Abstract
Objectives The Edinburgh Postnatal Depression Scale (EPDS) was originally created as a uni-dimensional scale to screen for postpartum depression (PPD); however, evidence from various studies suggests that it is a multi-dimensional scale measuring mainly anxiety in addition to depression. The factor structure of the EPDS seems to differ across various language translations, raising questions regarding its stability. This study examined the factor structure of the Hebrew version of the EPDS to assess whether it is uni- or multi-dimensional. Methods Seven hundred and fifteen (n = 715) women were screened at 6 weeks postpartum using the Hebrew version of the EPDS. Confirmatory factor analysis (CFA) was used to test four models derived from the literature. Results Of the four CFA models tested, a 9-item two factor model fit the data best, with one factor representing an underlying depression construct and the other representing an underlying anxiety construct. Conclusions for Practice The Hebrew version of the EPDS appears to consist of depression and anxiety sub-scales. Given the widespread PPD screening initiatives, anxiety symptoms should be addressed in addition to depressive symptoms, and a short scale, such as the EPDS, assessing both may be efficient.
Similar content being viewed by others
Notes
These centers provide all vaccination and well child visits from birth to 6 years old.
References
Adouard, F., Glangeaud-Freudenthal, N. M. C., & Golse, B. (2005). Validation of the Edinburgh Postnatal Depression Scale (EPDS) in a sample of women with high-risk pregnancies in France. Archives of Womens Mental Health, 8, 89–95.
Andajani-Sutjahjo, S., Manderson, L., & Astbury, J. (2007). Complex emotions, complex problems: Understanding the experiences of perinatal depression among new mothers in urban Indonesia. Culture, Medicine and Psychiatry, 31, 101–122.
Andrews Horowitz, J., & Cousins, A. (2006). Postpartum depression treatment rates for at-risk women. Nursing Research, 55(2S), s23–s27.
Berle, J. O., Aarre, T. F., Mykletun, A., Dahl, A. A., & 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. Journal of Affective Disorders, 76, 151–156.
Brockington, I. F., Macdonald, E., & Wainscott, G. (2006). Anxiety, obsessions and morbid preoccupations in pregnancy and the puerperium. Archives of Womens Mental Health, 9, 253–263.
Brouwers, E. P. M., Van Baar, A. L., & Pop, V. J. M. (2001). Does the Edinburgh Postnatal Depression Scale measure anxiety? Journal of Psychosomatic Research, 51, 659–663.
Brown, T. A. (2015). Confirmatory factor analysis for applied research (2nd ed.). New York: The Guilford Press.
Byrne, B. M. (2012). Structural equation modeling with Mplus. New York: Routledge.
Chabrol, H., & Teissedre, F. (2004). Relation between Edinburgh Postnatal Depression Scale scores at 2–3 days and 4–6 weeks postpartum. Journal of Reproductive and Infant Psychology, 22(1), 33–39.
Cox, J. L., & Holden, J. (2003). Perinatal mental health: A guide to the Edinburgh Postnatal Depression Scale. London: Gaskell.
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786.
DeVaus, D. (2002). Analyzing social science data: 50 key problems in data analysis. Thousand Oaks: Sage.
Earls, M. F. (2010). Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics, 126, 1032.
Farr, S. L., Dietz, P. M., O’Hara, M. W., Burley, K., & Ko, J. Y. (2014). Postpartum anxiety and comorbid depression in a population-based sample of women. Journal of Women’s Health, 23(2), 120–128.
Gibson, J., McKenzie-McHarg, K., Shakespeare, J., Price, J., & Gray, R. (2009). A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatrica Scandinavica, 119(5), 350–364.
Glasser, S., & Barell, V. (1999). Depression scale for research in and identification of postpartum depression. Harefuah, 136, 764–768. [Hebrew].
Guedeney, N., & Fermanian, J. (1998). Validation study of the French version of the Edinburgh Postnatal Depression Scale (EPDS): New results about use and psychometric properties. European Psychiatry, 13, 83–89.
Ip, W. Y., & Martin, C. R. (2007). The factor structure of the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS). Journal of Reproductive and Infant Psychology, 25, 83–86.
Jomeen, J., & Martin, C. R. (2005). Confirmation of an occluded anxiety component within the Edinburgh Postnatal Depression Scale (EPDS) during early pregnancy. Journal of Reproductive and Infant Psychology, 23, 143–154.
