Adaptation of the Edinburgh Postnatal Depression Scale in the Indonesian Version: Self-reported Anxiety and Depression Symptoms in Pregnant WomenAdaptation of the Edinburgh Postnatal Depression Scale in the Indonesian Version: Self-reported Anxiety and Depression Symptoms in Pregnant Women

Dewi Nirmala Sari; Hervita Diatri; Kemal Siregar; Hadi Pratomo

doi:10.3889/oamjms.2021.7783

Authors

Dewi Nirmala Sari Doctoral Program, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia; Department of Midwifery, Health Polytechnic Jakarta III, Ministry of Health Republic of Indonesia, Jakarta, Indonesia
Hervita Diatri Department of Psychiatry, Faculty of Medical, Universitas Indonesia, Jakarta, Indonesia
Kemal Siregar Reproductive Health Study Group, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
Hadi Pratomo Reproductive Health Study Group, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2021.7783

Keywords:

Pregnant women, EPDS, Validity, Reliability

Abstract

BACKGROUND: Anxiety and depression disorders in pregnant women are often not identified so that early treatment is not optimal. Indonesia already has comprehensive integrated antenatal care, including services for pregnant women with mental disorders, but until now Indonesia does not yet have a standardized instrument that is valid and suitable as a screening tool to assess symptoms of anxiety and depression in pregnant women. The Edinburgh Postnatal Depression Scale (EPDS) is a screening instrument with high sensitivity and specificity, has been translated into Indonesian, but until now, the Indonesian version of the EPDS instrument has not been evaluated for validity and reliability in the population of pregnant women.

AIM: this study aimed to adapt the Indonesian version of the EPDS instrument, including testing the validity and reliability of the instrument when used on pregnant women in Indonesia.

METHODS: This research is a cross sectional study. The number of pregnant women who participated were 125 samples. Data were collected randomly, and the assessment of symptoms of anxiety and depression was self-reported via online. Content validity was assessed with a content validity index from 5 experts, construct validation was analyzed by Explanatory Factor Analysis and Confirmatory Factor Analysis and Convergent Validity. The reliability of the EPDS instrument was assessed by construct reliability and Cronbach's Alpha.

RESULTS: Content validity index shows expert agreement with a value of .98. The Indonesian version of the EPDS shows assessing three factors, namely: Depression (5 items), Anxiety (3 items), and Anhedonia (2 items). The reliability of the Indonesian version of the EPDS instrument is good with Cronbach's Alpha .80 and the internal reliability of the 10 items (Cronbach's Alpha .767-.812).

CONCLUSION: The Indonesian version of the EPDS instrument is valid and reliable to be used to assess symptoms of anxiety and depression in pregnant women in antenatal care in Indonesia.

Keywords: pregnant women, EPDS, validity, reliability

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors and child outcomes in low-income and middle-income countries. Lancet Psychiatry. 2016;3(10):973-82. https://doi.org/10.1016/S2215-0366(16)30284-X PMid:27650773 DOI: https://doi.org/10.1016/S2215-0366(16)30284-X

Jha S, Salve HR, Goswami K, Sagar R, Kant S. Burden of common mental disorders among pregnant women: A systematic review. Asian J Psychiatr. 2018;36:46-53. https://doi.org/10.1016/j.ajp.2018.06.020 PMid:29966886 DOI: https://doi.org/10.1016/j.ajp.2018.06.020

Misrawati, Afiyanti Y. Antenatal depression and its associated factors among pregnant women in Jakarta, Indonesia. Enferm Clin. 2020;30:96-101. DOI: https://doi.org/10.1016/j.enfcli.2020.07.020

Hariyati NR, Raden A, Mawarti R, Tarigan M. Integrated antenatal care reduce childbirth anxiety among primigravida women. J Health Technol Assess Midwifery. 2019;2(1):33-9. DOI: https://doi.org/10.31101/jhtam.719

UNICEF. Roadmap of SDGs Indonesia: A Highlight. United States: UNICEF; 2017. p. 1-124. Available from: https://www.unicef.org/indonesia/media/1626/file/Roadmap of SDGs.pdf. [Last accessed on 2021 Jul 20].

