Objective: The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening tool for postpartum depression (PPD). We systematically reviewed the published evidence on its validity in detecting PPD and antepartum depression (APD) up to July 2008. Method: Systematic review of validation studies of the EPDS included 1987-2008. Cut-off points of 9 ⁄ 10 for possible PPD, 12 ⁄ 13 for probable PPD and 14 ⁄ 15 for APD were used. Results: Thirty-seven studies met the inclusion criteria. Sensitivity and specificity of cut-off points showed marked heterogeneity between different studies. Sensitivity results ranged from 34 to 100% and specificity from 44 to 100%. Positive likelihood ratios ranged from 1.61 to 78. Conclusion: Heterogeneity among study findings may be due to differences in study methodology, language and diagnostic interview ⁄ criteria used. Therefore, the results of different studies may not be directly comparable and the EPDS may not be an equally valid screening tool across all settings and contexts. Summations• There is a wide variation across different settings in sensitivity, specificity, positive and negative likelihood ratios in validation studies of the Edinburgh Postnatal Depression Scale (EPDS).• Differences in methodology of the included studies are likely to account for the variation in results.• There are only three studies evaluating the EPDS for use in antenatal populations. Considerations• Because of considerable differences in the methodology of included studies, quantitative approaches using meta-analysis were not performed.

In the triennium 2006-2008, 261 women in the UK died directly or indirectly related to pregnancy. The overall maternal mortality rate was 11.39 per 100,000 maternities. Direct deaths decreased from 6.24 per 100,000 maternities in 2003-2005 to 4.67 per 100,000 maternities in 2006–2008 (p = 0.02). This decline is predominantly due to the reduction in deaths from thromboembolism and, to a lesser extent, haemorrhage. For the first time there has been a reduction in the inequalities gap, with a significant decrease in maternal mortality rates among those living in the most deprived areas and those in the lowest socio-economic group. Despite a decline in the overall UK maternal mortality rate, there has been an increase in deaths related to genital tract sepsis, particularly from community acquired Group A streptococcal disease. The mortality rate related to sepsis increased from 0.85 deaths per 100,000 maternities in 2003-2005 to 1.13 deaths in 2006-2008, and sepsis is now the most common cause of Direct maternal death. Cardiac disease is the most common cause of Indirect death; the Indirect maternal mortality rate has not changed significantly since 2003-2005. This Confidential Enquiry identified substandard care in 70% of Direct deaths and 55% of Indirect deaths. Many of the identified avoidable factors remain the same as those identified in previous Enquiries. Recommendations for improving care have been developed and are highlighted in this report. Implementing the Top ten recommendations should be prioritised in order to ensure the overall UK maternal mortality rate continues to decline.

Health professionals are ideally placed to identify domestic violence but cannot do so without training on raising the issue and knowledge of advice and support servicesThe stigma surrounding domestic violence means that many of those affected are reluctant or do not know how to get help. A systematic review of screening for domestic violence in healthcare settings concluded that although there was insufficient evidence to recommend screening programmes, health services should aim to identify and support women experiencing domestic violence.1 The review highlighted the importance of education and training of clinicians in promoting disclosure of abuse and appropriate responses.1 We argue that a strong case exists for routinely inquiring about partner abuse in many healthcare settings. Size of problemDomestic violence includes emotional, sexual, and economic abuse as well as physical violence. The different forms of abuse may occur together or on their own, although always in the context of coercive control by one partner over the other. To reinforce the fact that domestic violence does not necessarily involve physical violence, we prefer the term partner abuse. Abuse can continue after the partners have separated.Partner abuse occurs in all types of relationships, both same sex and heterosexual.2 Although about one in seven men in the United Kingdom report experiencing physical assault by a current or former partner, 3 these incidents are generally less serious than those reported by women, and men are less likely to be injured, frightened, or seek medical care. 4 The context and severity of violence by men against women makes domestic violence against women a much larger problem in public health terms.2 5 Worldwide, 10-50% of women report having been hit or physically assaulted by an intimate partner at some time. w1 In the United Kingdom, 23% of women aged 16-59 have been physically assaulted by a current or former partner, and two women are killed every week.3 This article therefore focuses on routine inquiry of women accessing health services.

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