Screening for postpartum depression with the Edinburgh Postnatal Depression Scale (EPDS): an ethical analysis

AIMS: To assess the Edinburgh Postnatal Depression Scale (EPDS), a self-administered questionnaire created to screen for symptoms of postpartum depression in the community, from an epidemiological and ethical perspective. Screening, as the practice of investigating apparently healthy individuals to detect unrecognised disease or its precursors, has interpretation problems and is complicated by deliberations on probabilities for something to occur, on which the scientific community is unanimous. METHODS: Our ethical analysis is made using a framework with two different dimensions, the ethical principles autonomy and beneficence and the affected persons. To balance the ethical costs and the ethical benefits of EPDS an analogy with the assessment of pharmaceutics is used. RESULTS: In this article we argue that routine EPDS screening of Swedish postpartum women would lead to considerable ethical problems due to the weak scientific foundation of the screening instrument. Despite a multitude of published studies, the side-effects in terms of misclassifications have not been considered carefully. The EPDS does not function very well as a routine screening instrument. The dualism created is too reductive and fails to recognize the plurality of difference that exists in the social word. CONCLUSIONS: Public health authorities should not advocate screening of unproved value. Screening is not just a medical issue but also an ethical one.     

The Edinburgh Postnatal Depression Scale: translation and validation for a Greek sample

Background  

Edinburgh Postnatal Depression Scale (EPDS) is an important screening instrument that is used routinely with mothers during the postpartum period for early identification of postnatal depression. The purpose of this study was to validate the Greek version of EPDS along with sensitivity, specificity and predictive values.     

Methodological aspects of the 1993 Pelotas (Brazil) Birth Cohort Study

This paper describes the main methodological aspects of a cohort study, with emphasis on its recent phases, which may be relevant to investigators planning to carry out similar studies. In 1993, a population based study was launched in Pelotas, Southern Brazil. All 5,249 newborns delivered in the city's hospitals were enrolled, and sub-samples were visited at the ages of one, three and six months and of one and four years. In 2004-5 it was possible to trace 87.5% of the cohort at the age of 10-12 years. Sub-studies are addressing issues related to oral health, psychological development and mental health, body composition, and ethnography. Birth cohort studies are essential for investigating the early determinants of adult disease and nutritional status, yet few such studies are available from low and middle-income countries where these determinants may differ from those documented in more developed settings.     

产妇久坐行为对产后一年体重滞留影响的研究

  目的  了解山西省东南部地区产妇体重滞留现状及其影响因素,为制定合理的体重改善策略和措施提供依据。  方法  于2015年7月 — 2017年6月,采用前瞻性队列研究方法,纳入待分娩孕妇635人,于产后6个月进行追踪调查,观察指标包括一般情况、孕前体重、孕期增重和产后6个月体重。  结果  635名纳入研究的孕妇中,产后6个月随访到的有效人数为495人,应答率为77.95 %。研究对象产前平均体质指数（BMI）为（20.27 ± 2.28）kg/cm²,分娩后6个月平均BMI为（23.12 ± 2.74）kg/cm²,平均体重滞留为（2.68 ± 2.48）kg。超重和肥胖妇女比率由产前的16.36 %到产后6个月的24.65 %。295名（59.6 %）研究对象超过了美国医学研究会（IOM）2009年推荐的孕期增重标准至少1 kg,104名（21.01 %）研究对象超过标准5 kg。经多元线性回归分析,影响本地区产妇产后6个月体重滞留的影响因素为孕期增重、产后抑郁症患病情况和孕前BMI。  结论  怀孕期间以及产后6个月内需要进行体重管理以及心理卫生干预,以减少肥胖和肥胖相关疾病的发生率。     

Can mothers rely on the Brazilian health system for their deliveries? An assessment of use of the public system and out-of-pocket expenditure in the 2004 Pelotas Birth Cohort Study,Brazil

Background  

In a country where comprehensive free health care is provided via a public health system (SUS), an unexpected high frequency of catastrophic out-of-pocket expenditure has been described. We studied how deliveries were financed among mothers of a birth cohort and whether they were an important source of household out-of-pocket expenditure.     

Physical activity from adolescence to young adulthood and bone mineral density in young adults from the 1982 Pelotas (Brazil) Birth Cohort

ObjectiveTo evaluate a prospective association between physical activity (PA) and bone mineral density (BMD) in young adults.MethodTotal body (TB), lumbar spine (LS) and femoral neck (FN) BMD were measured in participants from the 1982 Pelotas Birth Cohort by dual-energy X-ray absorptiometry at 30 y. PA was evaluated at 15, 18 (males) and 23 y.Results3454 young adults were scanned (DXA) at least at one anatomical site. In males, PA at 15 y was associated with LS density (β = 0.061 g/cm²; 95% confidence interval (CI): 0.015; 0.108). A positive dose–response effect was found for the association between PA at 18 y and BMD. Males in the two highest quartiles of PA at 23 y had significantly greater BMD at all anatomical sites than males in the lowest quartile. We observed greater BMD at 30 y in boys who were active at least in one of the assessments (18 or 23 y) compared to inactive boys at both ages. Females in the highest quartile of PA at 23 y showed greater FN density at 30 y (β = 0.020; 95%CI: 0.001; 0.039).ConclusionsA physically active pattern is important to BMD across the first three decades of life. Potential beneficial effects of PA were not entirely lost with advancing age in male young adults.     