Kalcev G, Preti A, Orru G, Carta MG. Perinatal mental health: One of the biggest challenges in coronavirus disease-19 crisis. Open Access Maced J Med Sci. 2020;8(1):245-7. DOI: https://doi.org/10.3889/oamjms.2020.5058

Bonari L, Pinto N, Ahn E, Einarson A, Steiner M, Koren G. Perinatal risks of untreated depression during pregnancy. Can J Psychiatry. 2004;49(11):726-35. https://doi.org/10.1177/070674370404901103 PMid:15633850 DOI: https://doi.org/10.1177/070674370404901103

Littlewood E, Ali S, Ansell P, Dyson L, Gascoyne S, Hewitt C, et al. Identification of depression in women during pregnancy and the early postnatal period using the whooley questions and the Edinburgh postnatal depression scale. BMJ Open. 2016;6:1-9. https://doi.org/10.1136/bmjopen-2016-011223 PMid:27297012 DOI: https://doi.org/10.1136/bmjopen-2016-011223

O’Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary care screening for and treatment of depression in pregnant and postpartum women: Evidence report and systematic review for the US preventive services task force. J Am Med Assoc. 2016;315(4):388-406. https://doi.org/10.1001/jama.2015.18948 PMid:26813212 DOI: https://doi.org/10.1001/jama.2015.18948

Baron EC, Hanlon C, Mall S, Honikman S, Breuer E, Kathree T, et al. Maternal mental health in primary care in five low-and middle-income countries: A situational analysis. BMC Health Serv Res. 2016;16:53. http://doi.org/10.1186/s12913-016-1291-z PMid:26880075 DOI: https://doi.org/10.1186/s12913-016-1291-z

Surjaningrum ER, Minas H, Jorm AF, Kakuma R. The Feasibility of a role for community health workers in integrated mental health care for perinatal depression: A Qualitative study from Surabaya, Indonesia. Int J Ment Health Syst. 2018;12:27. https://doi.org/10.1186/s13033-018-0208-0 PMid:29881450 DOI: https://doi.org/10.1186/s13033-018-0208-0

Rahman A, Surkan PJ, Cayetano CE, Rwagatare P, Dickson KE. Grand challenges: Integrating maternal mental health into maternal and child health programmes. PLoS Med. 2013;10(5):e1001442. http://doi.org/10.1371/journal.pmed.1001442 PMid:23667345 DOI: https://doi.org/10.1371/journal.pmed.1001442

Arsenault C, Jordan K, Lee D, Dinsa G, Manzi F, Marchant T, et al. Equity in antenatal care quality: An analysis of 91 national household surveys. Lancet Glob Health. 2018;6(11):e1186-95. http://doi.org/10.1016/S2214-109X(18)30389-9 DOI: https://doi.org/10.1016/S2214-109X(18)30389-9

Noonan M, Doody O, Jomeen J, Galvin R. Midwives’ perceptions and experiences of caring for women who experience perinatal mental health problems: an integrative review. Midwifery. 2017;45:56-71. http://doi.org/10.1016/j.midw.2016.12.010 PMid:28039845 DOI: https://doi.org/10.1016/j.midw.2016.12.010

Sorsdahl K, Petersen P. Feasibility and Preliminary Responses to a Screening and Brief Intervention Program for Maternal Mental Disorders Within the Context of Primary Care. Community Ment Health J. 2015;51(8):962-9. http://doi.org/10.1007/s10597-015-9853-9 PMid:25744699 DOI: https://doi.org/10.1007/s10597-015-9853-9

Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 97 Tahun 2014 tentang Pelayanan Kesehatan Masa Sebelum Hamil,Masa Hamil, Persalinan dan Masa Sesudah Melahirkan, Penyelenggaraan Pelayanan Kontrasepsi Serta Pelayanan Kesehatan Seksual. Jakarta, Indonesia: Kementerian Kesehatan Republik Indonesia; 2014. Available from: http://www.peraturan.go.id. [Last accessed on 2021 Jul 01].

