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Different ways of using the Edinburgh Postnatal Depression Scale (EPDS)

The 10-item Edingurgh Postnatal Depression Scale (EPDS), which relies on self-report, is an established screening tool for monitoring depressive symptoms in the postnatal period. It is usually used as a single score, with variable cut-offs and has been used in longitudinal research studies and in many cross sectional studies on maternal wellbeing, as well as in clinical practice.

Inconsistent findings and replication difficulties have limited use of the EPDS as a multi-dimensional tool.

A newly published study by Maggie Redshaw and Colin Martin focuses on the factor structure and different models that have been reported in identifying possible dimensions within the scale. Participants were two samples of postpartum women in England assessed at three months and six months using 2016 Maternity Survey data. The findings indicate a multidimensional measure, with a three-factor seven-item EPDS model, reflecting anxiety, depression and anhedonia (a reduced ability to feel pleasure) fitting the data best in both datasets. The use of the sub-scale components identified requires further investigation with a range of populations in both research and clinical practice contexts.     

You can read the study titled Establishing a coherent and replicable measurement model of the Edinburgh Postnatal Depression Scale which is published in Psychiatry Research.

What explains the ethnic variation in infant mortality in England and Wales?

New research by Yangmei Li, Maria Quigley, Nirupa Dattani, Ron Gray, Hiranthi Jayaweera, Jenny Kurinczuk, Alison Macfarlane, and Jennifer Hollowell describes ethnic variations in infant mortality and explores the contribution of area deprivation, mother’s country of birth, and prematurity to these variations.

Using routine birth and death data on more than 4.6 million singleton live births in England and Wales, 2006-2012, they found that crude infant mortality rates were higher in Pakistani, Black Caribbean, Black African, and Bangladeshi infants (6.92, 6.00, 5.17 and 4.40 per 1,000 live births, respectively vs. 2.87 in White British infants). Adjustment for sociodemographic characteristics changed the results little. Further adjustment for gestational age strongly attenuated the risk in Black Caribbean (odds ratio 1.02, 95% CI 0.89-1.17) and Black African infants (1.17, 1.06-1.29) but not in Pakistani (2.32, 2.15-2.50), Bangladeshi (1.47, 1.28-1.69), and Indian infants (1.24, 1.11-1.38).

These results suggest that higher proportions of very premature infants appear to explain increased risks in Black infants but not in South Asian groups.

Read the research in full in the PLOS ONE journal.

Care associated with stillbirth for the most disadvantaged women

A study by Maggie Redshaw and Jane Henderson shows that women living in the most deprived areas in England, who are most at risk of stillbirth, perceived their care more negatively than other women.

In this study, women who had suffered a stillbirth were asked nine months later about their care around the time of the stillbirth. Women resident in the most deprived areas were significantly less likely to feel spoken to so that they could understand and treated with respect. Free text comments indicated that these women had difficulty accessing care, that communication was poor, many of them did not feel cared for, and felt that more could have been done to save their baby.

The study is published in the Birth journal and you can read it here.

Partners' mental health and well-being may be affected by holding their baby after stillbirth

A study by Julie Hennegan, Jane Henderson and Maggie Redshaw shows increased risk of depression and post-traumatic stress disorder (PTSD)-type symptoms in fathers who held their stillborn babies.

In this study, women were asked at nine months whether their partner had seen and held their stillborn baby after birth, and about their partners' subsequent wellbeing. Almost all fathers, 92%, saw their baby, and 82% held them.

At three months, partners who had held their stillborn babies had more than two-and-a-half times the risk of depression, and nearly twice the risk of PTSD-type symptoms compared to those who had not held their stillborn babies, even when comparing partners of similar characteristics. There was weaker evidence at nine months of a difference in outcomes between fathers who had held their stillborn baby and ones that had not, although a trend towards poorer outcomes remained.

You can read the study in the Journal of Reproductive and Infant Psychology.

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