Abstract
BackgroundEdinburgh Postnatal Depression Scale (EPDS) is an important screening instrument that is used routinely with mothers during the postpartum period for early identification of postnatal depression. The purpose of this study was to validate the Greek version of EPDS along with sensitivity, specificity and predictive values.Methods120 mothers within 12 weeks postpartum were recruited from the perinatal care registers of the Maternity Departments of 4 Hospitals of Heraklion municipality, Greece. EPDS and Beck Depression Inventory-II (BDI-II) surveys were administered in random order to the mothers. Each mother was diagnosed with depression according to the validated Greek version of BDI-II. The psychometric measurements that were performed included: two independent samples t-tests, One-way analysis of variance (ANOVA), reliability coefficients, Explanatory factor analysis using a Varimax rotation and Principal Components Method. Confirmatory analysis -known as structural equation modelling- of principal components was conducted by LISREL (Linear Structural Relations). A receiver operating characteristic (ROC) analysis was carried out to evaluate the global functioning of the scale.Results8 (6.7%) of the mothers were diagnosed with major postnatal depression, 14 (11.7%) with moderate and 38 (31.7%) with mild depression on the basis of BDI-II scores. The internal consistency of the EPDS Greek version -using Chronbach's alpha coefficient- was found 0.804 and that of Guttman split-half coefficient 0.742. Our findings confirm the multidimensionality of EPDS, demonstrating a two-factor structure which contained subscales reflecting depressive symptoms and anxiety. The Confirmatory Factor analysis demonstrated that the two factor model offered a very good fit to our data. The area under ROC curve AUC was found 0.7470 and the logistic estimate for the threshold score of 8/9 fitted the model sensitivity at 76.7% and model specificity at 68.3%.ConclusionOur data confirm the validity of the Greek version of the EPDS in identifying postnatal depression. The Greek EPDS scale could be used as a useful instrument in both clinical practice and research.
Highlights
Edinburgh Postnatal Depression Scale (EPDS) is an important screening instrument that is used routinely with mothers during the postpartum period for early identification of postnatal depression
Use of the Beck Depression Inventory (BDI) [6,7] and Beck Depression Inventory-II (BDI-II) with postpartum samples has been reported in the literature as well correlated with EPDS [3,5] and other instruments used to screen for postnatal depression like Postpartum Depression Screening Scale (PDSS) [3]
Written comments made by the participants in the Cognitive Debriefing Report were included in the final Greek version of EPDS that was validated with the women who participated in the study
Summary
Edinburgh Postnatal Depression Scale (EPDS) is an important screening instrument that is used routinely with mothers during the postpartum period for early identification of postnatal depression. The purpose of this study was to validate the Greek version of EPDS along with sensitivity, specificity and predictive values. The Edinburgh Post Natal Depression Scale (EPDS) has been developed in order to screen for postnatal depression [4]. The EPDS is a sensitive screening instrument for the early detection of depressive symptoms as well as a sensitive instrument according to diagnostic criteria for major depression [5]. With a cut-off score of 12/13 for screening English population it was reported sensitivity 86%, specificity 78%, Positive Predictive Value (PPV) 73% and alpha coefficient = 0.87 [4]. Not all validation studies include estimation of the cut-off scores that might be appropriate in different languages
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