Central European Journal of Medicine

, Volume 7, Issue 2, pp 216–223 | Cite as

Validation of a Romanian scale to detect antenatal depression

  • Anne B. WallisEmail author
  • Roberto Fernandez
  • Florin Oprescu
  • Răzvan Cherecheş
  • Alina Zlati
  • Claibourne I. Dungy
Research Article


The aim of this study was to develop and validate a linguistically and culturally appropriate version of the Edinburgh Postnatal Depression Scale (EPDS) for use with women attending antenatal care in Romania. We translated and tested a Romanian version of the EPDS (EPDS-R) in four hospitals in three Romanian cities: Cluj-Napoca, Satu Mare, and Sighetu-Marmatiei. The study population included third-trimester women attending antenatal clinics (n=418); 364 subjects were included in the analytic sample. We used the Center for Epidemiologic Studies Depression Scale (CES-D) as a “gold standard”. We assessed reliability, validity, and conducted sensitivity analysis to establish an EPDS-R cutpoint. We found that reliability was robust (α=0.89) and there was a significant linear relationship between EPDS-R and CES-D scores (r=0.77; p<0.001). We established an EPDS-R cutpoint of >12 to balance sensitivity and specificity. Principal component analysis revealed a two-factor solution. We detected antenatal depressive symptoms prevalence rates of 32% (CES-D) and 38% (EPDS-R). This is the first study to report exclusively on antenatal depression and the use of the EPDS in Central and Eastern Europe. The EPDS-R is easy to administer, reliable, and valid for screening depression among antenatal women in Romania.


