Skip to main content

Advertisement

SpringerLink
Log in

The performance of the Edinburgh Postnatal Depression Scale in English speaking and non-English speaking populations in Australia

  • ORIGINAL PAPER
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

The Edinburgh Postnatal Depression Scale (EPDS) has been widely used to assess maternal depression following childbirth in a range of English speaking countries, and increasingly also in translation in non-English speaking ones. It has performed satisfactorily in most validation studies, has proved easy to administer, is acceptable to women, and rates of depression in the range of 10–20% have been consistently found.

Methods

The performance of the EPDS was compared across different population samples in Australia: (i) Women born in Australia or in another English speaking country who completed the EPDS in English as part of the 1994 postal Survey of Recent Mothers (SRM) 6–7 months after birth (n = 1166); (ii) Women born in non-English speaking countries who also completed the EPDS in English in the same survey (n = 142); and (iii) Women born in Vietnam (n = 103), Turkey (n = 104) and the Philippines (n = 106) who completed the EPDS 6–9 months after birth in translation in the Mothers in a New Country Study (MINC) study (total n = 313). The pattern of item responses on the EPDS was assessed in various ways across the samples and internal reliability co-efficients were calculated. Exploratory factor analyses were also conducted to assess the similarity in the factor solutions across the samples.

Results

The EPDS had good construct validity and item endorsement by women was similar across the samples. Internal reliability of the scale was also very satisfactory with Cronbach’s alpha for each sample being ≥8. Between 39 and 46% of the variance in each of the three main samples was accounted for by one principal factor ‘depression’ (6–7 items loading), with two supplementary factors ‘loss of enjoyment’ (2 items loading) and ‘despair/self-harm’ (2–3 items loading) accounting for a further 20–25% of the variance. Alternative one and two factor solutions also showed a great deal of consistency between the samples.

Conclusions

The good item consistency of the EPDS and the relative stability of the factor patterns across the samples are indicative that the scale is understood and completed in similar ways by women in these different English speaking and non-English speaking population groups. With the proviso that careful translation processes and extensive piloting of translations are always needed, these findings lend further support to the use of the EPDS in cross-cultural research on depression following childbirth.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Littlewood R (1990) From categories to contexts: a decade of the ‘new cross-cultural psychiatry’. Br J Psychiatry 156:308–327

    PubMed  CAS  Google Scholar 

  2. Kleinman A (1977) Depression, somatization and the new ‘cross-cultural psychiatry’. Soc Sci Med 11:3–10

    Article  PubMed  CAS  Google Scholar 

  3. Leff J (1990) The ‘new cross-cultural psychiatry’: a case of the baby and the bathwater. Br J Psychiatry 156:305–307

    PubMed  CAS  Google Scholar 

  4. Kumar R (1994) Postnatal mental illness: a transcultural perspective. Soc Psychiatry Psychiatr Epidemiol 29:250–264

    Article  PubMed  CAS  Google Scholar 

  5. Canino G, Lewis-Fernandez R, Bravo M (1997) Methodological challenges in cross-cultural mental health research. Transcult Psychiatry 34:163–184

    Article  Google Scholar 

  6. O’Hara MW (1994) Postpartum depression: identification and measurement in a cross-cultural context. In: Cox J, Holden J (eds) Perinatal psychiatry. The use and misuse of the Edinburgh Postnatal Depression Scale. Gaskell, London

    Google Scholar 

  7. Cox JL, Holden J, Sagovsky R (1987) Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786

    Article  PubMed  CAS  Google Scholar 

  8. Murray L, Carothers AD (1990) The validation of the Edinburgh Postnatal Depression Scale on a community sample. Br J Psychiatry 157:288–290

    PubMed  CAS  Google Scholar 

  9. Boyce PM, Stubbs R, Todd A (1993) The Edinburgh Postnatal Depression Scale: validation in an Australian sample. Aust NZ J Psychiatry 27:472–476

    CAS  Google Scholar 

  10. Thompson WM, Harris B, Lazarus J Richards C (1998) A comparison of the performance of rating scales used in the diagnosis of postnatal depression. Acta Psychiatr Scand 98:224–227

