Use of the Edinburgh postnatal depression scale in a southern, rural population in the United States

Prog. .Veuro-Psychopha~acol.

d Bid

Pergamon

Psychic&

1995. Vol. 19. pp. 1219-1224

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USE OF THE EDINBURGH POSTNATAL DEPRESSION SCALE IN A SOUTHERN, RURAL POPULATION IN THE UNITED STATES FREDEL 1

(Caldwell

T. REIGHARDl

and MARILYN

L. EVANS2

College and Technical Institute, Hudson, NC, USA, 2 The University of North Carolina at Greensboro, Greensboro, NC, USA Community

(Final form, May

1995)

Abstract Reighard, Fredel T. and Marilyn L. Evans: Use of the Edinburgh Postnatal Depression Scale in a Southern, Rural Population in the United States. Prog. Neuro-Psychopharmacol. & Biol. Psychiat. 1995,19(7): 1219-1224. 1.

2.

3.

The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for the incidence of postpartum depression in women receiving their pre- and post-partal care at a southern, rural health department maternity clinic. One hundred eighty-one women completed the EPDS during their postpartum visit. Scores on the EPDS ranged from 0 to 27. Thirty-six of the 181 subjects (19.9%) had scores of 12 or more, the threshold identified by Cox, et al. (1987) as indicating women likely to be experiencing postpartum depression. Results support use of the EPDS as a screening tool for postpartum depression in this population.

Keywords:

Edinburgh

Postnatal

Depression

Abbreviations: certified nurse Depression Scale (EPDS).

midwife

Scale,

postpartum,

(CNM), Edinburgh

depression.

Postnatal

Introduction Estimates women

(Cooper stated

of the incidence

during

the first year

et al, 1988; that

a woman month

depression

frequently

et al,

1988;

than at any other

suffer Kumar

childbirth

and Pasnau,

is at greater

postpartum

unnecessarily

Gitlin

of nonpsychotic after

remains numerous

and Robson,

risk

from

Kaplan

in her life. and those

effects Philipps

1219

7% to 15%

1989).

undiagnosed

1984;

depression

range

for depression

time

adverse

postpartum

and Sadock during

in

(1989)

the first

Yet postpartum affected

(Flagler, and O'Hara,

often

1989;

Fleming

1991).

1220

F.T.Reighardand M.L.Evans

Prior

experience

postpartal

care

of a certified

to women

of the southeastern of postpartum assessment

the postpartum was

familiar

wished

United

depression

methods.

to test

The EPDS,

developed

to meet

criteria 1992).

important

measures

the percentage

of subjects

by the test.

percentage

of subjects

identified.

1989).

Positive

In addition,

administer Cox

et al.

(1987) reported predictive

a sensitivity

Carothers

value

by Cox et al,

hand,

is

refers

(Riegelman

easily

to the

who are correctly

is the proportion

of those with

a

and Hirsch,

understood,

and easy

of 86%, specificity

of 73% and Harris

et al,

of 93%, and positive

and Murray

completed

A split-half

of the EPDS

those

likely

to

be

between

(Cox et al, 1987).

the unbiased their

Sensitivity

that are correctly

the disease

of 64%, a specificity

of 67%.

not discriminate

states

value,

to

of 78%,

(1989) reported predictive

a validation

value

study

and

of 959, and a positive

reliability

of 0.88 was reported

(1987).

limitations

identifies does

1989;

predictive

a sensitivity

value

a sensitivity

predictive

Two

and Hirsch,

on the other

is short,

and determined

(Riegelman

the disease

of 95%, specificity

In 1990,

reported

The CNM

(EPDS) and

and positive

the disease

value

have

in

and score.

and positive

of 75%.

tests

who do not have

the scale

Scale

have been demonstrated.

predictive

by current

included

setting.

