Reliability and validity of the Edinburgh Postnatal Depression Scale (EPDS) for detecting perinatal common mental disorders (PCMDs) among women in low-and lower-middle-income countries: a systematic review

Abstract

BackgroundThe Edinburgh Postnatal Depression Scale (EPDS), originally developed in Britain, is one of the most widely used screening instruments for assessing symptoms of the Perinatal Common Mental Disorders (PCMDs) of depression and anxiety. However, its potential to detect PCMDs in culturally diverse low- and lower-middle income countries (LALMICs) is unclear. This systematic review aimed to appraise formally validated local language versions of the EPDS from these resource-constrained settings.MethodsFollowing the PRISMA protocol, we searched MEDLINE-OVID, CINAHL-Plus and PUBMED to identify studies reporting translation, cultural adaptation and formal validation of the EPDS to detect PCMDs among women in LALMICs. The quality of the studies meeting inclusion criteria was assessed using standard criteria and a new process-based criteria; which was developed specifically for this study.ResultsWe identified 1281 records among which 16 met inclusion criteria; three further papers were identified by hand-searching reference lists. The publications reported findings from 12 LALMICs in14 native languages. Most of these local language versions of the EPDS (LLV-EPDS) had lower precision for identifying true cases of PCMDs among women in the general perinatal population compared to the original English version. Only one study met all criteria for culturally sensitive translation, the others had not established the comprehensibility of the local version amongst representative groups of women in pre-testing. Many studies tested the LLV-EPDS only amongst convenience samples recruited at single health facilities. Diagnostic interviews for confirmation of mental disorders could have been influenced by the mental health professionals’ lack of blinding to the initial screening results. Additionally, even when diagnostic-interviews were carried out in the local language, questions might not have been understood as most studies followed standard diagnostic protocol which had not been culturally adapted.ConclusionsMost of the LLV-EPDS from non-English speaking low- and middle-income-countries did not meet all criteria for formal validation of a screening instrument. Psychometric properties of LLV-EPDS could be enhanced by adopting the new process-based criteria for translation, adaptation and validation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0859-2) contains supplementary material, which is available to authorized users.

A systematic review and meta-regression of the prevalence and incidence of perinatal depression

“…This symptom scale was designed to eliminate somatic indicators of depression (Pereira et al, 2014a); however it also contains a question more aligned with anxiety than depression, and thus may not indicate the presence of MDD alone (Boyd et al, 2005). Notably, this instrument has been validated in fourteen different languages, and may thus be an important tool in countries with poor access to psychiatric resources (Shrestha et al, 2016). Studies included in our analyses administered the EPDS using differing cut-off scores to determine the presence of symptoms, complicating our ability to compare prevalence between studies; we found cut-off values ranging from ten to fifteen.…”

Maternal Depression and Mother-to-Infant Bonding: The Association of Delivery Mode, General Health and Stress Markers

“…Numerous studies have used this instrument during the antenatal and/or postpartum period [15] [16]. In the present study we used the Japanese version of EPDS, which shows good internal consistency and test-retest reliability [17].…”

Prenatal depression screening among a diverse healthy start population.

“…The authors found that when the diagnostic interviews for EPDS were done in the local language, questions may not have been understood as the questions were not culturally adapted (28).…”

“…(where EPDS was translated into local languages) had lower precision for identifying the true cases of PCMD compared to the original English version (28).…”

“…One systematic review assessed the reliability and validity of the EPDS for detecting prenatal common mental disorders (PCMD) among women in low-and lower-middle-income countries (28). It was found that the local language versions…”