Replicability of structural models of the Edinburgh Postnatal Depression Scale (EPDS) in a community sample of postpartum African American women with low socioeconomic status

Abstract

The Edinburgh Postnatal Depression Scale (EPDS) is increasingly used in public health and social service programs serving postpartum women of racially, ethnically, and socioeconomically diverse backgrounds at risk for depression. However, we know little about its factor structure across groups of women with implications for measuring symptom levels in research. This study evaluated the underlying structure of the EPDS using a confirmatory factor analyses model comparison approach of five factor models from the literature in a purposive community sample of 169 postpartum African American women of low socioeconomic status. Participants were identified through an exhaustive review of local health department program files dated August 2006 to August 2010 in a Midwestern state of USA. Tuohy and McVey’s (Br JClin Psychol 47:153–169, 2008) three-factor model (depression, anxiety, and anhedonia) demonstrated the best fit to the data with a nonsignificant Satora–Bentler scaled chi-square value (21.70, df024, p00.60) and the lowest root mean square error of approximation (0.00) and standardized root mean square residual (0.05) values. The results call for further study of the factor structure of the EPDS in other racial and ethnic groups and cautious use of the EPDS among perinatal women of racially, ethnically, and socioeconomically diverse backgrounds until its factorial invariance is better understood.

Subconstructs of the Edinburgh Postnatal Depression Scale in a multi-ethnic inner-city population in the U.S.

“…Their postpartum survey data fit best with a 3-factor model as identified by Tuohy and McVey (2008) as described above, which is similar to our findings in the same racial group. Notably, the socioeconomic characteristics in our sample were similar to the sample in Lee King et al (2012). On the other hand, Hartley et al (2014) examined a sample of Hispanic women (n=220) in the Southeastern U.S. recruited from their child’s pediatric primary care clinic in a large pediatric hospital using CFA, and found that a two-factor model of depression and anxiety was the structure that demonstrated best fit.…”

“…To our knowledge, only two studies to date have examined the factor structure of ethnic and racial subgroups in the U.S. Lee King et al (2012) used a CFA approach with a sample of African American women (n = 169) in the Midwestern U.S. recruited from a Medicaid or similar prenatal care coordination program through local health departments. Their postpartum survey data fit best with a 3-factor model as identified by Tuohy and McVey (2008) as described above, which is similar to our findings in the same racial group.…”

“…The 10-item Edinburgh Postpartum Depression Scale (EPDS) (Cox et al 1987) is the most widely used self-report measure for the assessment of PPD across diverse racial/ethnic and cultural groups including African Americans and Hispanics (Gibson et al 2009; Hartley et al 2014; Howell et al 2012; Lau et al 2010; Lee King 2012; Montazeri et al 2007; Odalovic et al 2015; Okano et al 1996; Pop et al 1992; Small et al 2007; Toreki et al 2014; Vivilaki et al 2009). Although Cox et al (1987) originally designed the EPDS as a one-dimensional measurement tool, the recognition that depressive symptoms can be differentially experienced across cultural and racial/ethnic groups has led to studies examining structural equivalence of the measure in different populations using factor analysis (Cunningham et al 2015; Reichenheim et al 2011).…”

“…Although Cox et al (1987) originally designed the EPDS as a one-dimensional measurement tool, the recognition that depressive symptoms can be differentially experienced across cultural and racial/ethnic groups has led to studies examining structural equivalence of the measure in different populations using factor analysis (Cunningham et al 2015; Reichenheim et al 2011). Some studies suggest that items from the EPDS cluster into two factors, one generally indicating “depression” and the other indicating “anxiety” (Astbury et al 1994; Guedeney and Fermanian 1998; Hartley et al 2014; Massoudi et al 2013; Matthey 2008; Phillips et al 2009; Toreki et al 2014; Vivilaki et al 2009), whereas other studies suggest three factors indicating “depression”, “anxiety”, and “anhedonia” (Chabrol and Teissedre 2004; Lee King 2012; Montazeri et al 2007; Pop et al 1992; Ross et al 2003; Small et al 2007). Notably, some of these factors were comprised of different items across the different studies.…”

“…Variation of the factor structure remains understudied across ethnic and racial groups in the U.S. A recent study in Hispanic women drawn from a pediatric primary care setting identified a 2-factor model (depression, anxiety) as the best fitting model (Hartley et al 2014), whereas a study in postpartum African American women of low socioeconomic status showed that a 3-factor model (depression, anxiety, and anhedonia) demonstrated the best fit (Lee King 2012). No studies to date have been large and diverse enough to permit direct multi-group analyses comparing factor structures across different race and ethnicities.…”