Is Validating the Cutoff Score on Perinatal Mental Health Mood Screening Instruments, for Women and Men from Different Cultures or Languages, Really Necessary?

Abstract

Background: The most commonly used mood screening instrument in perinatal health is the Edinburgh Depression Scale. The screen-positive cut-off score on this scale, as for others, has been determined, via validation techniques, for over 20 languages/cultures, and for both women and men. While such validation appears to be considered essential, there are studies that could be interpreted to suggest that this is not an important consideration. Methods: Selective studies have been chosen to indicate these opposing points of view. Results: Examples of studies that support the notion of validating cut-off scores are described, as are examples of studies that appear not to support this point of view. Conclusions: (i) Clinical services and researchers need to be mindful of these opposing points of view, and openly discuss them when using screening cut-off scores for their respective populations. (ii) Researchers and Journals need to be more rigorous in ensuring this issue is correctly reported in studies, and/or openly discussed when relevant.

Determining the optimal cut-off scores for the Chinese version of the Memorial Anxiety Scale for Prostate Cancer (MAX-PC)

“…Compared with the empirically derived cutoff score, the results of this study will promote the further application of the MAX-PC scale. However, there are differences in the optimal cutoff values for the same scale in different cultural background groups [21,22]; therefore, we hope that more researchers will construct appropriate cutoff values for other language versions of the MAX-PC scale to further validate or compare the results of this study.…”

A Psychometric Study of the Perinatal Assessment of Maternal Affectivity (PAMA) for the Screening of Perinatal Affective Disorders in Mothers

“…The identification of an appropriate cut-off score for PAPA/PAMA will be the subject of future studies by our research group. In any case, it is useful to note that the calculation of cut-off scores for this kind of screening questionnaires might be useless or highly open to criticism due to methodological, linguistic and socio-cultural issues [ 10 ]. In fact, searching appropriate cut-off points for this kind of tool requires the use of a more refined diagnostic methodology (semi-structured, psychiatric interviews) and a careful consideration of methodological, cultural and linguistic factors that might influence the results.…”

“…A recent systematic review and meta-analysis [ 9 ], including seven studies and a total of 2393 fathers, confirmed that the EPDS has acceptable properties for detecting paternal postpartum depressive symptomatology with cut-off scores ranging from seven to ten to optimize the balance between sensitivity and specificity, therefore decreasing the risk of false positives. However, as highlighted by Matthey [ 10 ], only a small number of studies on fathers followed these guidelines and the respective cut-off scores. Therefore, prior findings need to be interpreted with caution, considering the heterogeneity of study samples in terms of education, cultural and socio-economic background and time of EPDS administration.…”

Using the WHO Self-Reporting Questionnaire-20 (SRQ-20) to Detect Symptoms of Common Mental Disorders among Pregnant Women in Vietnam: a Validation Study

“… 38 The variation in the test characteristics of the SRQ-20 across different populations confirmed the need for studies examining different optimal cut-off scores to detect cases in different target groups, which has been previously mentioned by researchers. 17 , 46 …”

“…38 The variation in the test characteristics of the SRQ-20 across different populations confirmed the need for studies examining different optimal cut-off scores to detect cases in different target groups, which has been previously mentioned by researchers. 17,46 Our study has some limitations. The study was conducted with pregnant women from four rural communes in a northern province of Vietnam; therefore, the study sample may not represent all Vietnamese pregnant women.…”