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Screening for postnatal depression: Validation of the Norwegian version of the Edinburgh Postnatal Depression Scale, and assessment of risk factors for postnatal depression

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Abstract

Objective: The Edinburgh Postnatal Depression Scale (EPDS) is a self-rating scale developed to screen for postnatal depression. The aim of this study was to validate a Norwegian translation of the EPDS, study its psychometric properties, and identify risk factors for postnatal depression. Method: EPDS was filled in by 411 women at 6–12 weeks postpartum. Of these, 100 were interviewed using the Mini International Neuropsychiatric Interview for DSM-IV major and minor depressive disorders. Results: When using a cut-off of 11 on the EPDS, 26 of 27 women with major depression were identified (sensitivity 96%, specificity 78%). An aggregate point prevalence of 10.0% of major and minor depression was found. A one-factor model accounted for 46.6% of the variance. Strongest risk factors for postpartum depression were previous depression, depression in current pregnancy, and current somatic illness. Limitations: Women screened using the EPDS who had a score above threshold, yet did not attend the diagnostic interview could cause the point prevalence of depression to be higher than indicated here. Conclusion: The Norwegian translation of EPDS functions equally well as other translations as a screening tool for postnatal depression. The risk factors that were found are compatible with other studies.

Introduction

In the postpartum period, women show an increased vulnerability for major depressive episodes (Cox et al., 1987; O’Hara and Swain, 1996). Untreated postpartum depression can have a detrimental effect on mother–child interaction and negative influence on child development (Murray and Cooper, 1997). The Edinburgh Postnatal Depression Scale (EPDS) is a questionnaire with 10 items that are specifically designed for detecting depression in the postpartum period (Cox et al., 1987). It has been used extensively in various languages. The use of the EPDS as a screening tool is particularly important among women who are at risk for postpartum depression (Nielsen et al., 2000).

Since its introduction, the EPDS has been used extensively in both clinical settings and in epidemiological studies. The EPDS has shown good psychometric properties in the postpartum population, is well accepted by women, and has also, in recent years, been used for pregnant and non-puerperal women (Cox et al., 1996).

The EPDS was designed as a one-dimensional instrument for depression, yet the suggestion of a two-factor model exists (Pop et al., 1992; Guedeney and Fermanian, 1998).

In the first EPDS studies, a cut off score of 10 was recommended for community surveys and screening (Cox et al., 1987), while a cut-off score of 13 was seen as more appropriate for a clinical setting.

The aim of the present study was to validate a Norwegian translation of the EPDS and to assess risk factors for postnatal depression.

Section snippets

Translation

A translation of the EPDS into Norwegian was followed by a back-translation into English. This procedure was done twice.

Sampling

Women attending routine post-natal visits, 6–12 weeks post partum, were screened using the EPDS. A majority of them also filled in the Beck Depression Inventory (BDI) (Beck et al., 1961) and the Hospital Anxiety and Depression Rating Scale (HADS) (Zigmond and Snaith, 1983).

Procedure

All women with an EPDS sum score of 8 or higher, and every tenth woman who scored below this threshold

Results

Items 1–9 correlated between 0.55 and 0.72 with the EPDS total score. Item 10 (suicidal ideation) correlated lowest (0.30). The internal consistency of EPDS assessed by Cronbach’s α was 0.87.

Interrater reliability had a κ of 0.82, 0.84 and 0.78 between rater pairs. Diagnosis was concurred upon for 25 of the 30 women who had had their videotaped interview rated. Disagreement on five cases was between major and minor depression.

According to DSM-IV, 27 women (6.6%) filled the criteria for major

Discussion

A point prevalence of 10% for postpartum major and minor depression using the Norwegian translation of the EPDS was found. This prevalence is in accordance with other studies.

In research, a cut-off score of 12 to detect women with major depression and a cut-off of 11 to detect both major and minor depression is recommended according to ROC (Fig. 1). In a clinical setting, a cut-off of 8 should detect both women at risk for developing depression and identify those who have minor depression. In

Acknowledgements

This research was supported by a grant from the Gerda Nyquist Trust in Bergen. We wish to thank the staff at the children’s health clinics in Bergen and at the gynaecologist’s specialist practice of Nyland and Johannessen in Bergen for their assistance in this study.

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