Abstract
Problem
Routine administration of the Edinburgh Postnatal Depression Scale (EPDS) is intended
to promote early detection and preventative support for those who may be at risk of
perinatal depression and anxiety. The cultural suitability of the EPDS has not been
validated in the Aboriginal Australian context.
Background
Marked differences in health outcomes and service access between Australian Aboriginal
and non-Aboriginal women and infants continue to exist.
Aim
This study aimed to explore the cultural validity of the EPDS through understanding
the experiences of Aboriginal women and midwives.
Methods
Qualitative data was drawn from semi-structured interviews/yarns with 13 Perth-based
Aboriginal antenatal women and 10 non-Aboriginal midwives.
Findings
Utilising a grounded theory approach, thematic analysis of verbatim transcripts revealed
that, surprisingly, women expressed generally favourable views of the EPDS, especially
when the relationships between women and midwives were focused on. Midwives, however,
expressed reservations about administering the EPDS and used the EPDS as a conversation-starter
rather than as a standardised, standalone tool.
Discussion
In attempt to reconcile conflicting perspectives, analysis of recordings extended
to evaluate micro-processes in the interviews. At the process level, it was clear
that demand characteristics operated in some interviews, including socially desirable
response biases, demand biases and acquiescent response styles.
Conclusion
This highlights the need for researchers and clinicians to be trained in non-leading
interview questioning techniques and in yarning methodology. Researchers and clinicians
should also be aware of the cognitive biases and demand characteristics that may influence
responding, likely perpetuated by dominant forces of a colonised society.
Keywords
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References
- The roles of DNA methylation of NR3C1 and 11β-HSD2 and exposure to maternal mood disorder in utero on newborn neurobehavior.Epigenetics. 2013; 8: 1321-1329https://doi.org/10.4161/epi.26634
- Prenatal maternal stress, fetal programming, and mechanisms underlying later psychopathology—a global perspective.Dev. Psychopathol. 2018; 30: 843https://doi.org/10.1017/S095457941800038X
- Prenatal maternal depressive symptoms predict early infant health concerns.Matern. Child Health J. 2018; 22: 786-793https://doi.org/10.1007/s10995-018-2448-7
- First-time parenthood: influences on pre- and postnatal adjustment in fathers and mothers.J. Psychosom. Obstet. Gynecol. 2000; 21: 109-120https://doi.org/10.3109/01674820009075616
- Trauma Trails, Recreating Song Lines: The Transgenerational Effects of Trauma in Indigenous Australia.Spinifex Press, North Melbourne2002
- Perinatal mortality and morbidity among low birth weight babies.Int. J. Community Med. Public Health. 2015; 2 (Available from): 51-58
- Australia’s health 2018. Australia’s health series no. 16. AUS 221.AIHW, Canberra2018
- Aboriginal and Torres Strait Islander Health Performance Framework 2017 Report: Western Australia. Report.Australian Government, 2017 (Report Catalogue No.: IHW 185. Available from)
- Perinatal Deaths in Australia 2013–2014. Report.Australian Government, 2018 (Report Catalogue No.: PER 94. Available from)
- Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality.Br. Med. Bull. 2003; 67: 219-229https://doi.org/10.1093/bmb/ldg011
- Suicide: the leading cause of maternal death.Br. J. Psychiatry. 2003; 183: 279-281https://doi.org/10.1192/bjp.183.4.279
- Trends in mental health related contacts among mothers of Aboriginal children in Western Australia (1990–2013): a linked data population-based cohort study of over 40 000 children.BMJ Open. 2019; 9e027733https://doi.org/10.1136/bmjopen-2018-027733
- Aboriginal and Torres Strait Islander Health Performance Framework: 2017 Report.Australian Government, 2017 (Available from)
- Addressing Aboriginal Disadvantage: The Need to Do Things Differently.New South Wales Ombudsman, 2011 (A special report to Parliament under s 31 of the Ombudsman Act 1974. Available from)
- Aboriginal women’s experiences of accessing health care when state apprehension of children is being threatened.J. Adv. Nurs. 2014; 70: 1105-1116https://doi.org/10.1111/jan.12271
- Colonisation it’s bad for your health: the context of Aboriginal health.Contemp. Nurse. 2013; 46: 28-40https://doi.org/10.5172/conu.2013.46.1.28
- Aboriginal and Torres Strait Islander social and emotional wellbeing and mental health.Aust. Psychol. 2017; 52: 255-260https://doi.org/10.1111/ap.12299
- Social determinants and the health of Indigenous Australians.Med. J. Aust. 2011; 194: 512-513https://doi.org/10.5694/j.1326-5377.2011.tb03086.x