Jomeen, J., & Martin, C. R. (2007). Replicability and stability of the multidimensional model of the Edinburgh Postnatal Depression Scale in late pregnancy. Journal of Psychiatric and Mental Health Nursing, 14, 319–324.
Kandel-Katznelson S, Maisel S, Zilber N, Lerner J. (2000) Validation of the Hebrew translation of the Edinburgh postnatal depression scale: Background, methods and findings. Tenth Annual Conference of the Israeli Psychiatric Association, Jerusalem, Israel [Hebrew].
Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). New York: The Guilford Press.
Lee King, P. A. (2012). Replicability of structural models of the Edinburgh Postnatal Depression Scale (EPDS) in a community sample of postpartum African American women with low socioeconomic status. Archives of Womens Mental Health, 15, 77–86.
Matthey, S. (2008). Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders. Depression and Anxiety, 25, 926–931.
Matthey, S., Fisher, J., & Rowe, H. (2013). Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders: Conceptual and methodological considerations. Journal of Affective Disorders, 146, 224–230.
Montazeri, A., Torkan, B., & Omidvari, S. (2007). The Edinburgh Postnatal Depression Scale (EPDS): Translation and validation study of the Iranian version. BMC Psychiatry, 7, 11.
Phillips, J., Charles, M., Sharpe, L., & Matthey, S. (2009). Validation of the subscales of the Edinburgh Postnatal Depression Scale in a sample of women with unsettled infants. Journal of Affective Disorders, 118, 101–112.
Pop, V. J., Komproe, I. H., & Van Son, M. J. (1992). Characteristics of the Edinburgh Post Natal Depression Scale in the Netherlands. Journal of Affective Disorders, 26, 105–110.
Reck, C., Müller, M., Tietz, A., & Möhler, E. (2013). Infant distress to novelty is associated with maternal anxiety disorder and especially with maternal avoidance behavior. Journal of Anxiety Disorders, 27, 404–412.
Reichenheim, M. E., Moraes, C. L., Oliveira, A. S. D., & Lobato, G. (2011). Revisiting the dimensional structure of the Edinburgh Postnatal Depression Scale (EPDS): Empirical evidence for a general factor. BMC Medical Research Methodology, 11, 93.
Ross, L. E., Gilbert Evans, S. E., Sellers, E. M., & Romach, M. K. (2003). Measurement issues in postpartum depression part 1: Anxiety as a feature of postpartum depression. Archives of Womens Mental Health, 6, 51–57.
Rowe, H. J., Fisher, J. R. W., & Loh, W. M. (2008). The Edinburgh Postnatal Depression Scale detects but does not distinguish anxiety disorders from depression in mothers of infants. Archives of Womens Mental Health, 11, 103–108.
Sijtsma, K. (2009). On the use, the misuse, and the very limited usefulness of Cronbach’s alpha. Psychometrika, 74, 107–120.
Small, R., Lumley, J., Yelland, J., & Brown, S. (2007). The performance of the Edinburgh Postnatal Depression Scale in English speaking and non-English speaking populations in Australia. Social Psychiatry Psychiatric Epidemiology, 42, 70–78.
Swalm, D., Brooks, J., Doherty, D., Nathan, E., & Jacques, A. (2010). Using the Edinburgh Postnatal Depression Scale to screen for perinatal anxiety. Archives of Womens Mental Health, 13, 515–522.
Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). New York, NY: Pearson.
Tuohy, A., & McVey, C. (2008). Subscales measuring symptoms of non-specific depression, anhedonia, and anxiety in the Edinburgh Postnatal Depression Scale. British Journal of Clinical Psychology, 47, 153–169.
Woolhouse, H., Brown, S., Krastev, A., Perlen, S., & Gunn, J. (2009). Seeking help for anxiety and depression after childbirth: Results of the Maternal Health Study. Archives of Womens Mental Health, 12, 75–83.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Bina, R., Harrington, D. The Edinburgh Postnatal Depression Scale: Screening Tool for Postpartum Anxiety as Well? Findings from a Confirmatory Factor Analysis of the Hebrew Version. Matern Child Health J 20, 904–914 (2016). https://doi.org/10.1007/s10995-015-1879-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-015-1879-7