Specificity,

test who actually

question

(1987), was reviewed

who have

area

that the incidence

identified

Depression

specificity,

of validity,

in a rural

l'nervousness and depression". Postnatal

for screening

identified

positive

than was being

by Cox et al,

cited

(CNM) providing

department

led her to believe

in the clinic

Sensitivity,

midwife,

health

only one general

addresses

the Edinburgh

its use

Valanis,

States,

was higher

For example,

history with

nurse

at a county

should

mild,

Second,

but does not allow

from

according women

First,

while

postpartum

moderate,

tone of the EPDS gives

feelings,

be noted.

suffering

and severe to Affonso

permission

them to qualify

it

depression,

it

depressive

et al,

(IYYO),

to speak

about

or elaborate

on their

responses. To date, reported al,

while

in only

returned

above. purpose

the EPDS

in Great

(60%) of whom

who were

32

state

urban

six-weeks

City medical

that using

has been

one.

center.

told that

The EPDS of 12 or the

for postpartum

the term

Roy et

postpartum

(17.4%) had a score

(1993) study were

the EPDS was to screen

The researchers

use of the EPDS

a northeastern,

New York

in the Roy et al.

of administering

Britain,

to 308 women

at a large,

by 185 women

Subjects

depression.

used

one U.S. population:

(1993) mailed

and had delivered was

widely

"postpartum

depression scale

Edinburghpostnatal depression" while

may have

mail

only

decreased

administration

60% of American

containing

women

To assist

the CNM

depression

result

if women

incidence

of clinic

would

complete

patients

and what

clinic

the range

setting,

tool

by

be identified. for postpartum

the authors

in the clinic

suffering

of scores

that

probably

would

screening

the EPDS

possibly

concluded

scorers

depression

,s useful

rural

They

of the questionnaire

of high

postpartum

in identifying

determine

in return

a subsample

experiencing

in a southern,

depression,

the rate of return.

might

women,

1221

wished

setting,

to the

from postpartum

would

be.

Methods Subiects A convenience attended

sample

the county

subjects.

Using

health

Peavy's

size of 148 subjects identifying

of one hundred department

(undated)

postpartum

maternity

Surveys

was determined

the proportion

postpartum

eighty-one

clinic

served

and SamDlinq,

to be necessary

of the population

women

who

as

a minimum

sample

to be 80% sure of

likely

to be suffering

a

depression.

Assessment The EPDS

is a 10 item scale

item is followed depending

upon

receives

responses subjects

to each

the EPDS

to circle

severe

above

response

labeled

the letter

which

assessed.

were

a cover

a 0.

"a" though most

According

of 30. Each

0 to 3

severe

setting,

response

For ease

In

the 4 "d," and

closely

corresponded

to Cox et al.

12 may be experiencing

be further

score

from

The most

in the clinic

in the past week.

scores

possible

are scored

of the response.

of the 10 items were

asked

had felt

with

and should

a maximum which

of 3 and the least

and scoring

were

to how they patients

the severity

a score

administering

with

by four responses

postpartum

(1987)

depression

Procedures Subjects the EPDS visit.

given

to complete,

Completion letter

"maternal

feelings"

wish

to participate

were

asked

to complete

represented

and the explanation

in order

after

having

to avoid were

to return the EPDS.

explaining

the study

they came to the clinic

of the EPDS

the cover

depression

when

letter

bias

told

the cover

consent

for their

postpartum

to participate.

Both

at the top of the EPDS addressed

a baby

rather

than postpartum

in data collection.

that their letter

and a copy of

care would

and the EPDS.

Women

who did not

not be affected Few women

and

declined

1222

F.T. Keighard

and M.1,. E\~ans

Results A total from

of 181 completed

0 to 27. Thirty-six

(Table 1). The remaining study,

the usual

were maintained

clinic

questionnaires

were

obtained.

Scores

ranged

of the 181 subjects

(19.9%) scored

participants

from 0 to 11. During

procedures

and resulted

scored

for identifying

in five women

being

12 or above

postpartum referred

the

depression

for further

assessment.

Table Scores

EPDS

on EPDS

of 36 Women

1 Who Scored

12 or Above

Number

Score

12

8

13

4

14

8

15

4

16

1

17

4

18

1

19

1

20

0

21

0

22

2

23

2

24

0

25

0

26

0

27

1

of Subjects

Discussion Women

were

appointment of scores range

willing and were

from

scoring

urban

reported Subjects

(17.4%)

in the present

waiting

for their

five minutes.

study

is comparable

in the Roy et al. study

The range to the

(1993) of a

population.