    PubMed  CAS  Google Scholar 

  11. Jadresic E, Araya R, Jara C (1995) Validation of the Edinburgh Postnatal Depression Scale in Chilean postpartum women. J Psychosom Obstet Gynaecol 16:187–191

    PubMed  CAS  Google Scholar 

  12. Lee DTS, Yip SK, Chiu HFK, Leung TYS, Chan KPM, Chau IOL, Leung HCM, Chung TKH (1998) Detecting postnatal depression in Chinese women. Validation of the Chinese version of the Edinburgh Postnatal Depression Scale. Br J Psychiatry 172:433–437

    Article  PubMed  CAS  Google Scholar 

  13. Benvenuti P, Ferrara M, Niccolai C, Valoriani V, Cox JL (1999) The Edinburgh Postnatal Depression Scale: validation for an Italian sample. J Affect Disord 53:137–141

    Article  PubMed  CAS  Google Scholar 

  14. Wickberg B, Hwang CP (1996) The Edinburgh Postnatal Depression Scale: Validation on a Swedish community sample. Acta Psychiatr Scand 94:181–184

    PubMed  CAS  Google Scholar 

  15. Ghubash R, Abou-Saleh MT, Daradkeh TK (1997) The validity of the Arabic Postnatal Depression Scale. Soc Psychiatry Psychiatr Epidemiol 32:474–476

    PubMed  CAS  Google Scholar 

  16. Eberhard-Gran M, Eskild A, Tambs K, Opjordsmoen S, Samuelsen SO (2001) Review of validation studies of the Edinburgh Postnatal Depression Scale. Acta Psychiatr Scand 104:243–249

    Article  PubMed  CAS  Google Scholar 

  17. Brown S, Lumley J (1997) The 1993 Survey of Recent Mothers: Issues in survey design, analysis and influencing policy. Int J Qual Health Care 9:265–275

    PubMed  CAS  Google Scholar 

  18. Brown S, Lumley J (1998) Maternal health after childbirth: results of an Australian population based survey. BJOG 105:156–161

    Article  CAS  Google Scholar 

  19. Small R, Lumley J, Yelland J, Liamputtong Rice P (1998) Shared antenatal care fails to rate well with women of non-English speaking backgrounds. Med J Aust 168:15–18

    PubMed  CAS  Google Scholar 

  20. Small R, Lumley J, Yelland J (2003) Cross-cultural experiences of maternal depression: associations and contributing factors for Vietnamese, Turkish and Filipino immigrant women in Victoria, Australia. Ethnicity Health 8:189–206

    Article  PubMed  Google Scholar 

  21. Harris B, Huckle P, Thomas R, John S, Fung H (1989) The use of rating scales to identify postnatal depression. Br J Psychiatry 154:813–817

    PubMed  CAS  Google Scholar 

  22. Cox JL (1986) Postnatal Depression A Guide for Health Professionals. Churchill Livingstone, Edinburgh

    Google Scholar 

  23. Small R, Lumley J, Yelland J, Rice PL, Cotronei V, Warren R (1999) Cross-cultural research: trying to do it better. 2. Enhancing data quality. Aust NZ J Public Health 33:390–395

    Google Scholar 

  24. Fayers PM, Machin D (1998) Factor analysis. In: Staquet MJ, Hays RD, Fayers PM (eds) Quality of Life Assessment in Clinical Trials: Methods and Practice. OUP, Oxford, pp 191–223

    Google Scholar 

  25. SPSS for Windows (1998) Version 9.0 for Windows. Chicago, Illinois: SPSS Inc

  26. Dean AG, Dean JA, Coulombier D, et al (1994) Epi Info, Version 6: A word processing, database and statistics program for epidemiology on microcomputers. Centers for Disease Control and Prevention, Atlanta, Georgia

    Google Scholar 

  27. Floyd FJ, Widaman KF (1995) Factor analysis in the development and refinement of clinical assessment instruments. Psychol Assess 7:286–299

