Abstract
BackgroundInformation on clinical acceptability is needed when making cost-utility decisions about health screening implementation. Despite being in use for two decades, most data on the clinical acceptability of the Edinburgh Postnatal Depression Scale (EPDS) come from qualitative reports, or include relatively small samples of depressed women. This study aimed to measure acceptability in a survey of a relatively large, community sample with a high representation of clinically depressed women.MethodsUsing mail, telephone and face-to-face interview, 920 postnatal women were approached to take part in a survey on the acceptability of the EPDS, including 601 women who had screened positive for depression and 245 who had received DSM-IV diagnoses of depression. Acceptability was measured on a 5-point Likert scale of comfort ranging from "Not Comfortable", through "Comfortable" to "Very Comfortable".ResultsThe response rate was just over half for postal surveys (52%) and was 100% for telephone and face-to-face surveys (432, 21 and 26 respondents for postal, telephone and face-to-face surveys respectively) making 479 respondents in total. Of these, 81.2% indicated that screening with the EPDS had been in the range of "Comfortable" to "Very Comfortable". The other 18.8 % rated screening below the "Comfortable" point, including a small fraction (4.3%) who rated answering questions on the EPDS as "Not Comfortable" at the extreme end of the scale. Comfort was inversely related to EPDS score, but the absolute size of this effect was small. Almost all respondents (97%) felt that screening was desirable.ConclusionThe EPDS had good acceptability in this study for depressed and non-depressed women. Women's views on the desirability of postnatal depression screening appear to be largely independent of personal level of comfort with screening. These results should be useful to policy-makers and are broadly supportive of the Edinburgh Postnatal Depression Scale as a suitable tool for universal perinatal depression screening.
Highlights
Information on clinical acceptability is needed when making cost-utility decisions about health screening implementation
Whilst quantitative measurement of acceptability is common for other health screening and diagnostic tools [8,9,10,11] this has not been common for Postnatal depression (PND) screening instruments
This reflects the deliberately high representation of women scoring above the cut-off (601 of those surveyed) who had a mean Edinburgh Postnatal Depression Scale (EPDS) of 16.29 compared to a mean of 5.26 for the 319 who scored below cut-off
Summary
Information on clinical acceptability is needed when making cost-utility decisions about health screening implementation. More recently Shakespeare, Blake and Garcia [14] reported the qualitative results of 39 faceto-face interviews investigating women's experience of completing the EPDS in General Practice settings in the United Kingdom Twenty one of these women (54%) found this screening process "unacceptable" and issues of fear of stigma as well as a perceived inappropriateness of the screening venue were raised. No existing acceptability study has included a large sample of postnatal women exhibiting elevated scores on the EPDS and/or a sizeable cohort of clinically depressed postnatal women This is potentially important since any useful health screening instrument must have good acceptability in the general population that includes the much smaller target group, but the acceptability must be high in that target group
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