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The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh Postnatal Depression Scale

Published online by Cambridge University Press:  21 November 2016

A. Di Florio ,
K. Putnam ,
M. Altemus ,
G. Apter ,
V. Bergink ,
J. Bilszta ,
R. Brock ,
A. Buist ,
K. M. Deligiannidis  and
E. Devouche
...Show all authors
A. Di Florio
Affiliation:
Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University School of Medicine, Cardiff, UK
K. Putnam
Affiliation:
Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
M. Altemus
Affiliation:
Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
G. Apter
Affiliation:
Erasme Hospital, Paris Diderot University, Paris, France
V. Bergink
Affiliation:
Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands Department of Economics and Business, National Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
J. Bilszta
Affiliation:
Women's Mental Health, University of Melbourne, Melbourne, VIC, Australia
R. Brock
Affiliation:
Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
A. Buist
Affiliation:
Women's Mental Health, University of Melbourne, Melbourne, VIC, Australia
K. M. Deligiannidis
Affiliation:
Departments of Psychiatry and Obstetrics and Gynecology, Hofstra Northwell School of Medicine, Glen Oaks, NY, USA
E. Devouche
Affiliation:
Erasme Hospital, Paris Descartes University, Paris, France
C. N. Epperson
Affiliation:
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
C. Guille
Affiliation:
Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
D. Kim
Affiliation:
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
P. Lichtenstein
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
P. K. E. Magnusson
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
P. Martinez
Affiliation:
Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Health and Human Services, Bethesda, MD, USA
T. Munk-Olsen
Affiliation:
Department of Economics and Business, National Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
J. Newport
Affiliation:
Department of Psychiatry, University of Miami, Miami, FL, USA
J. Payne
Affiliation:
Department of Psychiatry, The Johns Hopkins University, Baltimore, MD, USA
B. W. Penninx
Affiliation:
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
M. O'Hara
Affiliation:
Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
E. Robertson-Blackmore
Affiliation:
Department of Family Medicine, Halifax Health, Daytona Beach, FL, USA
S. J. Roza
Affiliation:
Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
K. M. Sharkey
Affiliation:
Department of Psychiatry, Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
S. Stuart
Affiliation:
Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
H. Tiemeier
Affiliation:
Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
A. Viktorin
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
P. J. Schmidt
Affiliation:
Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Health and Human Services, Bethesda, MD, USA
P. F. Sullivan
Affiliation:
Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Z. N. Stowe
Affiliation:
Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
K. L. Wisner
Affiliation:
Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
I. Jones
Affiliation:
Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University School of Medicine, Cardiff, UK
D. R. Rubinow
Affiliation:
Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
S. Meltzer-Brody*
Affiliation:
Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
*
*Address for correspondence: S. Meltzer-Brody, Department of Psychiatry, University of North Carolina at Chapel Hill, Campus Box #7160, Chapel Hill, NC 27599, USA. (Email: [email protected])
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Abstract

Background

Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.

Method

Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.

Results

Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) < 0.01]. The structure of EPDS responses significantly differed between Europe and the USA (∆*CFI > 0.01), but not between European countries (∆*CFI < 0.01).

Conclusions

Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.

Keywords

CultureEdinburgh Postnatal Depression Scale (EPDS)educationpostpartum depressionrace
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 5 , April 2017 , pp. 787 - 799
Copyright
Copyright © Cambridge University Press 2016 

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