    Article  Google Scholar 

  28. Streiner DL (1994) Figuring out factors: The use and misuse of factor analysis. Can J Psychiatry 39:135–140

    PubMed  CAS  Google Scholar 

  29. Brislin RW (1973) Factor analysis. In: Brislin RW, Lonner E, Thorndike RM (eds) Cross Cultural Research Methods. John Wiley and Sons, New York 255–287

    Google Scholar 

  30. Ahmad WIU (1996) The trouble with culture. In: Kelleher D, Hillier S (eds) Researching Cultural Differences in Health. Routledge, London, pp 190–219

    Google Scholar 

  31. Stubbs P (1993) ‘Ethnically sensitive’ or ‘anti-racist’? Models for health research and service delivery. In: Ahmad WIU (ed) ‘Race’ and Health in Contemporary Britain. Open University Press, Buckingham, pp 34–50

    Google Scholar 

  32. Smaje C (1996) The ethnic patterning of health: New directions for theory and research. Sociol Health Illness 18:139–171

    Article  Google Scholar 

  33. Watkins D (1989) The role of confirmatory factor analysis in cross-cultural research. Int J Psychol 24:685–701

    Google Scholar 

  34. Pop VJ, Komproe IH, van Son MJ (1992) Characteristics of the Edinburgh Postnatal Depression Scale in The Netherlands. J Affect Disord 26:105–110

    Article  PubMed  CAS  Google Scholar 

  35. Astbury J, Brown S, Lumley J, Small R (1994) Birth events, birth experiences and social differences in postnatal depression. Aust J Public Health 18:176–184

    Article  PubMed  CAS  Google Scholar 

  36. Berle JØ, Aarre TF, Mykeltun A, Dahl AA, Holsten F (2003) Screening for postnatal depression. Validation of the Norwegian version of the Edinburgh Postnatal Depression Scale, and assessment of risk factors for postnatal depression. J Affect Disord 76:151–156

    Article  PubMed  CAS  Google Scholar 

  37. Guedenay N, Fermanian J (1998) Validation study of the French version of the Edinburgh Postnatal Depression Scale (EPDS): new results and psychometric properties. Eur Psychiatry 13:83–89

    Article  Google Scholar 

  38. Des Rivières-Pigeon C, Séguin L, Brodeur J-M, Perreault M, Boyer G, Colin C (2000) L’ Échelle de Dépression Postnatale d’ Édimbourg: validité au Québec auprès de femmes de statut socio-économique faible. Revue Canadienne de Santé Mentale Communautaire 19:201–214

    PubMed  Google Scholar 

  39. Teissedre F, Chabrol H (2004) Étude de l’EPDS (Échelle postnatale d’Édinbourg) chez 859 mères: dépistage des mères à risque de developper une dépression du post-partum. L’Éncephale 30:376–381

    PubMed  CAS  Google Scholar 

  40. Chabrol H, Teissedre F (2004) Relation between the Edinburgh Postnatal Depression Scale scores at 2–3 days and 4–6 weeks postpartum. J Reprod Infant Psychol 22:33–39

    Article  Google Scholar 

  41. Adouard F, Glangeaud-Freudenthal NMC (2005) Validation of the Edinburgh Postnatal Depression Scale (EPDS) in a sample of women with high risk pregnancies in France. Arch Womens Ment Health 8:89–95

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mother and Child Health Research, La Trobe University, 251 Faraday Street, Carlton, VIC, 3053, Australia

    Rhonda Small, Judith Lumley, Jane Yelland & Stephanie Brown

Authors
  1. Rhonda Small
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Judith Lumley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jane Yelland
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephanie Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rhonda Small.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Small, R., Lumley, J., Yelland, J. et al. The performance of the Edinburgh Postnatal Depression Scale in English speaking and non-English speaking populations in Australia. Soc Psychiat Epidemiol 42, 70–78 (2007). https://doi.org/10.1007/s00127-006-0134-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-006-0134-3

Keywords

Search

Navigation