Heilsa - Sjúkrakassagrunnurin
Identification of postnatal depressions in a small-scale society – A mixed method investigation of the Edinburgh Postnatal Depression Scale
Anna Sofía Fjallheim
Sjúkrarøktarfrøðiskúlin, Fróðskaparsetur Føroya
Kristianna Hammer, Hanne Kronborg, Poul Videbech, Malan Kastalag, Hannes Gislason
Stuðul úr Granskingargrunninum:
One out of eigth women giving birth suffers from postnatal depression. This makes postnatal depression one of the most frequent birth-related complications. If untreated, postnatal depression can have adverse consequences for the woman, her partner and the child's emotional, linguistic and cognitive development. Women with postnatal depression do not proactively seek help identification. Sreening has therefore been proposed as a method to optimize the identification of postnatal depression. Since 2012 women in the Faroe Islands have been screened with EPDS (the Edinburgh Postnatal Depression Scale) on a national basis. Previous studies have found the optimal cut-off score on EPDS to be affected by cultural diversities. However, no validation studies have examined the application of EPDS in small-scale societies such as the Faroe Islands. As small-scale societies are characterized by different properties than large scale societies, with lack of anonymity, social control and multiplex relational structure, this might affect the optimal cut-off score when screening with EPDS, the women’s acceptability towards the screening instrument, and the experience with going through a postnatal depression, compared with women from large scale societies.
The aim is therefore to examine the validity and capability of EPDS to identify PND in small-scale societies and to detect areas in EPDS that might require adjustments for application to a small-scale society.
The study will have a mixed method design. Firstly, a quantitative validation of EPDS in a year population of women giving birth, will be performed. The study vill include all women in the Faroe Islands who give birth to a living child, are over 18, and are able to complete the faroese version of EPDS. Women who score ≥ 7 on EPDS and a third of women scoring <6 on EPDS, randomly selected, will be diagnostically tested by a psychologist using SCID-I. The women will be screened 8 week post partum and within one week diagnostically tested. Data will be analyzed measuring sensitivity, specificity, positive predictive value, negative predictive value and best cut-off score. Statistical calculations will be performed to find possible seasonal variation and the prevalence of postnatal depression. Furthermore, a factor analysis will be performed to estimate if there are certain question in EPDS that in particular measure a postnatal depression in accordance with the clinical diagnostic test. Secondly, a qualitative study, containing two parts will be performed. The first part will examine the lived experience with postnatal depression in the context of a small-scale society. The study will use visual phenomenology, developed for analysing drawings in psychotherapy, in combination with hermeneutic phenomenology, developed for researching lived experiences of existential phenomena. The lived experiences will be compared to the psychometric properties of EPDS. The second part will examine the women’s acceptability towards EPDS as a screening instrument and will run in parallel with quantitative study. Data will be analysed using qualitative content analysis.
As this study will take into account methodological limitations in previous validation studies, such as shorter period of time and blinding between the diagnostic tests and the screening, the results are expected to add to current knowledge of EPDS as a screening instrument in general. The results are also expected to broaden the understanding of cultural importance to the application of EPDS in general and in small-scale societies such as the Faroe Islands in particular.