Skip to main content

Advertisement

SpringerLink
Log in

Replicability of structural models of the Edinburgh Postnatal Depression Scale (EPDS) in a community sample of postpartum African American women with low socioeconomic status

  • Original Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Abstract

The Edinburgh Postnatal Depression Scale (EPDS) is increasingly used in public health and social service programs serving postpartum women of racially, ethnically, and socioeconomically diverse backgrounds at risk for depression. However, we know little about its factor structure across groups of women with implications for measuring symptom levels in research. This study evaluated the underlying structure of the EPDS using a confirmatory factor analyses model comparison approach of five factor models from the literature in a purposive community sample of 169 postpartum African American women of low socioeconomic status. Participants were identified through an exhaustive review of local health department program files dated August 2006 to August 2010 in a Midwestern state of USA. Tuohy and McVey’s (Br J Clin Psychol 47:153–169, 2008) three-factor model (depression, anxiety, and anhedonia) demonstrated the best fit to the data with a nonsignificant Satora–Bentler scaled chi-square value (21.70, df = 24, p = 0.60) and the lowest root mean square error of approximation (0.00) and standardized root mean square residual (0.05) values. The results call for further study of the factor structure of the EPDS in other racial and ethnic groups and cautious use of the EPDS among perinatal women of racially, ethnically, and socioeconomically diverse backgrounds until its factorial invariance is better understood.

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.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. The EPDS major depression values are across four studies.

References

  • Adouard F, Glangeaud-Freudenthal NM, Golse B (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 

  • Astbury J, Brown S, Lumley J, Small R (1994) Birth events, birth experiences and social differences in postnatal depression. Aust J Public Health 18:176–84

    Article  PubMed  CAS  Google Scholar 

  • Bedford A, Foulds GA (1978) Delusions-symptoms-states-inventory: state of anxiety and depression (manual). NFER, Berkshire

    Google Scholar 

  • Bentler PM (1995) EQS structural equations program manual. Encino: Multivariate Software. Inc.

  • Berle JØ, Aarre TF, Mykletun 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 76:151–6

    Article  PubMed  CAS  Google Scholar 

  • Boyd RC, Le HN, Somberg R (2005) Review of screening instruments for postpartum depression. Arch Wom Ment Health 8:141–53

    Article  CAS  Google Scholar 

  • Brouwers EPM, van Baar AL, Pop VJM (2001) Does the Edinburgh Postnatal Depression Scale measure anxiety? J Psychosom Res 51:659–63

    Article  PubMed  CAS  Google Scholar 

  • Brown TA (2006) Confirmatory factor analysis for applied research. Guilford, New York

    Google Scholar 

  • U.S. Census Bureau (2000) Census of Population and Housing, Summary File 3, Table 3.

  • Chabrol H, Teissedre F (2004) Relation between Edinburgh Postnatal Depression Scale scores at 2–3 days and 4–6 weeks postpartum. J Reprod Infant Psychol 22:33–9

    Article  Google Scholar 

  • Chaudron LH, Szilagyi PG, Tang W, Anson E, Talbot NL, Wadkins HIM, Tu X, Wisner KL (2010) Accuracy of depression screening tools for identifying postpartum depression among urban mothers. Pediatr 125:e609–17

    Article  Google Scholar 

  • Cheng C, Fowles ER, Walker LO (2006) Continuing education module: postpartum maternal health care in the United States: a critical review. J Perinat Educ 15:34–42

    Article  PubMed  CAS  Google Scholar 

  • Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatr 150:782–6

    Article  CAS  Google Scholar 

  • Dennis C (2004) Can we identify mothers at risk for postpartum depression in the immediate postpartum period using the Edinburgh Postnatal Depression Scale? J Affect Disord 78:163

    Article  PubMed  Google Scholar 

  • Forero CG, Maydeu-Olivares A, Gallardo-Pujol D (2009) Factor analysis with ordinal indicators: a Monte Carlo study comparing DWLS and ULS estimation. Struct Equ Modeling 16:625–41

    Article  Google Scholar 

  • Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, Brody S, Miller WC (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ).

  • Goodchild CE, Platts RG, Treharne GJ, Booth DA Excessive negative affect and deficient positive affect in anxiety and depression: balancing the valences in the hospital anxiety and depression scale (HADS). Health Psychol Update 14:45-50.

  • 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. Eur Psychiatr 13:83–9

    Article  CAS  Google Scholar 

  • Jomeen J, Martin CR (2005) Confirmation of an occluded anxiety component within the Edinburgh Postnatal Depression Scale (EPDS) during early pregnancy. J Reprod Infant Psychol 23:143–54

    Article  Google Scholar 

  • Jomeen J, Martin CR (2007) Replicability and stability of the multidimensional model of the Edinburgh Postnatal Depression Scale in late pregnancy. J Psychiatr Ment Health Nurs 14:319–24

    Article  PubMed  CAS  Google Scholar 

  • Jöreskog KG, Sörbom D (1996) LISREL user’s reference guide. Scientific Software International, Chicago

    Google Scholar 

  • Kaminsky LM, Carlo J, Muench MV, Nath C, Harrigan JT, Canterino J (2008) Screening for postpartum depression with the Edinburgh Postnatal Depression Scale in an indigent population: does a directed interview improve detection rates compared with the standard self-completed questionnaire? J Matern Fetal Neonatal Med 21:321–5

    Article  PubMed  Google Scholar 

  • Logsdon MC, Hutti MH (2006) Readability: an important issue impacting healthcare for women with postpartum depression. MCN Am J Matern Child Nurs 31:350–5

