South Western Sydney Area Health Service, Park House for Children & Families: Research Unit, 1st Floor, 13 Elizabeth Street, Liverpool NSW, Australia 2170
The Edinburgh Postnatal Depression Scale (EPDS; Cox et al, 1987) is one of the most widely used self-report instruments to screen for depression in the post-partum and antenatal periods. As with all instruments, it is important for validity that the wording of a measure remains faithful to that described in the original validation study. While checking our EPDS against the original, we noticed a difference in the wording of one of the items. We believe that the EPDS used elsewhere may also contain the same anomaly. Item 4 on the EPDS provided in the paper by Cox et al (1987) is phrased: I have been anxious or worried for no good reason. However, the version reproduced in Cox & Holden's book (1994), which is also likely to be the source from which many centres copy their EPDS, is different: I have felt worried and anxious for no very good reason (differences from the journal version italicised for clarity). In addition, the order of anxious and worried has been reversed. Personal communication with Professor Cox has confirmed that the wording in the journal paper is correct. That these mistakes have occurred in a book about the use and misuse of the scale is somewhat ironic. Indeed, this makes us a little anxious and worried!
What effect might these differences have on the self-reports of women or men? It is hard to know hopefully, none. It would not, however, be surprising if these alterations lead to differential responding and scores.
Over the many years of our involvement in this field, we have also noted usage where the EPDS preamble was omitted or altered, provenance (e.g. authors and date) was not acknowledged, and incorrect cut-off scores were inadvertently applied. We should all, therefore, be more rigorous in our use of this scale.
REFERENCES
Cox, J. L., Holden, J. M. & Sagovsky, R. (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786.[Abstract]
Cox, J. L., & Holden, J. M. (eds) (1994) Perinatal Psychiatry: Use and Misuse of the Edinburgh Postnatal Depression Scale. London: Gaskell.
Keele University Medical School (Harplands Campus), Academic Psychiatry Unit, Hilton Road, Harplands, Stoke-on-Trent ST4 6TH, UK
Flat 4, 19B Gayfield Square, Edinburgh EHI 3NX, UK
J.C. and J.H. developed the EPDS and are authors of Cox & Holden (2003), sales of which may generate personal royalty payments.
We are indebted to our distinguished colleagues in Australia for pointing out this ambiguity. We will be indicating in our definitive EPDS book, soon to be published by Gaskell (Cox & Holden, 2003), that the scale from the first validation study as published in 1987 contains the correct and original wording.
The differences between being and feeling, anxious or worried and worried and anxious are not only semantic. Perhaps committed EPDS advocates, like your correspondents, will test their hypothesis that these word changes may affect the total EPDS score. We doubt it, but a local grant-giving body might support an ambitious master's student.
The EPDS is not, of course, a precise measuring-rod of feelings, but its total score has been shown to provide a remarkably accurate indication of the likelihood of clinical depression in many cultures and countries.
Our new book, Perinatal Mental Health: A Guide to the Edinburgh Postnatal Depression Scale (EPDS), is our definitive and final attempt to ensure that the EPDS is used as frequently as appropriate; and misused never!
REFERENCES
Cox, J. & Holden, J. (2003) Perinatal Mental Health: A Guide to the Edinburgh Postnatal Depression Scale (EPDS). London: Gaskell.
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