Validity and Reliability of Marathi Version of Edinburgh Postnatal Depression Scale As a Screening Tool for Post Natal Depression
Total Page：16
File Type：pdf, Size：1020Kb
ORIGINAL ARTICLE pISSN 0976 3325│eISSN 2229 6816 Open Access Article www.njcmindia.org Validity and Reliability of Marathi Version of Edinburgh Postnatal Depression Scale as a Screening Tool for Post Natal Depression Meenakshi Khapre1, Nikhil Dhande2, Abhay Mudey3 Financial Support: None declared ABSTRACT Conflict of Interest: None declared Copy Right: The Journal retains the copyrights of this article. However, re- Context: The prevalence of Post natal depression in India ranges production of this article in the part or from 12 – 23 %. It has substantial impact on mother, father, family total in any form is permissible with and thereby cognitive and emotional development of child. There- due acknowledgement of the source. fore the post natal depression screening should be given foremost importance. The Edinburgh Postnatal Depression Scale (EPDS) is a How to cite this article: reliable tool used in many countries. The study conducted to vali- Khapre M, Dhande N, Mudey A. Valid- date the Marathi version of EPDS ity and Reliability of Marathi Version of Edinburgh Postnatal Depression Method: All the mothers with history of delivery in last six Scale as a Screening Tool for Post Natal months but not less than six weeks were included in study. Lin- Depression. Ntl J Community Med guistically validated Questionnaire was posed by interviewer and 2017; 8(3):116-121. recorded. To test the reliability, mothers were revisited after a pe- riod of 2 weeks to administer same questionnaire and assessed by Author’s Affiliation: 1Assistant Professor, Dept of Commu- expert. nity and Family Medicine, AIIMS, Statistical analysis: SPSS 17 was used to know the floor and ceil- 2 Rishikesh; Assistant Professor, Dept of ing effect, exploratory factor analysis, receiver and operating Community Medicine; 3Professor, Dept curve, cronbach’s alpha, intraclass correlation coefficient. of Community Medicine, Jawaharlal Nehru Medical College, Wardha Result: Total mean score was 10.3 ± 4.1. No floor and ceiling effect seen. Three factors were extracted. Best cut off point was 12 with Correspondence: 95 % sensitivity and specificity. Depression was associated with Dr Meenakshi Khapre birth of female child, pregnancy complications and health of new- [email protected] born. Date of Submission: 02-11-16 Conclusion: The findings of study indicates that Marathi version Date of Acceptance: 11-03-17 of EPDS has good validity, internal consistency and adequate reli- Date of Publication: 31-03-17 ability Keywords: postnatal depression, EPDS, validity, reliability INTRODUCTION postpartum depression, whereas a third psychiat- ric disorder, namely, postpartum psychosis, which Depression is the most frequently occurring psy- is most widely responsible for cases involving ma- chiatric condition among women of childbearing ternal acts like infanticide, and lasts upto 4 yrs. The age, with more than 8% being affected at any given biological cause for depression is due to sudden time.1 Depression occurring amongst women spe- drop in a woman’s oestrogen and progesterone cifically in the postnatal period has been the focus level following childbirth and low hormone pro- of a great deal of research. According to ICD-10 duction by the thyroid gland thereby leading to classification, postnatal depression is mild mental chemical changes in brain. Most commonly studied and behavioural disorder associated with the psycho-social risk factors for development of Post puerpurium and onset is considered to be within 6 natal depression are younger age,2,3 gender of the weeks after delivery. The Postnatal depression can newborn child,4,5 health of new born ,6 antenatal take a mild clinical course or it can range to suicid- and post natal complications ,7 unwanted pregnan- al ideations (thoughts).In the postpartum period, cy 8 seems to be the strongly associated with de- there are two major depressive disorders associat- pression. While other risk factors like low socioec- ed with maternal health: postpartum blues and National Journal of Community Medicine│Volume 8│Issue 3│Mar 2017 Page 116 Open Access Journal │www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816 onomic status, maternal education, social support, In the same visit, psychiatrist, psychologist, or psy- parity , occupation have synergistic effect on post chiatry resident, trained for the administration of a natal depression. semi-structured interview, based on ICD-10 diag- nostic criteria,19 explored the presence of depressed In India, estimates of maternal depression among mood most of the days of the last two consecutive women accessing antenatal care range from 11.9%- weeks. Mothers were classified as 'normal' or ‘posi- 23%.9 Most cases develop within the first 3 postna- tive,’. tal months,10 with a peak incidence at around 4–6 weeks. It can last for minimum of 3 mnths to 4 yrs. Statistical analysis: SPSS 17 was used for below analysis. Postnatal depression has a substantial impact on the mother and her partner, 11 the family, mother– Floor and ceiling effects were defined by means of baby interactions and the longer-term emotional the percentage of the subjects who scored beyond and cognitive development of the baby, 12-14 espe- the lower or upper bound, respectively, of the total cially when depression occurs in the first postnatal possible score. Cut-offs for floor and ceiling effects year of life. Postnatal depression screening and were set at 5% of the total score. As a consequence, case identification strategies have been advocated scores below 3 points and scores above 28 points as a remedy to this problem, but less than 50% of on the EPDS scale were determined as a floor cases of Postnatal depression are identified by and/or ceiling effect, respectively. Significant floor primary healthcare professionals in routine clinical and ceiling effects were considered to be present if practice. The Edinburgh Postnatal Depression more than 20% of the patients fell outside the low- Scale was thereby developed to assist primary er or upper bound, respectively .20 health care professionals to screen whether moth- Mean, standard deviation, range was calculated for ers are suffering from postnatal depression. 15 The each items in scale. Sampling size adequacy was scale can be used at community level. The EPDS, tested by KMO and Barletts test. For classifying the only self administered scale consists of 10 items factors related to the items of the questionnaires, with acceptable sensitivity, specificity and positive explanatory factor analysis was used with Eigen predictive value. It has been very widely used and value greater than 1. The cutoff point showing found to be acceptable screening tool in different simultaneously the highest sensitivity and specific- cultures.16 As no translation is still available in Ma- ity was determined using a Receiver Operator rathi language commonly spoken in Maharashtra, Characteristic (ROC) curve considering gold we therefore took a task to translate the scale in standard (ICD-10). To test internal consistency Marathi and evaluate the validity and reliability of Cronbach’s alpha was calculated. Test –retest abil- scale in this part of India. ity of scale was assessed by Intra class correlation coefficient for consistency. METHOD Construct validity was assess from the hypothesis This was a cross sectional study done in Seloo “Depression in Post natal period is related to Block of Wardha district. All the mothers with his- Younger age, Female child, ANC/PNC Complica- tory of delivery in last six months but not less than tions and Poor health of newborn” six weeks willing to give consent were included in study. Those with previous history of any other severe mental disorders, family history of maternal RESULTS depression, suicidal tendencies or on antidepres- EPDS questionnaire (English version ) was trans- sants were excluded. lated in Marathi and then back translated to Eng- Information about deliveries in past six months lish till the best consensus between two question- was obtained from Anganwadi worker, ASHA naire was obtained. The questionnaire was admin- and/or ANM. Participants were approached by istered to All the Mothers with history of delivery home visit and Immunisation clinics. A informed in last six months but not less than six weeks. Fur- written consent, was obtained from all of the par- ther, were the test results to know the validity of ticipants. Translated and linguistically validated translated EPDS scale in the rural Maharashtra. Questionnaire was posed by trained interviewer in same order as original instrument. As large num- ber of participants had little schooling, questions Table 1: Floor and ceiling effect were posed verbally instead of self administered. The administration of EPDS as an interview is also Score Frequency (n=280)(%) been accepted method.17,18 These mothers were 5-10 173 (61.7 again revisited at home after a period of 2 weeks to 11-16 78 (27.85 17-23 29 (10.3 administer the same questionnaire to test the relia- bility of scale. National Journal of Community Medicine│Volume 8│Issue 3│Mar 2017 Page 117 Open Access Journal │www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816 Table 2: Exploratory Factor analysis of EPDS scale Questions Anhedonia Anxiety Depression 1-I have been able to laugh and see the funny side of things .710 - - 2-I have looked forward with enjoyment to things .606 - - 3-I have blamed myself unnecessarily when things went wrong - .590 - 4-I have been anxious or worried for no good reason - .639 - 5-I have felt scared or panicky for not very good reason - .843 - 6-Things have been getting on top of me - - .645 7-I have been so unhappy that I have had difficulty sleeping - - .602 8-I have felt sad or miserable - - .721 9-I have been so unhappy that I have been crying - - .684 10-The thought of harming myself has occurred to me - .4 Eigen 1.01 1.2 3.85 % variance 16.8 17.7 26 factor.