The percentage

of participants

(19.9%)

on the EPDS

in the present

study

than the

reported

in the literature completed

the EPDS while

to do so in less than

0 to 24, found

12 or above

incidence

able

0 to 27 found

of scores,

northeastern,

to complete

by Roy et al. and higher

is higher

than the 7% to 15%

in general.

the EPDS during

the winter

months.

Depression

Edinburghpostnataldepr~ssion sc,ale associated

with

as well

the holidays,

severe

winter

that

higher

percentage.

kept

many

as the effects may have

housebound,

1223 of an unusually

contributed

to the

Conclusions Results

support

depression period

the use of the EPDS as a screening

in this population.

of time

to beginning

and scored

the postpartum

with

the opportunity

than

twelve.

should

postpartum

immediately. exam would

for further

Follow-up

be completed

The EPDS

assessment

prior

The availability provide

evaluation of women

to referral

tool

for postpartum

can be administered

with

of results

the health

of women

with

scores

for further

in a short

scores

greater

evaluation

References AFFONSO, D. A. LOVETT, S. PAUL, S. M. and SHEPTAK, S. (1990) A standardized interview that differentiates pregnancy and postpartum symptoms from perinatal depression. Birth, 17: 121-130. (1990) The validation Scale on a community

of the sample.

COOPER, P. J. CAMPBELL, E. A. DAY, A. KENNERLEY, H. and BOND, A. (1988) Non-psychotic psychiatric disorder after childbirth: A prospective study of prevalence, incidence, course and Br J Psychiat, 152: 799-806. nature. COX, J. L. HOLDEN, J. M. and SAGOVSKY, R. (1987) Detection of postnatal depression: Development of the lo-item Edinburgh Postnatal Depression Scale. Br J Psychiat, 150: 782-786. FLAGLER, S. (1989) Relationships between stated feelings measures of maternal adjustment. Journal of Obstetric, and Neonatal Nursing, 19: 411-416. Gynecologic,

and

FLEMING, A. S. FLETT, G. L. RUBLE, D. N. and SHAUL, D. L. (1988) Postpartum adjustment in first-time mothers: Relations between mood, maternal attitudes, and mother-infant Development Psychology, 2: 71-81. interactions. syndromes linked to GITLIN, M. and PASNAU, R. (1989) Psychiatric reproductive function in women: a review of current knowledge. Amer J of- Psychiat, 146: 1413-1422. HARRIS, B. HUCKLE, P. THOMAS, R. JOHNS, S. and FUNG, H. (1989) The use of rating scales to identify post-natal depression. Br J Psychiat, 154: 813-817. KAPLAN, H. I. and SADOCK, B. J. (1989) Comprehensive of psychiatry. Baltimore: Williams & Wilkins.

textbook

study of emotional KUMAR, R. and ROBSON, K. (1984) A prospective disorders in childbearing women. Br J Psychiat, 157: 288-290. PEAVY, J. V. (undated) Surveys Centers fior Disease Control,

and sampling. Atlanta, Bureau of Training.

GA:

greater

than

for

depression.

CAROTHERS, A. D. and MURRAY, L. Edinburgh Postnatal Depression Br J Psychiat, 157: 288-290.

prior

care provider

12

1224

F.'f. Keighardwn(IM.1,. Evans

PHILIPPS, L. and O'HARA, M. W. (1991) Prospective study of postpartum depression: 4 l/2-year follow-up of women and children. J of Abnor Psychology, 100: 151-155. RIEGELMAN, R. K. and HIRSCH, R. P. (1989) Studying a study and testing a test: How to read the medical literature. Boston: Little, Brown & Co. ROY, A. GANG, P. COLE, K. RUTSKY, M. REESE, L. and WEISBORD, J. (1993) Use of Edinburgh Postnatal Depression Scale in a North American population. Prog in Neuro-Psychopharmacol & Biol Psychiat, 17: 501-504. in nursing VALANIS, B. (1992) Epidemiology Norwalk, CT; Appleton & Lange.

Inquiries

and reprint

requests

should

and health

be addressed

to:

Fredel T. Reighard, MSN, RN Director, Nursing Education Options Program Caldwell Community College and Technical Institute 1000 Hickory Blvd. Hudson, NC 28638 U.S.A.

care.