- Child Protection Australia 2015-16. Report.Australian Government, 2017 (Child Welfare Series No.: 66. Report Catalogue CWS No.: 60. Available from)
- Infant removals: the need to address the over-representation of Aboriginal infants and community concerns of another ‘stolen generation’.Child Abuse Negl. 2019; 90: 88-98https://doi.org/10.1016/j.chiabu.2019.01.017
- Success in closing the gap: favourable neonatal outcomes in a metropolitan aboriginal maternity group practice program.Med. J. Aust. 2015; 203: 262https://doi.org/10.5694/mja14.01754
- Elements of cultural competence in an Australian Aboriginal maternity program.Women Birth. 2017; 30: 121-128https://doi.org/10.1016/j.wombi.2016.09.007
- Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners.Aust. N. Z. J. Public Health. 2014; 38: 355-361https://doi.org/10.1111/1753-6405.12231
- Supporting aboriginal knowledge and practice in health care: lessons from a qualitative evaluation of the strong women, strong babies, strong culture program.BMC Pregnancy Childbirth. 2015; 15: 19https://doi.org/10.1186/s12884-015-0433-3
- Birthweights and growth of infants in five Aboriginal communities.Aust. N. Z. J. Public Health. 2000; 24: 124-135https://doi.org/10.1111/j.1467-842X.2000.tb00132.x
- Aboriginal and Torres Strait Islander maternal and child health and wellbeing: a systematic search of programs and services in Australian primary health care settings.BMC Pregnancy Childbirth. 2014; 14: 251https://doi.org/10.1186/1471-2393-14-251
- National Key Performance Indicators for Aboriginal and Torres Strait Islander Primary Health Care: Results to June 2018. Web Report.Australian Government, 2019 (Available from)
- Clinical Practice Guidelines: Pregnancy Care (2019 Edition). Guidelines.Australian Government, 2019 (Available from)
- Queensland intervention initiative: “Indigenous women’s project: report of process and preliminary results”. Final report. beyondblue the National Depression Initiative.Volume II: State-based Antenatal Intervention Initiatives. 2005 (Available from)
- Perinatal depression and screening among Aboriginal Australians in the Kimberley.Contemp. Nurse. 2016; 52: 42-58https://doi.org/10.1080/10376178.2016.1198710
- Validity and acceptability of Kimberley Mum’s mood scale to screen for perinatal anxiety and depression in remote aboriginal health care settings.PLoS One. 2017; 12e0168969https://doi.org/10.1371/journal.pone.0168969
- ‘Having a quiet word’: Yarning with Aboriginal Women in the Pilbara Region of Western Australia about mental health and mental health screening during the perinatal period.Int. J. Environ. Res. Public Health. 2019; 16: 4253https://doi.org/10.3390/ijerph16214253
- Study protocol: a clinical trial for improving mental health screening for Aboriginal and Torres Strait Islander pregnant women and mothers of young children using the Kimberley Mum’s Mood Scale.BMC Public Health. 2019; 19: 1521-1610https://doi.org/10.1186/s12889-019-7845-3
- Aboriginal and Torres Strait Islander women’s experience when interacting with the edinburgh postnatal depression scale: a brief note.Aust. J. Rural Health. 2008; 16: 124-131https://doi.org/10.1111/j.1440-1584.2007.00930.x
- The interface of mental and emotional health and pregnancy in urban indigenous women: research in progress.Infant Ment. Health J. 2010; 31: 277-290https://doi.org/10.1002/imhj.20256
- The EPDS and Australian Indigenous women: a systematic review of the literature.Women Birth. 2020; 34: e128-e134https://doi.org/10.1016/j.wombi.2020.02.007
- Cultural security in the perinatal period for Indigenous women in urban areas: a scoping review.Women Birth. 2019; https://doi.org/10.1016/j.wombi.2019.06.012
- Research protocol for the exploration of experiences of Aboriginal Australian mothers and healthcare professionals when using the Edinburgh Postnatal Depression Scale: a process-oriented validation study using triangulated participatory mixed methods.BMJ Open. 2018; 8e022273https://doi.org/10.1136/bmjopen-2018-022273
- Co-constructing Research: A Critical Literature Review. Arts and Humanities Research Council.2016 (Available from)
- ‘Baby Coming – You Ready?’ Delivers for Parents-to-be. National Aboriginal Community Controlled Health Organisation Aboriginal Health Newspaper.2016 (Jun 29; Edition 6. Available from)
- ‘Yarn with me’: applying clinical yarning to improve clinician-patient communication in Aboriginal health care.Aust. J. Prim. Health. 2016; 22: 377https://doi.org/10.1071/PY16051
- Risk of vicarious trauma in nursing research: a focused mapping review and synthesis.J. Clin. Nurs. 2016; 25: 2768-2777https://doi.org/10.1111/jocn.13235