Perinatal depression EPDS Pregnancy Psychometrics Validity Reliability Central Europe Eastern Europe 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. [1]
    Gavin, N.I., et al., Perinatal depression: A systematic review of prevalence and incidence. Obstet Gynecol, 2005. 106(5 Pt 1): p. 1071–1083PubMedCrossRefGoogle Scholar
  2. [2]
    Cox, J., et al., Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women. J Affect Disord, 1996. 39(3): p. 185–189PubMedCrossRefGoogle Scholar
  3. [3]
    Ritter, C., et al., Stress, psychosocial resources, and depressive symptomotology during pregnancy in low-income, inner-city women. Health Psychol, 2000. 19(6): p. 576–585PubMedCrossRefGoogle Scholar
  4. [4]
    Ross, L., et al., Measurement issues in postpartum depression, part 1: Anxiety as a feature of postpartum depression. Arch Womens Ment Health, 2003. 6(1): p. 51–57PubMedCrossRefGoogle Scholar
  5. [5]
    Boath, E., A. Pryce, and J. Cox, Postnatal depression: The impact on the family. J Reprod Infant Psychol, 1998. 16: p. 199–203CrossRefGoogle Scholar
  6. [6]
    Lovestone, S. and R. Kumar, Postnatal psychiatric illness: The impact on partners. Br J Psychiatry, 1993. 163: p. 210–216PubMedCrossRefGoogle Scholar
  7. [7]
    Murray, L. and P. Cooper, Postpartum depression and child development. Psychol Med, 1997. 27: p. 253–260PubMedCrossRefGoogle Scholar
  8. [8]
    Murray, D., et al., The socio-emotional development of 5-year-old children of postnatally depressed mothers. J Child Psychol Psychiatry, 1999. 40: p. 1259–1271PubMedCrossRefGoogle Scholar
  9. [9]
    Caplan, H., et al., Maternal depression and the emotional development of the child. Br J Psychiatry, 1989. 154: p. 818–822PubMedCrossRefGoogle Scholar
  10. [10]
    Field, T., Prenatal depression effects on early development: A review. Infant Behav Dev, 2011. 34(1): p. 1–14PubMedCrossRefGoogle Scholar
  11. [11]
    Alwan, S., et al., National Birth Defects Prevention Study: Use of selective serotonin reuptake inhibitors in pregnancy and the risk of birth defects. N Engl J Med, 2007. 356: p. 2684–2692PubMedCrossRefGoogle Scholar
  12. [12]
    Kulin, N., et al., Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA, 1998. 279: p. 609–610PubMedCrossRefGoogle Scholar
  13. [13]
    Nulman, I., et al., Neurodevelopment of children exposed in utero to antidepressent drugs. N Engl J Med, 1997. 336Google Scholar
  14. [14]
    Elluminate Live USA, Elluminate Live Academic Edition 7.0. 2006, Elluminate Live USA: Ft. Lauderdale, FLGoogle Scholar
  15. [15]
    National Institute of Statistics, Populatie. Anuarul Statistic al Romaniei. 2007, National Institute of Statistics: Bucharest, RomaniaGoogle Scholar
  16. [16]
    Cox, J.L., J.M. Holden, and R. Sagovsky, Edinburgh Postnatal Depression Inventory. 1987Google Scholar
  17. [17]
    Radloff, L.S., The CES-D scale: A self report depression scale for research in the general population. Appl Psychol Meas, 1977. 1: p. 385–401CrossRefGoogle Scholar
  18. [18]
    Radloff, L.S., The use of the Center for Epidemiologic Studies Depression Scale in adolescents and young adults. Journal of Youth and Adolescence, 1991. 20: p. 149–165CrossRefGoogle Scholar
  19. [19]
    Radloff, L.S. and L. Teri, Use of the Center for Epidemiologic Studies Depression Scale with older adults. Clin Gerontol, 1986. 5: p. 119–135CrossRefGoogle Scholar
  20. [20]
    Shafer, A., Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung. J Clin Psychol, 2006. 62(1): p. 123–146PubMedCrossRefGoogle Scholar
  21. [21]
    Robila, M., Effects of economic pressure on marital conflict in Romania. J Fam Psychol, 2005. 19(2): p. 246–251PubMedCrossRefGoogle Scholar
  22. [22]
    WebSurveyor Corporation, WebSurveyor. 2006, WebSurveyor Corporation: Herndon, VAGoogle Scholar
  23. [23]
    Wallis, A.B., et al., An international model for staffing maternal and child health research: the use of undergraduate students. Breastfeed Med, 2007. 2(3): p. 139–144PubMedCrossRefGoogle Scholar
  24. [24]
    IBM, IBM SPSS Statistics 19. 2010: Chicago, ILGoogle Scholar
  25. [25]
    StataCorp LE, Stata 10. 2007, StataCorp LP: College Station, TXGoogle Scholar
  26. [26]
    Streiner, D.L. and G.R. Norman, Health Measurement Scales: A Practical Guide to their Development and Use. Second ed. 1998, Oxford: Oxford University PressGoogle Scholar
  27. [27]
    Charter, R.A., Sample size requirements for precise estimates of reliability, generalizability, and validity coefficients. J Clin Exp Neuropsychol, 1999. 21(4): p. 559–566PubMedCrossRefGoogle Scholar
  28. [28]
    Cronbach, L.J., Coefficient alpha and the internal structure of tests. Psychometrika, 1951. 16(3): p. 297–334CrossRefGoogle Scholar
  29. [29]
    Cronbach, L.J., My current thoughts on coefficient alpha and successor procedures. Educ Psychol Meas, 2004. 64(3): p. 391–418CrossRefGoogle Scholar
  30. [30]
    Radloff, L.S. and B.Z. Locke, The Community Mental Health Assessment Survey and the CES-D Scale, in Community Surveys, M. Weissman, J. Myers, and C. Ross, Editors. 1986, Rutgers University Press: New Brunswick, NJGoogle Scholar
  31. [31]
    Juul, S., An Introduction to Stata for Health Researchers. 2006, College Station, TX: Stata PressGoogle Scholar
  32. [32]
    Streiner, D.L. and G.R. Norman, Health Measurement Scales: A Practical Guide to Their Development and Use. 4th edition ed. 2008, Oxford: Oxford University PressGoogle Scholar
  33. [33]
    Brouwers, E., A. van Baar, and V. Pop, Does the Edinburgh Postnatal Depression Scale measure anxiety? J Psychosom Res, 2001. 51(659–63)Google Scholar
  34. [34]
    Ross, L., et al., Measurement issues in postpartum depression, Part 1: Anxiety as a feature of postpartum depression. Archives of Women’s Mental Health, 2003. 6: p. 51–57PubMedCrossRefGoogle Scholar
  35. [35]
    Logsdon, M., W. Usui, and M. Nering, Validation of the Edinburgh postnatal depression scale for adolescent mothers. Arch Womens Ment Health, 2009. 12: p. 433–440PubMedCrossRefGoogle Scholar

Copyright information

© © Versita Warsaw and Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Anne B. Wallis
    • 1
    • 2
    Email author
  • Roberto Fernandez
    • 3
  • Florin Oprescu
    • 2
  • Răzvan Cherecheş
    • 2
    • 4
  • Alina Zlati
    • 2
  • Claibourne I. Dungy
    • 1
    • 5
    • 6
  1. 1.Department of Epidemiology, College of Public HealthUniversity of IowaIowa CityUSA
  2. 2.Open Minds: Center for Mental Health ResearchCluj-NapocaRomania
  3. 3.College of Osteopathic MedicineDes Moines UniversityDes MoinesUSA
  4. 4.Department of Occupational and Environmental Health, College of Public HealthUniversity of IowaIowa CityUSA
  5. 5.Department of Pediatrics, Children’s Hospital of IowaUniversity of IowaIowa CityUSA
  6. 6.College of LawUniversity of IowaIowa CityUSA

Personalised recommendations