Validation of the culturally adapted Edinburgh postpartum depression scale among east Asian, southeast Asian and south Asian populations: A scoping review

Abstract

The Edinburgh Postnatal Depression Scale (EPDS) is a widely used self-report instrument to screen for postpartum depression (PPD). Assessing the relevance of the EPDS as a screening tool for minority ethnic populations is pertinent for ensuring culturally appropriate care. This scoping review aimed to explore what is known about the cultural adaptations of the EPDS in antepartum and postpartum mothers and fathers in East Asian, Southeast Asian and South Asian populations, and to what extent these adaptations are able to accurately screen for postpartum depression symptoms among these cultural groups. The scoping review was guided by the PRISMA-ScR checklist. The search strategy included databases of MEDLINE, PsycINFO, EMBASE, CINAHL and Grey literature. Included studies were primary articles published in English language peer-reviewed journals that investigated the validation or cultural adaptation of the EPDS in mothers who were pregnant and/or had recently given birth, or fathers who were new parents, and were limited to the following cultural groups, whether living locally or abroad in a foreign country: East Asian, Southeast Asian or South Asian populations. Thirty-six of 2469 studies met criteria for inclusion. Twenty-one of 36 studies utilizing a culturally validated EPDS demonstrated a cut-off score lower than the original recommended cut-off. Important themes identified included the Role of Culture, Somatization of PPD, Method of Interview, and contrasting performance compared to other scales used to assess depression and/or anxiety. Accessibility to translated and validated EPDS and mindfulness of ethnically relevant EPDS cut-off scores are critical when using this tool among minority ethnic populations.

Keywords: East Asia; South Asia; Southeast Asia; depression; immigrant; postpartum; questionnaire; validation study.