- Becoming a Reflexive Researcher: Using Our Selves in Research.J. Kingsley Publishers, London;Philadelphia2004
- Yarning about yarning as a legitimate method in Indigenous research.Int J Crit Indigenous Stud. 2010; 3: 37-50
- Yarning/Aboriginal storytelling: towards an understanding of an Indigenous perspective and its implications for research practice.Contemp. Nurse. 2013; 46: 13-17https://doi.org/10.5172/conu.2013.46.1.13
- Disability “In-Justice”: the benefits and challenges of “Yarning” with young people undergoing diagnostic assessment for fetal alcohol Spectrum disorder in a youth detention center.Qual. Health Res. 2020; 30: 314-327https://doi.org/10.1177/1049732319882910
- Common pitfalls in published grounded theory research.Qual. Health Res. 1993; 3: 254-260https://doi.org/10.1177/104973239300300207
- Grounded theory in the 21st century: applications for advancing social justice research.in: Denzin N. Lincoln Y. The SAGE Handbook of Qualitative Research. 2005: 507-535 (Available from)
- Threats to psychometric quality.in: Furr R.M. Scale Construction and Psychometrics for Social and Personality Psychology. SAGE, London2011: 67-76
- "We’re checking them out": Indigenous and non-Indigenous research participants’ accounts of deciding to be involved in research.Int. J. Equity Health. 2016; 15: 8https://doi.org/10.1186/s12939-016-0301-4
- Dirty questions: indigenous health and ‘Western research’.Aust. N. Z. J. Public Health. 2001; 25: 197-202https://doi.org/10.1111/j.1467-842X.2001.tb00563.x
- Indigenous Australian views on knowledge production and Indigenist Research.in: Kunnie J.E. Goduka N.L. Indigenous Peoples’ Wisdom and Power: Affirming Our Knowledge Through Narratives. 2006: 32-50 (Available from)
- "Yarning" as a Method for Community-Based Health Research With Indigenous Women: The Indigenous Women’s Wellness Research Program.Health Care Women Int. 2014; 35: 1216-1226https://doi.org/10.1080/07399332.2013.815754
- Reducing the health disparities of Indigenous Australians: time to change focus.BMC Health Serv. Res. 2012; 12: 151https://doi.org/10.1186/1472-6963-12-151
- It’s enough to make you sick: the impact of racism on the health of Aboriginal Australians.Aust. N. Z. J. Public Health. 2007; 31: 322-329https://doi.org/10.1111/j.1753-6405.2007.00079.x
- Working at the interface in Aboriginal and Torres Strait Islander health: focussing on the individual health professional and their organisation as a means to address health equity.Int. J. Equity Health. 2016; 15: 187https://doi.org/10.1186/s12939-016-0476-8
- Reducing racism in Aboriginal health care in Australia: where does cultural education fit?.Aust. N. Z. J. Public Health. 2010; 34: S87-S92https://doi.org/10.1111/j.1753-6405.2010.00560.x
- Yarning with remote Aboriginal communities about seeking consent for research, culturally respectful community engagement and genuine research partnerships.Intern. Med. J. 2017; 47: 22https://doi.org/10.1111/imj.2_13463
- The intersection of trauma, racism, and cultural competence in effective work with Aboriginal people: waiting for trust.Aust. Soc. Work. 2013; 66: 104-117https://doi.org/10.1080/0312407X.2012.697566
- Aboriginal and Torres Strait Islander Views on Research in Their Communities.Australian Government, 2006 (Occasional Paper No. 16. Available from)
- Negotiating policy in practice: child and family health nurses’ approach to the process of postnatal psychosocial assessment.BMC Health Serv. Res. 2013; 13: 133https://doi.org/10.1186/1472-6963-13-133
- ‘Happy that someone cared’—non-native-speaking immigrant mothers’ experiences of participating in screening for postpartum depression in the Swedish child health services.J. Child Health Care. 2019; 23: 118-130https://doi.org/10.1177/1367493518778387
- A systematic review of EPDS cultural suitability with Indigenous mothers: a global perspective.Arch. Womens Ment. Health. 2021; 24: 353-365https://doi.org/10.1007/s00737-020-01084-2
- Overview and Summary Report of Antenatal Services Audit for Aboriginal Women and Assessment of Aboriginal Content in Health Education in Western Australia. Report.Telethon Institute for Child Health Research, 2009 (Available from)
- Antenatal services for Aboriginal women: the relevance of cultural competence.Qual. Prim. Care. 2010; 18 (Available from): 65-74
- Monitoring the ‘strong women, strong babies, Strong Culture Program’: the first eight years.J. Paediatr. Child Health. 2003; 39: 668-672https://doi.org/10.1046/j.1440-1754.2003.00272.x
- Birthweight changes in the pilot phase of the Strong Women Strong Babies Strong Culture Program in the Northern Territory.Aust. N. Z. J. Public Health. 2001; 25: 34-40https://doi.org/10.1111/j.1467-842X.2001.tb00547.x
