health Questionnaire (GHQ-30) antenatally. At 6–8 weeks postpartum they completed an EPDS, the GHQ-30 and a Faces Scale, and were interviewed using the depression module of the DIS. Members of a small convenience sample of women were asked about the cultural appropriateness of each of the instruments. Results: Vietnamese women admitted to few depressive symptoms on the DIS, whereas they appeared more open to reporting these on the EPDS and the GHQ-30. Arabic women responded more openly to the questionnaires and the interview, although they too were reluctant to report specific symptoms on the DIS. Conclusion: The usefulness of the DIS in determining rates of major depression in the Vietnamese and Arabic community in Australia is questionable. Further studies designed specifically to investigate this are needed.

Adolescent antecedents of maternal and paternal perinatal depression: a 36-year prospective cohort

2020 ◽  
pp. 1-8 ◽  
Author(s):  
Kimberly C Thomson ◽  
Helena Romaniuk ◽  
Christopher J Greenwood ◽  
Primrose Letcher ◽  
Elizabeth Spry ◽  
...  
Keyword(s):  
Mental Health ◽  
Young Adulthood ◽  
Postnatal Depression ◽  
Transition To Parenthood ◽  
Perinatal Depression ◽  
Mental Health Problems ◽  
Health Problems ◽  
Self Report ◽  
Common Mental Health Problems ◽  
History Of

Abstract Background Rates of common mental health problems (depression/anxiety) rise sharply in adolescence and peak in young adulthood, often coinciding with the transition to parenthood. Little is known regarding the persistence of common mental health problems from adolescence to the perinatal period in both mothers and fathers. Methods A total of 393 mothers (686 pregnancies) and 257 fathers (357 pregnancies) from the intergenerational Australian Temperament Project Generation 3 Study completed self-report assessments of depression and anxiety in adolescence (ages 13–14, 15–16, 17–18 years) and young adulthood (ages 19–20, 23–24, 27–28 years). The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms at 32 weeks pregnancy and 12 months postpartum in mothers, and at 12 months postpartum in fathers. Results Most pregnancies (81%) in which mothers reported perinatal depression were preceded by a history of mental health problems in adolescence or young adulthood. Similarly, most pregnancies (83%) in which fathers reported postnatal depression were preceded by a preconception history of mental health problems. After adjustment for potential confounders, the odds of self-reporting perinatal depression in both women and men were consistently higher in those with a history of persistent mental health problems across adolescence and young adulthood than those without (ORwomen 5.7, 95% CI 2.9–10.9; ORmen 5.5, 95% CI 1.03–29.70). Conclusions Perinatal depression, for the majority of parents, is a continuation of mental health problems with onsets well before pregnancy. Strategies to promote good perinatal mental health should start before parenthood and include both men and women.

Edinburgh Postnatal Depression Scale (EPDS) for screening for depression in the first year post delivery in a low-resourced rural setting in Kenya

2022 ◽  
pp. 136346152110437
Author(s):  
Victoria N. Mutiso ◽  
Christine W. Musyimi ◽  
Albert Tele ◽  
Rita Alietsi ◽  
Pauline Andeso ◽  
...  
Keyword(s):  
Mental Health ◽  
Predictive Value ◽  
Postnatal Depression ◽  
Edinburgh Postnatal Depression Scale ◽  
Common Mental Disorders ◽  
Depression Scale ◽  
Self Report ◽  
Screening Tools ◽  
Rural Setting ◽  
Research Assistants

Postnatal depression is one of the most common mental disorders among postnatal mothers and may have severe consequences for mothers and their children. Locally validated screening tools that can be self- or lay interviewer-administered are required to identify at-risk women, especially in settings with no mental health specialists. This study aimed to assess the validity and reliability of a culturally adapted version of the Edinburgh Postnatal Depression Scale (EPDS) in a local dialect (Kamba) in a Kenyan setting. Trained research assistants administered the local-language version of self-report scales (EPDS) to a sample of 544 Kamba-speaking women. The same scale was re-administered to the same research participants two weeks later by the same research assistants. The test scores were compared with an external ‘gold standard’ according to the DSM-IV criteria Mini-International Neuropsychiatric Interview for adults (MINI-Plus). The EPDS had an area under the curve (AUC) of 0.867 with 95% C.I of 0.836 to 0.894, with a cut-off point of ≥11, sensitivity of 81.0% (95% C.I 70.6–89.0) and specificity of 82.6% (95% CI 78.8–85.9). The positive predictive value (PPV) and negative predictive value (NPV) were 44.1% and 96.2%, respectively. The internal reliability was 0.852 and the test-retest reliability was 0.496. The EPDS showed good utility in detecting depressive disorder in Kamba-speaking postnatal women. It does not have to be administered by mental health workers (who are few in low- and middle-income countries); rather, this can be done by a trained lay interviewer.

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