Applying new techniques to an old ally: a qualitative validation study of the Edinburgh Postnatal Depression Scale.

PURPOSE To present the results of a study that used cognitive interviewing techniques to interview pregnant and postpartum women about their experience of completing the Edinburgh Postnatal Depression Scale. BACKGROUND Most large-scale initiatives that screen women for depression during pregnancy and the first 3-6 months postpartum use the Edinburgh Postnatal Depression Scale. The scale is a 10-item instrument that is commonly self-administered and has been extensively validated using quantitative methods. However, the authors could find no published research that applied newer in-depth methods for assessing comprehension and interpretation to the scale. PARTICIPANTS AND METHODS The design was an in-depth, qualitative instrument validation study. A total of nine pregnant and postpartum women who were referred for psychiatric care completed the Edinburgh Postnatal Depression Scale and then were interviewed about their experiences. Cognitive interviewing techniques were used to generate an in-depth examination of how women understood and interpreted the items, and to explore meaning, acceptability, and disclosure issues. RESULTS Overall, participants felt that the instrument was straightforward, easy to read, and relatively simple to answer. It is important to note that eight of the nine participants had completed some post-secondary education and, thus, participant's average literacy level was relatively high. Women identified minor concerns or expressed interpretive differences on six of the ten Edinburgh Postnatal Depression Scale items. These six items are examined in detail. CONCLUSION The results suggest that it may be useful for the Edinburgh Postnatal Depression Scale to be administered in the context of a discussion about a woman's mental health concerns, which could involve asking her for more details about her responses to particular items that have been identified in this study as potentially problematic. This will help ensure that practitioners are accurately interpreting a woman's answers to the items on the scale.