- National Stocktake of Organisational Cultural Competence in Public Maternity Care for Aboriginal and Torres Strait Islander Women. Report 2016-2017.Australian Health Ministers’ Advisory Council, 2017 (Available from)
- Sustainable Health Review: Final Report to the Western Australian Government. Final Report.Government of Western Australia, 2019 (Available from)
- Perspectives of rural and remote primary healthcare services on the meaning and goals of clinical governance.Aust. J. Prim. Health. 2017; 23: 451https://doi.org/10.1071/PY16168
- Use and misuse of the Edinburgh Postnatal Depression Scale (EPDS): a ten point ‘survival analysis’.Arch. Womens Ment. Health. 2017; 20: 789-790https://doi.org/10.1007/s00737-017-0789-7
- Perinatal Mental Health and Psychosocial Assessment: Practice Resource Manual for Victorian Maternal and Child Health Nurses. Training Program and Manual.State Government Victoria, 2013 (Available from)
- Aboriginal and Torres Strait Islander Perinatal Mental Health Mapping Project: a Scoping of Current Practice Surrounding the Screening, Assessment and Management of Perinatal Mental Health Across Australia’s New Directions: Mothers and Baby Service Program.Centre of Perinatal Excellence, 2014 (Available from)
- Applying new techniques to an old ally: a qualitative validation study of the Edinburgh Postnatal Depression Scale.Women Birth. 2009; 22: 17-23https://doi.org/10.1016/j.wombi.2008.10.002
- WHO principles of perinatal care: the essential antenatal, perinatal, and postpartum care course.Birth. 2001; 28: 202-207https://doi.org/10.1046/j.1523-536x.2001.00202.x
- The development of a survey instrument to assess aboriginal and torres strait islander students’ resilience and risk for self-harm.Front. Educ. 2017; 2https://doi.org/10.3389/feduc.2017.00019
- Antenatal screening and early intervention for "perinatal" distress, depression and anxiety: where to from here?.Arch. Womens Ment. Health. 2004; 7: 1-6https://doi.org/10.1007/s00737-003-0034-4
- Screening for perinatal depression.Best Pract. Res. Clin. Obstet. Gynaecol. 2014; 28: 13-23https://doi.org/10.1016/j.bpobgyn.2013.08.014
- The Role of Psychosocial Risk Factors When Screening with the EPDS. Excerpt From EPDS Training Materials.Government of Western Australia North Metropolitan Health Service, 2011 (Available from)
- Clinical Practice Guideline: Edinburgh Postnatal Depression Scale (EPDS) Mental Health Screening and Referral: CMP.Government of Western Australia North Metropolitan Health Service, 2014 (Available from)
- Thirty years with the Edinburgh Postnatal Depression Scale: voices from the past and recommendations for the future.Br. J. Psychiatry. 2019; 214: 127-129https://doi.org/10.1192/bjp.2018.245
- Aboriginal and Torres Strait Islander social and emotional wellbeing.in: Dudgeon P. Milroy H. Walker R. Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice. 2014: 55-68 (Available from)
- Aboriginal and Torres Strait Islander social and emotional wellbeing and mental health.Aust. Psychol. 2017; 52: 255-260https://doi.org/10.1111/ap.12299
- Social and emotional wellbeing screening for aboriginal and torres strait islanders within primary health care: a series of missed opportunities?.Front. Public Health. 2017; 5: 159https://doi.org/10.3389/fpubh.2017.00159
- Qualitative data analysis: a compendium of techniques and a framework for selection for school psychology research and beyond.Sch. Psychol. Q. 2008; 23: 587-604https://doi.org/10.1037/1045-3830.23.4.587
- An international study exploring levels of postpartum depressive symptomatology.J. Psychosom. Res. 2000; 49: 207-216https://doi.org/10.1016/S0022-3999(00)00176-8
- Aboriginal Concepts of Place and Country and Their Meaning in Mental Health. 24. The Australian Community Psychologist, 2012: 26-42 (Available from)
- Culturally-sensitive complaints of depressions and anxieties in women.J. Affect. Disord. 2007; 102: 159-176https://doi.org/10.1016/j.jad.2006.09.033
- Screening tools for postpartum depression: validity and cultural dimensions.Afr. J. Psychiatry. 2010; 13 (Available from): 357-365
- Lost in translation: staff and interpreters’ experiences of the edinburgh postnatal depression scale with women from refugee backgrounds.Issues Ment. Health Nurs. 2013; 34: 648-657https://doi.org/10.3109/01612840.2013.80489
- Closing the Gap: Report.2020 (Available at:)
Article info
Publication history
Published online: September 13, 2021
Accepted:
September 7,
2021
Received in revised form:
August 15,
2021
Received:
June 23,
2021
Identification
Copyright
© 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
