Validation of the Edinburgh Postpartum Depression Scale in a population of puerperal women in Mexico

Abstract

Background: The Edinburgh postnatal depression scale (EPDS) has been validated and used successfully in detecting postnatal depression in several language versions in a number of countries. However, there is not any Mexican version of the EPDS that had been validated. Therefore, we sought to validate a Spanish translated Mexican version of the EPDS in a population of puerperal Mexican women.

Methods: One hundred puerperal women within their three month postpartum period attending routine postnatal consultations in a public hospital in Durango City, Mexico participated in the study. The participants were divided into two groups: one group included 49 women with less than 4 weeks of postpartum, and the other group included 51 women within 4 to 13 weeks of postpartum. All participants submitted a Spanish translated Mexican version of the EPDS and were interviewed by a psychiatrist to assess major and minor depression by using DSM-IV criteria.

Results: Out of the 49 women with less than 4 weeks of postpartum, 4 were found as suffering from major depression and none from minor depression by using the DSM-IV criteria. In this group of women we found that the best EPDS score for screening depression was 11/12. This threshold showed a sensitivity of 75% (95% CI: 63.8-86.2), a specificity of 93% (95% CI: 84.6-100), a positive predictive value of 50%, a negative predictive value of 97.6%, and an area under the curve of 0.84. While in the 51 women within 4 to 13 weeks of postpartum, 7 were found as suffering from major depression and 1 from minor depression by using the DSM-IV criteria. In this group we found that the best EPDS score for screening depression was 7/8. This threshold showed a sensitivity of 75% (95% CI: 66.1-83.9), a specificity of 84% (95% CI: 76.1-91.9), a positive predictive value of 46.2%, a negative predictive value of 94.7% and an area under the curve of 0.80.

Conclusion: The Mexican version of the EPDS can be considered for screening depression in puerperal Mexican women whenever cut-off scores of 11/12 and 7/8 in women with less than 4 weeks and within 4 to 13 weeks of postpartum are used, respectively.

Figure 1

A receiver operating characteristic curve that shows different cut-off points of the EPDS in women with less than 4 weeks of postpartum. Good performance of the Mexican version of the EPDS in these women was found at 11/12 cut-off point.

Figure 2

A receiver operating characteristic curve that shows different cut-off points of the EPDS in women within 4 to 13 weeks of postpartum. Good performance of the Mexican version of the EPDS in these women was found at 7/8 cut-off point.