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Detecting postnatal common mental disorders in Addis Ababa, Ethiopia: validation of the Edinburgh Postnatal Depression Scale and Kessler Scales.
J Affect Disord. 2010 Apr; 122(1-2):102-8.JA

Abstract

BACKGROUND

The Edinburgh Postnatal Depression Scale (EPDS) has been used successfully across diverse cultural settings. However, a recent study found poor validity in detecting postnatal common mental disorders (CMD) in rural Ethiopia. Using similar methodology, the study was replicated in the capital, Addis Ababa.

METHODS

Semantic, content and criterion validity of EPDS, Kessler Scale-6 (K6) and Kessler Scale-10 (K10) were assessed in postnatal women attending vaccination clinics. Criterion validation was undertaken on 100 postnatal women, with local psychiatrist diagnosis of CMD using the Comprehensive Psychopathological Rating Scale (CPRS) as the criterion measure.

RESULTS

The areas under the Receiver Operating Characteristic (AUROC) curve for the EPDS, K6 and K10 were 0.85 (95%CI 0.77-0.92), 0.86 (95%CI 0.76-0.97) and 0.87 (95%CI 0.78-0.97), respectively. The EPDS generated sensitivity, specificity and misclassification rates of 78.9%, 75.3% and 24.0%, respectively at an optimal cut-off point of 6/7. The corresponding values for the K6 were 84.2%, 82.7% and 17.0% at a cut-off point of 4/5, and for K10 were 84.2%, 77.8% and 21.0% at a cut-off point of 6/7, respectively. The internal reliability Cronbach's alpha for the EPDS, K6 and K10 were 0.71, 0.86 and 0.90, respectively.

LIMITATIONS

Not all postnatal women bring their infants to vaccination clinics which may limit generalisability.

CONCLUSION

The EPDS, K6 and K10 all demonstrated acceptable clinical utility as screening scales for postnatal CMD in an urban setting in Ethiopia. The marked urban-rural difference in EPDS performance within Ethiopia highlights the difficulty of applying urban-validated instruments to rural settings in LAMIC.

Authors+Show Affiliations

Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia. tesmarkos@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Validation Study

Language

eng

PubMed ID

19615753

Citation

Tesfaye, Markos, et al. "Detecting Postnatal Common Mental Disorders in Addis Ababa, Ethiopia: Validation of the Edinburgh Postnatal Depression Scale and Kessler Scales." Journal of Affective Disorders, vol. 122, no. 1-2, 2010, pp. 102-8.
Tesfaye M, Hanlon C, Wondimagegn D, et al. Detecting postnatal common mental disorders in Addis Ababa, Ethiopia: validation of the Edinburgh Postnatal Depression Scale and Kessler Scales. J Affect Disord. 2010;122(1-2):102-8.
Tesfaye, M., Hanlon, C., Wondimagegn, D., & Alem, A. (2010). Detecting postnatal common mental disorders in Addis Ababa, Ethiopia: validation of the Edinburgh Postnatal Depression Scale and Kessler Scales. Journal of Affective Disorders, 122(1-2), 102-8. https://doi.org/10.1016/j.jad.2009.06.020
Tesfaye M, et al. Detecting Postnatal Common Mental Disorders in Addis Ababa, Ethiopia: Validation of the Edinburgh Postnatal Depression Scale and Kessler Scales. J Affect Disord. 2010;122(1-2):102-8. PubMed PMID: 19615753.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Detecting postnatal common mental disorders in Addis Ababa, Ethiopia: validation of the Edinburgh Postnatal Depression Scale and Kessler Scales. AU - Tesfaye,Markos, AU - Hanlon,Charlotte, AU - Wondimagegn,Dawit, AU - Alem,Atalay, Y1 - 2009/07/16/ PY - 2008/09/25/received PY - 2009/06/04/revised PY - 2009/06/15/accepted PY - 2009/7/21/entrez PY - 2009/7/21/pubmed PY - 2010/6/3/medline SP - 102 EP - 8 JF - Journal of affective disorders JO - J Affect Disord VL - 122 IS - 1-2 N2 - BACKGROUND: The Edinburgh Postnatal Depression Scale (EPDS) has been used successfully across diverse cultural settings. However, a recent study found poor validity in detecting postnatal common mental disorders (CMD) in rural Ethiopia. Using similar methodology, the study was replicated in the capital, Addis Ababa. METHODS: Semantic, content and criterion validity of EPDS, Kessler Scale-6 (K6) and Kessler Scale-10 (K10) were assessed in postnatal women attending vaccination clinics. Criterion validation was undertaken on 100 postnatal women, with local psychiatrist diagnosis of CMD using the Comprehensive Psychopathological Rating Scale (CPRS) as the criterion measure. RESULTS: The areas under the Receiver Operating Characteristic (AUROC) curve for the EPDS, K6 and K10 were 0.85 (95%CI 0.77-0.92), 0.86 (95%CI 0.76-0.97) and 0.87 (95%CI 0.78-0.97), respectively. The EPDS generated sensitivity, specificity and misclassification rates of 78.9%, 75.3% and 24.0%, respectively at an optimal cut-off point of 6/7. The corresponding values for the K6 were 84.2%, 82.7% and 17.0% at a cut-off point of 4/5, and for K10 were 84.2%, 77.8% and 21.0% at a cut-off point of 6/7, respectively. The internal reliability Cronbach's alpha for the EPDS, K6 and K10 were 0.71, 0.86 and 0.90, respectively. LIMITATIONS: Not all postnatal women bring their infants to vaccination clinics which may limit generalisability. CONCLUSION: The EPDS, K6 and K10 all demonstrated acceptable clinical utility as screening scales for postnatal CMD in an urban setting in Ethiopia. The marked urban-rural difference in EPDS performance within Ethiopia highlights the difficulty of applying urban-validated instruments to rural settings in LAMIC. SN - 1573-2517 UR - https://www.unboundmedicine.com/medline/citation/19615753/Detecting_postnatal_common_mental_disorders_in_Addis_Ababa_Ethiopia:_validation_of_the_Edinburgh_Postnatal_Depression_Scale_and_Kessler_Scales_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-0327(09)00281-X DB - PRIME DP - Unbound Medicine ER -