    Article  PubMed  Google Scholar 

  • Matthey S (2008) Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders. Depress Anxiety 25:926–31

    Article  PubMed  Google Scholar 

  • Mîndrilă D (2010) Maximum likelihood (ML) and diagonally weighted least squares (DWLS) estimation procedures: a comparison of estimation bias with ordinal and multivariate non-normal data. Int J Digital Soc 1:93–102

    Google Scholar 

  • Mineka S, Watson D, Clark LA (1998) Comorbidity of anxiety and unipolar mood disorders. Annu Rev Psychol 49:377

    Article  PubMed  CAS  Google Scholar 

  • Montazeri A, Torkan B, Omidvari S (2007) The Edinburgh Postnatal Depression scale (EPDS): translation and validation study of the Iranian version. BMC Psychiatry 7.

  • Mook J, Kleijn WC, van der Ploeg HM (1991) Symptom-positively and -negatively worded items in two popular self-report inventories of anxiety and depression. Psychol Rep 69:551–60

    PubMed  CAS  Google Scholar 

  • Nye CD, Drasgow F (2011) Assessing goodness of fit: simple rules of thumb simply do not work. Organ Res Methods 14:548–70

    Article  Google Scholar 

  • 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. J Affect Disord 118:101–12

    Article  PubMed  Google Scholar 

  • Pitt B (1968) ‘Atypical’ depression following childbirth. Br J Psychiatr 114:1325–35

    Article  CAS  Google Scholar 

  • Pop VJ, Komproe IH, Van Son MJ (1992) Characteristics of the Edinburgh Post Natal Depression Scale in the Netherlands. J Affect Disord 26:105–10

    Article  PubMed  CAS  Google Scholar 

  • Ross LE, Gilbert Evans SE, Sellers EM, Romach MK (2003) Measurement issues in postpartum depression part 1: anxiety as a feature of postpartum depression. Arch Wom Ment Health 6:51–7

    Article  CAS  Google Scholar 

  • Satorra A, Bentler PM (1994) Corrections to test statistics and standard errors in covariance structure analysis. In: von Eye A, Clogg CC, von Eye A, Clogg CC (eds) Latent variables analysis: Applications for developmental research. Sage, Thousand Oaks, pp 399–419

    Google Scholar 

  • Satorra A, Bentler PM (2001) A scaled difference chi-square test statistic for moment structure analysis. Psychometrika 66:507–14

    Article  Google Scholar 

  • 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. Soc Psychiatr Psychiatr Epidemiol 42:70–8

    Article  Google Scholar 

  • Snaith RP, Constantopoulos AA, Jardine MY, McGuffin P (1978) A clinical scale for the self-assessment of irritability. Br J Psychiatr 132:164–71

    Article  CAS  Google Scholar 

  • Steiger JH, Lind JM (1980) Statistically based tests for the number of common factors. Paper presented at the Annual Meeting of the Psychometric Society. Iowa City

  • Tabachnick BG, Fidell LS (2001) Using multivariate statistics. Allyn & Bacon, Boston

    Google Scholar 

  • Tuohy A, McVey C (2008) Subscales measuring symptoms of non-specific depression, anhedonia, and anxiety in the Edinburgh Postnatal Depression Scale. Br J Clin Psychol 47:153–69

    Article  PubMed  Google Scholar 

  • U.S. Department of Health & Human Services (2011) The 2011 HHS poverty guidelines. Fed Regist 76:3637–8

    Google Scholar 

  • Watson D (2005) Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V. J Abnorm Psychol 114:522–36

    Article  PubMed  Google Scholar 

  • Wisconsin Department of Health and Family Services (2006) Evaluation of Wisconsin’s Medicaid Prenatal Care Coordination Benefit.

  • Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–70

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The author wishes to thank the City of Milwaukee, City of West Allis, City of Racine, and Ozaukee County health departments and the women they serve for their partnership in this research. Thanks also to Dr. Michael Brondino, for his mentorship in all phases of this study, as well as Dr. Laura Otto-Salaj and Dr. Susan Rose for their insightful review of this manuscript. This work was funded in part by the University of Wisconsin-Milwaukee Graduate School Dissertation Fellowship.

Conflict of interest

The author declares no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Social Work, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, PO Box 786, Milwaukee, WI, 53201, USA

    Patricia A. Lee King

Authors
  1. Patricia A. Lee King
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patricia A. Lee King.

Appendix

Appendix

Items of the EPDS (Cox et al. 1987)

  1. 1.

    I have been able to laugh and see the funny side of things

  2. 2.

    I have looked forward with enjoyment to things

  3. 3.

    I have blamed myself unnecessarily when things went wrong

  4. 4.

    I have been anxious or worried for no good reason

  5. 5.

    I have felt scared or panicky for no very good reason

  6. 6.

    Things have been getting on top of me

  7. 7.

    I have been so unhappy that I have had difficulty sleeping

  8. 8.

    I have felt sad or miserable

  9. 9.

    I have been so unhappy that I have been crying

  10. 10.

    The thought of harming myself has occurred to me

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee King, P.A. Replicability of structural models of the Edinburgh Postnatal Depression Scale (EPDS) in a community sample of postpartum African American women with low socioeconomic status. Arch Womens Ment Health 15, 77–86 (2012). https://doi.org/10.1007/s00737-012-0260-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-012-0260-8

Keywords

Search

Navigation