Trends in socioeconomic inequalities in anthropometric status in a population undergoing the nutritional transition: data from 1982, 1993 and 2004 Pelotas Birth Cohort studies

ABSTRACT: BACKGROUND: Socioeconomic inequalities in child nutrition may change rapidly over time, particularly in populations undergoing the nutrition transition. Yet, the few available studies are repeated cross-sectional surveys. By studying three prospective birth cohorts in the same city over a period of more than two decades, we describe secular trends in overweight and stunting at different ages, according to socioeconomic position. METHODS: Population-based birth cohort studies were launched in the city of Pelotas (Brazil) in 1982, 1993 and 2004, with follow-up visits at twelve, 24 and 48 months. Children were weighed and measured at every visit. Z-scores of length/height-for-age and body mass index-for-age were calculated using the WHO Child Growth Standards. The slope and relative indices of inequality, based on family income quintiles, were estimated for each follow-up visit. RESULTS: Between the 1982 and 2004 cohorts, stunting among four-year-olds declined (from 10.9% to 3.6%), while overweight increased (from 7.6% to 12.3%). In every visit, stunting prevalence was inversely related to income. Both absolute and relative inequalities declined over time; among four-year-olds stunting dropped from 26.0% in the 1982 cohort to 6.7% in the 2004 cohort in the poorest group, while in the richest group stunting prevalence dropped from 2.7% in 1982 to 1.1% in the 2004 cohort study. The secular trend towards increased overweight was evident for four-year-olds, in almost all socioeconomic groups, but not among one and two-year-olds. Among four-year old children, overweight prevalence increased in all income quintiles, by 130% in the middle-income group, 64% in the poorest and 41% in the richest group. CONCLUSIONS: The decline in stunting is remarkable, but the increase in overweight among four-year olds - particularly among the poorest and the middle-income groups- requires concerted efforts to prevent the long term consequences of child overweight.     

Screening for depression during pregnancy using the Kurdish version of the Edinburgh Postnatal Depression Scale in Erbil city

Abstract

We aimed to determine any difference in the prevalence rate of depression during the three trimesters of pregnancy and its association with certain obstetric risk factors. In total, 1000 pregnant women attending primary health centers in the city of Erbil, Kurdistan, Iraq were assessed for depression using the Edinburgh Postnatal Depression Scale. Women in the first and second trimesters had a significantly higher probability of depression than those in the third trimester. Screening early in pregnancy and following pregnant women in each trimester may help to identify those who are susceptible to depression and enable appropriate intervention.     

Aboriginal and Torres Strait Islander women's experience when interacting with the Edinburgh Postnatal Depression Scale: a brief note

Background: The Edinburgh Postnatal Depression Scale (EPDS) is one of the most widely used screening instruments for maternal perinatal anxiety and depression. It has maintained its robust performance when translated into multiple languages, when used prenatally and when used with perinatal fathers; thus the tool is also known as the Edinburgh Depression Scale (EDS). However, there have been no published psychometric data on versions of the EPDS adapted for screening Australian Aboriginal and Torres Strait Islander women. We describe the development of ‘translations’ of the EPDS and report their basic psychometric properties. Method: During the Queensland arm of the beyondblue National Postnatal Depression Program (2001–2005), partnerships with Aboriginal and Torres Strait Islander women were forged. At TAIHS’ stand alone “Mums and Babies” unit 181 women of Aboriginal or Torres Strait Islander descent were recruited into the study through their antenatal and postnatal visits and 25 were recruited at Mt Isa. Participants completed either the translation or the standard version of the EPDS both antenatally and postnatally. Results: The ‘translations’ of the EPDS demonstrated a high level of reliability. The was a strong correlation between the ‘translations’ and the EPDS. The ‘translations’ and the standard EPDS both identified high rates of women at risk of depression although the ‘translations’ identified higher rates. Conclusion: We argue that the ‘translation’ may have been a more accurate predictor of perinatal women at risk for depression, but acknowledge that a lack of validity evidence weakens this conclusion.     

Responsiveness of the Short Warwick Edinburgh Mental Well-Being Scale (SWEMWBS): evaluation a clinical sample

Background

SWEMWBS is a popular measure of mental wellbeing, shown to be valid in clinical populations. Responsiveness to change has not yet been formally assessed.

Methods

Analysis of data from a clinical sample of 172 clients undergoing up to 4 sessions of cognitive hypnotherapy. Cohen’s D effect size (ES), Standardised response mean (SRM), probability of change statistic (P^) were used to evaluate whether SWEMWBS detected statistically important changes at the group level. Cohen’s D effect size (ES) and Standard error of measurement (SEM) and were used to evaluate whether SWEMWBS detected statistically important changes at the individual level.

Results

Mean (SD) SWEMWBS scores increased from baseline to therapy 4 from 19.28 (3.921) to 23.32 (4.873). At group level, using Cohen’s D effect size, improvement ranges from ES?=?0.20–1.41 and using SRM, ranged from 0.30–0.88, increasing with number of therapy sessions. (P^) ranged from 0.65–0.8. At individual level, use of Cohens D ES >?0.5 indicated statistically important improvement in 29.9–86.1% cf. 20.1–80.6% using a standard of 2.77 SEM (2.87 points). The lower threshold of 1 SEM (1.03 points) indicated statistically important improvement in 43.0–81.0%.

Conclusion

SWEMWBS is responsive to change at individual and group level. At individual level a change of between 1 and 3 points meets thresholds for statisticially important change, depending on standard used. Anchor based studies are necessary to confirm that such change represents minimally important change from the perspective of study participants.

     

爱丁堡产后抑郁量表在产前抑郁筛查中的应用研究

目的评价爱丁堡产后抑郁量表(EPDS)的独立题目和分量表(情感分量表、焦虑分量表和抑郁分量表)对产前抑郁的筛查能力,探索简化EPDS在产前抑郁的临床筛查中应用方法及价值。方法选择495例早、中期孕妇进行EPDS测评,计算EPDS独立题目和分量表得分,遂分为抑郁组和正常组,分析独立题目和分量表的筛查能力,绘制受试者工作特征曲线(ROC),通过不同题目和分量表的ROC曲线下面积(AUC)选择具有较高诊断价值的题目或分量表,综合考虑敏感度和特异度,提出合适的临界值及临床筛查流程。结果抑郁组和正常组的EPDS独立题目和各分量表评分差异有统计学意义(P0. 05),其中焦虑分量表和抑郁分量表AUC值分别为0. 92和0. 90,具有较好的孕期抑郁筛查能力。当焦虑和抑郁分量表临界分数分别为4和2时其敏感度、特异度达到较好平衡。结论 EPDS的焦虑分量表和抑郁分量表具有较强的产前抑郁筛查能力,能够替代完整EPDS进行产前抑郁筛查。     

Prenatal and Postnatal Tobacco Exposure and Behavioral Problems in 10-Year-Old Children: Results from the GINI-plus Prospective Birth Cohort Study

Background

Prenatal and postnatal tobacco exposure have been reported to be associated with behavioral problems. However, the magnitude of the association with tobacco exposure at specific periods of exposure is unclear.

Objective

We assessed the relative risk of behavioral problems in children who had been exposed to tobacco smoke in utero and postnatally.

Methods

We analyzed data from a prospective birth cohort study in two cities in Germany: the German Infant Nutrition Intervention. Our sample included 5,991 children born between 1995 and 1998 as well as their parents. We measured behavioral problems using the Strength and Difficulties Questionnaire (SDQ) at follow-up 10 years after birth. According to prespecified SDQ cutoff values, children were classified as “normal,” “borderline,” or “abnormal” according to the subscales “emotional symptoms,” “conduct problems,” “hyperactivity/inattention,” “peer-relationship problems,” and a total difficulties score. Smoke exposure and further covariates were assessed using parent questionnaires.

Results

Compared with children not exposed to tobacco smoke, children exposed both pre- and postnatally to tobacco smoke had twice the estimated risk [95% confidence interval (CI), 1.4–3.1] of being classified as abnormal according to the total difficulties score of the SDQ at 10 years of age. Children who were only prenatally exposed had a 90% higher relative risk (95% CI, 0.9–4.0), whereas children who were only postnatally exposed had a 30% higher relative risk (95% CI, 0.9–1.9). These results could not be explained by confounding by parental education, father’s employment, child’s time spent in front of computer or television screen, being a single father or mother, or mother’s age.

Conclusions

Prenatal exposure to tobacco smoke is associated with behavioral problems in school-age children. Although our findings do not preclude the influence of postnatal exposure, prenatal exposure seems to be more important.     

Validation of the Rasch-based Depression Screening in a large scale German general population sample

Background  

The study aimed at presenting normative data for both parallel forms of the "Rasch-based Depression Screening (DESC)", to examine its Rasch model conformity and convergent and divergent validity based on a representative sample of the German general population.