He J, van de Vijver FJ. Choosing an adequate design and analysis in cross-cultural personality research. Curr Issues Personal Psychol. 2017;5(1):3-10. http://doi.org/10.5114/cipp.2017.65824 DOI: https://doi.org/10.5114/cipp.2017.65824

ACOG committee opinion No. 757: Screening for perinatal depression. Obstet Gynecol. 2018;132(5):208-12. http://doi.org/10.1097/AOG.0000000000002927 PMid:30629567 DOI: https://doi.org/10.1097/AOG.0000000000002927

Stewart RC, Umar E, Tomenson B, Creed F. Validation of screening tools for antenatal depression in Malawi-a comparison of the Edinburgh postnatal depression scale and self reporting questionnaire. J Affect Disord. 2013;150:1041-7. http://doi.org/10.1016/j.jad.2013.05.036 PMid:23769290 DOI: https://doi.org/10.1016/j.jad.2013.05.036

Van Heyningen T, Honikman S, Tomlinson M, Field S, Myer L. Comparison of mental health screening tools for detecting antenatal depression and anxiety disorders in South African women. PLoS One. 2018;10:1-18. https://doi.org/10.1371/journal.pone.0193697 PMid:29668725 DOI: https://doi.org/10.1371/journal.pone.0193697

Ali GC, Ryan G, De Silva MJ. Validated screening tools for common mental disorders in low and middle income countries: A systematic review. PLoS One. 2016;11(6):e0156939. https://doi.org/10.1371/journal.pone.0156939 PMid:27310297 DOI: https://doi.org/10.1371/journal.pone.0156939

Kendig S, Keats JP, Hoffman MC, Kay LB, Miller ES, Simas TA, et al. Consensus bundle on maternal mental health: Perinatal depression and anxiety. J Midwifery Womens Health. 2017;62(2):232-9. https://doi.org/10.1097/AOG.0000000000001902 PMid:28178041 DOI: https://doi.org/10.1111/jmwh.12603

Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry. 1987;150:782-6. https://doi.org/10.1192/bjp.150.6.782 PMid:3651732 DOI: https://doi.org/10.1192/bjp.150.6.782

Department of Health, Australia Government of Western. Edinburgh Postnatal Depression Scale (EPDS): Translated Versions. State Perinatal Mental Health Reference Group, Western Australia. Australia: Department of Health, Australia Government of Western; 2006. p. 1-271.

Konicki C, Iorio D. Measurement in Health Behavior: Methods for Research and Education. 1st ed. United States: Jossey-Bass; 2005. p. 1-336.

Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate Data Analysis. 7th ed. United Kingdom: Pearson; 2014.

Tajudin M, Puteh M, Adnan M. Developing themes of guiding principles to foster higher order thinking skills in teaching and learning of mathematics. Int J Acad Res Progress Educ Dev. 2017;6(4):90-103. DOI: https://doi.org/10.6007/IJARPED/v6-i4/3464

Coates R, Ayers S, De Visser R. Factor structure of the Edinburgh postnatal depression scale in a population-based sample. Psychol Assess. 2017;29(8):1016-27. https://doi.org/10.1037/pas0000397 PMid:27736124 DOI: https://doi.org/10.1037/pas0000397

Marsay C, Manderson L, Subramaney U. Validation of the Whooley questions for antenatal depression and anxiety among low-income women in urban South Africa. South Afr J Psychiatry. 2017;23(1):1013. https://doi.org/10.4102/sajpsychiatry.v23i0.1013 PMid:30263185 DOI: https://doi.org/10.4102/sajpsychiatry.v23i0.1013