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 ◽  
...  

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.

Author(s):  
Dagmar Lagerberg ◽  
Margaretha Magnusson ◽  
Claes Sundelin

Abstract Background: The Edinburgh Postnatal Depression Scale (EPDS) is widely used in early child health care. This study examined the appropriateness of the recommended EPDS cut-off score 11/12. Methods: Two main analyses were performed: 1. Associations between EPDS scores and maternal health behaviour, stress, life events, perceived mother-child interaction quality and child behaviour. 2. Screening parameters of the EPDS, i.e., sensitivity, specificity and positive predictive value. EPDS scores were available for 438 mothers and maternal questionnaires for 361 mothers. Results: Already in the EPDS score intervals 6–8 and 9–11, there were notable adversities, according to maternal questionnaires, in stress, perceived quality of mother-child interaction, perceived child difficultness and child problem behaviours. Using maternal questionnaire reports about sadness/distress postpartum as standard, the recommended EPDS cut-off score 11/12 resulted in a very low sensitivity (24%). The cut-off score 6/7 yielded a sensitivity of 61%, a specificity of 82% and a positive predictive value of 61%. Conclusions: In terms of both clinical relevance and screening qualities, an EPDS cut-off score lower than 11/12 seems recommendable.


2014 ◽  
Vol 75 (04) ◽  
pp. 393-398 ◽  
Author(s):  
Linda B. Lydsdottir ◽  
Louise M. Howard ◽  
Halldora Olafsdottir ◽  
Marga Thome ◽  
Petur Tyrfingsson ◽  
...  

2005 ◽  
Vol 39 (4) ◽  
pp. 262-265 ◽  
Author(s):  
Jon J Pfaff ◽  
Jon J Pfaff ◽  
Osvaldo P Almeida

Objective: To determine the characteristics of depressed older patients whose mental health status is detected by their general practitioner (GP). Method: Cross-sectional analytical design of 218 patients scoring above the cut-off (≥ 16) of the Center for Epidemiological Studies – Depression Scale (CES-D), from a sample of 916 consecutive patients aged 60 years or over attending one of 54 randomly selected GPs in Western Australia. Prior to their medical consultation, patients completed a self-report questionnaire, which included questions about depressive symptomatology (CES-D). Following the consultation, general practitioners recorded the patient's presenting complaint(s), medication information, and mental health details on a patient summary sheet. Results: Among these 218 patients, 39.9% (87/218) were correctly classified as depressed by their GP. Detection of depressive symptomatology was associated with patients who acknowledged taking sleeping tablets (OR = 2.6, 95% CI = 1.3–5.4), had CES-D scores indicative of major depression (≥ 22) (OR = 2.8, 95% CI = 1.4–5.6) and were thought to be at risk for suicide (OR = 35.1, 95% CI = 4.5–274.2). Conclusions: While GPs are most apt to detect depression among older patients with prominent mental health symptoms, many patients in this age group silently experience significant depressive symptomatology and miss the opportunity for effective treatment. The routine use of screening tools in primary care is recommended to enhance the detection rate of depression in older adults.


2020 ◽  
Author(s):  
Alexandra Lautarescu ◽  
Suresh Victor ◽  
Alex Lau-Zhu ◽  
Serena J. Counsell ◽  
Anthony David Edwards ◽  
...  

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.


Author(s):  
Alexandra Lautarescu ◽  
Suresh Victor ◽  
Alex Lau-Zhu ◽  
Serena J. Counsell ◽  
A. David Edwards ◽  
...  

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.


2021 ◽  
Author(s):  
Pradeep Badiya ◽  
Sasidhar Siddabattuni ◽  
Debarshi Dey ◽  
Akkamahadevi C Hiremath ◽  
Raj Lakshmi Nalam ◽  
...  

BACKGROUND Edinburgh Postnatal Depression Scale (EPDS) is a validated screening tool widely used to assess perinatal depression (PND). However, due to stigma associated with PND, respondents could answer sensitive questions differently depending on the mode of administration, especially in culturally and linguistically diverse country like India. The present study explored longitudinal differences in EPDS scores between self-administered and interviewer-administered modes OBJECTIVE The main objective of this study was to evaluate the differences in EPDS administration between the self-administered and interviewer-administered modes, a longitudinal observational study to understand and improve the test score interpretation. The present study explores differences in EPDS scores in assessing PND longitudinally, comparing self and interview-based modes of EPDS administration in perinatal women of rural South India METHODS 177 women from rural South India were administered EPDS, self-administration followed by interviewer-administered for four visits, twice each during prenatal and postnatal visits. EPDS scores were compared between the two modes descriptively, graphically and by repeated mixed measure models. Classification of antenatal depression (AD), postnatal depression (PD) and PND based on the two modes were compared by McNemar Chi-square test. Clinical and psychosocial characteristics were examined to identify factors associated with differences in the scoring modes. Concordance rates and Goodman Kruskal’s Gamma coefficients were measured for individual EPDS items. RESULTS Longitudinal EPDS scores and rates of AD, PD and PND were significantly higher in self-administered mode. Recent adverse life events were the only factor observed to be significantly associated with the differences between the two modes. Rank correlation and concordance rates suggested stronger association for EPDS items relating to anhedonia subscale and moderate/weaker association for EPDS items relating to anxiety/depression subscales. CONCLUSIONS Our study findings suggest that the effect of mode of administration should be taken into account while using PND screening tools such as EPDS, especially in countries such as India with higher levels of illiteracy. CLINICALTRIAL The study was registered with the Clinical Trials Registry of India, registration no. CTRI/2017/11/010497 and was conducted from October 2017 to May 2019.


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