Academic journal article Pre- and Peri-natal Psychology Journal

Self-Rating Assessment of Postnatal Depression: A Comparison of the Beck Depression Inventory and the Edinburgh Postnatal Depression Scale

Academic journal article Pre- and Peri-natal Psychology Journal

Self-Rating Assessment of Postnatal Depression: A Comparison of the Beck Depression Inventory and the Edinburgh Postnatal Depression Scale

Article excerpt

ABSTRACT: Two self-report rating scales of depression, the Beck Depression Inventory and the Edinburgh Postnatal Depression Scale, were administered simultaneously to a large sample of new mothers at two and six months postpartum. Scores computed as continuous variables yielded high correlation coefficients at both moments of measure. Classification of subjects on the basis of recommended cutoff points yielded identical frequencies and defined similar patterns of onset and recovery, but showed a high degree of discrepancy between the two scales in the identification of dysphoric individuals. A preliminary examination of this low concordance revealed distinct response patterns belonging to divergent subgroups, suggesting that the two instruments are differently attuned to the various aspects of postnatal depression presentation.

The recent resurgence of interest in mild to moderate postpartum depression has intensified the need to confront the methodological issues that plague the field of postnatal research. Assessment strategies for the screening of postpartum depression have been so diverse and inconsistent as to hamper the meaningful comparison of studies, hence compromising the development of a cumulative body of knowledge. The lack of consensus regarding the definition of postnatal disorders has translated into widely varying experimental designs, with the use of different measurement methods mirroring the absence of conceptual agreement. Main differences concern the type and number of instruments (clinician vs self-report scales, single vs multiple assessment strategies), selection of cutoff scores and definition of measurement period.

At the same time as the need for standardization is being felt, there is growing evidence that existing screening procedures are ill-suited to the perinatal period (Huffman et al., 1990). Symptomatic overlap between depression and normal features of pregnancy and postpartum adjustment has led researchers to modify existing scales or create new ones (Cox et al., 1987). In the absence of common guidelines however, increased specificity tends to be achieved at the expense of homogeneity. If a measure of standardization is to be attained, a more systematic scrutiny of various assessment methods' liabilities and assets in the perinatal context seems in order before any meaningful revision of current practices can take place.

In the light of the need for a unification of screening procedures, self-rating scales or questionnaires seem especially suited to the standardization of assessment strategies. Considering that they are relatively inexpensive, easy to use, and that their administration requires little time or previous training, they lend themselves to generalized use more readily than clinician ratings.

On the other hand, their obvious pitfalls in the postpartum context is that self-rating depression scales do not benefit from a clinician's judgment when weighing symptoms which may be normative in the perinatal period while being otherwise considered as hallmarks of depression (sleep and appetite disturbances, decreased energy, dissatisfaction with body image, loss of libido, etc.). If the use of clinician ratings is deemed too expensive to be realistically recommended as standard procedure, some fine tuning of existing self-rating scales must be completed before they can reasonably be relied upon.

The purpose of the present study is to compare the relative merits of two such instruments by applying them simultaneously to a large sample of new mothers. The juxtaposition of a widely used scale, the Beck Depression Inventory (BDI), considered as a standard in its class, with one that has been constructed specifically for the post-partum, the Edinburgh Postnatal Depression Scale (EPDS), is intended to yield detailed information on the possible inadequacies of the former while highlighting any benefits offered by the latter, with subsequent recommendations regarding their applicability in the context of perinatal research. …

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