title: Screening for postnatal depression in Chinese-speaking women using the Hong Kong translated version of the Edinburgh Postnatal Depression Scale.
abstract: BACKGROUND
  The Edinburgh Postnatal Depression Scale (EPDS) may not be a uniformly valid postnatal depression (PND) screen across populations. We evaluated the performance of a Chinese translation of 10-item (HK-EPDS) and six-item (HK-EPDS-6) versions in post-partum women in Singapore.
  
  
  METHODS
  Chinese-speaking post-partum obstetric clinic patients were recruited for this study. They completed the HK-EPDS, from which we derived the six-item HK-EPDS-6. All women were clinically assessed for PND based on Diagnostic and Statistical Manual, Fourth Edition-Text Revision criteria. Receiver-operator curve (ROC) analyses and likelihood ratio computations informed scale cutoff choices. Clinical fitness was judged by thresholds for internal consistency [α ≥ 0.70] and for diagnostic performance by true-positive rate (>85%), false-positive rate (≤10%), positive likelihood ratio (>1), negative likelihood ratio (<0.2), area under the ROC curve (AUC, ≥90%) and effect size (≥0.80).
  
  
  RESULTS
  Based on clinical interview, prevalence of PND was 6.2% in 487 post-partum women. HK-EPDS internal consistency was 0.84. At 13 or more cutoff, the true-positive rate was 86.7%, false-positive rate 3.3%, positive likelihood ratio 26.4, negative likelihood ratio 0.14, AUC 94.4% and effect size 0.81. For the HK-EPDS-6, internal consistency was 0.76. At 8 or more cutoff, we found a true-positive rate of 86.7%, false-positive rate 6.6%, positive likelihood ratio 13.2, negative likelihood ration 0.14, AUC 92.9% and effect size 0.98.
  
  
  CONCLUSIONS
  The HK-EPDS (cutoff ≥13) and HK-EPDS6 (cutoff ≥8) are fit for PND screening for general population post-partum women. The brief six-item version appears to be clinically suitable for quick screening in Chinese speaking women.
authors.affiliation: Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore. helen.chen.y@kkh.com.sg
authors.forename: Helen
authors.initials: H
authors.lastname: Chen
authors.forename: Dianne
authors.initials: D
authors.lastname: Bautista
authors.forename: Ying Chia
authors.initials: YC
authors.lastname: Ch'ng
authors.forename: Wenyun
authors.initials: W
authors.lastname: Li
authors.forename: Edwin
authors.initials: E
authors.lastname: Chan
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
mesh_terms: D000328:Adult; D044466:Asian People / Q000208:ethnology; D003430:Cross-Sectional Studies; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000208:ethnology; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D011247:Pregnancy; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D012846:Singapore / Q000453:epidemiology; D014177:Translations; D055815:Young Adult
keywords: Edinburgh Postnatal Depression Scale; depression screening; post-partum depression