Validating the Edinburgh Postnatal Depression Scale (EPDS) for use in less at risk Ugandan postpartum women

Abstract

Background Although the Edinburgh Postnatal Depression Scale (EPDS) has been recognized as a reliable screening scale for postpartum depression among mothers worldwide, no study has validated this scale in Uganda. The objective of this study was to establish the accuracy of the EPDS as a screening scale for postpartum depression (PPD) for use in less at risk Ugandan postpartum women in comparison with the Mini-International Neuropsychiatric Interview (MINI 7.0.2) for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Methods We conducted a descriptive, cross-sectional study at one regional referral hospital and two peri-urban primary care postpartum clinics that serve a rural community in the southwestern region of Uganda. The study targeted 287 mothers aged 18 to 49 years during their six weeks’ postpartum visit. During data collection, mothers were first screened using the EPDS in one of the private rooms and then clinically diagnosed in another private room using the MINI 7.0.2. With the EPDS, PPD was diagnosed if the mother had a cutoff point of ≥ 10. Runyankore-Rukiga was the language used in the Ugandan version of the EPDS and this data was obtained from 11th November 2019 to 10th June 2020. The accuracy of the EPDS was determined using the MINI 7.0.2 as a reference standard. Results A total of 287 mothers aged 18 to 49 years during their six weeks’ postpartum visit were included in the study. Overall PPD prevalence was 29.5% versus 26.5% with EPDS and the MINI 7.0.2 for the DSM-5 diagnostic criteria for depression respectively, p = 0.239. The sensitivity, specificity, positive predictive value and negative predictive value of the EPDS established by this study were 86.8%, 92.1%, 80.5% and 94.9% respectively. The cut-off point ≥10 was the most acceptable point in detecting mothers suffering from PPD. The area under the ROC curve that shows the overall performance of the scale against the MINI 7.0.2 was 0.89 for Bwizibwera HCIV, 0.97 for Kinoni HCIV and 0.84 for MRRH. Conclusion EPDS can successfully screen for postpartum depression in southwestern Uganda at a cutoff score of ≥10. It has a good diagnostic performance to correctly detect PPD among postpartum mothers.