Screening for postpartum depression with the Edinburgh Postnatal Depression Scale (EPDS): an ethical analysis.
OBJECTIVE
To assess the Edinburgh Postnatal Depression Scale (EPDS), a self-administered questionnaire created to screen for symptoms of postpartum depression in the community, from an epidemiological and ethical perspective. Screening, as the practice of investigating apparently healthy individuals to detect unrecognised disease or its precursors, has interpretation problems and is complicated by deliberations on probabilities for something to occur, on which the scientific community is unanimous.


METHODS
Our ethical analysis is made using a framework with two different dimensions, the ethical principles autonomy and beneficence and the affected persons. To balance the ethical costs and the ethical benefits of EPDS an analogy with the assessment of pharmaceutics is used.


RESULTS
In this article we argue that routine EPDS screening of Swedish postpartum women would lead to considerable ethical problems due to the weak scientific foundation of the screening instrument. Despite a multitude of published studies, the side-effects in terms of misclassifications have not been considered carefully. The EPDS does not function very well as a routine screening instrument. The dualism created is too reductive and fails to recognize the plurality of difference that exists in the social word.


CONCLUSIONS
Public health authorities should not advocate screening of unproved value. Screening is not just a medical issue but also an ethical one.
Department of Medical Ethics, Lund University, Sweden. ingela.krantz@skaraborg-institute.se
Ingela
I
Krantz
Bo
B
Eriksson
Cristina
C
Lundquist-Persson
Beth Maina
BM
Ahlberg
Tore
T
Nilstun
D019052:Depression, Postpartum / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000009:adverse effects / Q000941:ethics* / Q000379:methods; D026684:Personal Autonomy; D011237:Predictive Value of Tests; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology