Psychometric Features of the Edinburgh Postnatal Depression Scale Among Malaysian Women: A Cross-Sectional Study

Adam Bied; Susan Njuguna; Nurul Husna Mohd Shukri; Zurina Zainudin

doi:10.7759/cureus.34822

Psychometric Features of the Edinburgh Postnatal Depression Scale Among Malaysian Women: A Cross-Sectional Study

Cureus. 2023 Feb 9;15(2):e34822. doi: 10.7759/cureus.34822. eCollection 2023 Feb.

Authors

Adam Bied¹, Susan Njuguna¹, Nurul Husna Mohd Shukri^{2

3}, Zurina Zainudin⁴

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, ABC Medical, Reading, USA.
² Laboratory of Youth and Community Well, Institute for Social Science Studies, Universiti Putra Malaysia, Serdang, MYS.
³ Faculty of Medicine and Health Sciences, Department of Nutrition, Universiti Putra Malaysia, Serdang, MYS.
⁴ Faculty of Medicine and Health Sciences, Department of Pediatrics, Universiti Putra Malaysia, Serdang, MYS.

Abstract

Background The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item questionnaire developed to identify women at risk for postpartum depression (PD). EPDS symptom patterns appear to vary by nation. The EPDS items and their correlation with affirmative EPDS screens have thus far been minimally studied among Malaysians. Using positive predictive value (PPV) and negative predictive value (NPV), this study aims to evaluate the EPDS-based psychometric features of individual answer items. Methodology A cross-section of postpartum women receiving care at two tertiary care facilities in Malaysia underwent screening assessments in the course of receiving treatment. EPDS was employed with an aggregate cutoff score (≥12). EPDS items were assessed as predictors of abnormal EPDS screens. Results A total of 219 participants were screened, among which 66 were positive on the EPDS. EPDS item responses were collected (item responses 0-3: PPV = 0.07-0.78 and NPV = 0.93-0.22). A negative response to any item strongly predicted a negative EPDS screen (item entry = 0 and NPV = 0.93). Affirmative responses on items 8, 9, and 10 were particularly strong predictors of abnormal EPDS scores, while negative responses to items 3, 5, and 7 were strong predictors of negative EPDS scores. A substantial NPV for any item (response 0 and NPV items 1-10 = 0.93) and a moderate PPV for any affirmative response (responses 1-3, PPV items 1-10 = 0.60) were observed. Conclusions This is one of the few studies to examine the EPDS item responses among Malaysian women. The results suggest that depression remains prevalent in this postpartum population. Our findings reveal a robust NPV for any negative response to the individual items of the scale, a moderate PPV for any affirmative response, and a particularly robust validity for specific EPDS items. Physical complaints, rather than feelings of sadness, figure prominently in this population, suggesting a tendency among Malaysian women toward somatization.

Keywords: consultation liaison psychiatry; edinburgh postnatal depression scale; postpartum depression; public psychiatry; screening program.