Department of Economics and Business Economics

The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh Postnatal Depression Scale

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • A Di Florio, UNC Center for Women's Mood Disorder, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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  • K Putnam, UNC Center for Women's Mood Disorder, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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  • M Altemus, Department of Psychiatry, Weill Medical College of Cornell University and New York Presbyterian Hospital, Westchester Division, White Plains, NY, USA.
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  • G Apter, Erasme Hospital, Paris Diderot University,Paris,France.
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  • V Bergink, Department of Psychiatry/Psychology,Erasmus MC,Rotterdam,The Netherlands.
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  • J Bilszta, Women's Mental Health, University of Melbourne,Melbourne,VIC,Australia.
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  • R Brock, Department of Psychological and Brain Sciences,The University of Iowa,Iowa City,IA,USA.
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  • A Buist, Women's Mental Health, University of Melbourne,Melbourne,VIC,Australia.
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  • K Dan
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  • E Devouche, Erasme Hospital, Paris Descartes University,Paris,France.
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  • C N Epperson, Department of Psychiatry,University of Pennsylvania,Philadelphia,PA,USA.
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  • C Guille, Department of Psychiatry,Medical University of South Carolina,Charleston,SC,USA.
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  • D Kim, Department of Psychiatry,University of Pennsylvania,Philadelphia,PA,USA.
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  • P Lichtenstein, University of Gothenburg
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  • P K E Magnusson, University of Gothenburg
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  • P Martinez, Behavioral Endocrinology Branch,National Institute of Mental Health, National Institutes of Health, Health and Human Services,Bethesda,MD,USA.
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  • Trine Munk-Olsen
  • J Newport, Department of Psychiatry,University of Miami,Miami,FL,USA.
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  • J Payne, Department of Psychiatry,The Johns Hopkins University,Baltimore,MD,USA.
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  • B W Penninx, Department of Psychiatry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
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  • M O'Hara, Department of Psychological and Brain Sciences,The University of Iowa,Iowa City,IA,USA.
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  • E Robertson-Blackmore, Department of Family Medicine,Halifax Health,Daytona Beach,FL,USA.
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  • S J Roza, Department of Psychiatry/Psychology,Erasmus MC,Rotterdam,The Netherlands.
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  • K M Sharkey, Department of Psychiatry,Alpert Medical School of Brown University/Rhode Island Hospital,Providence,RI,USA.
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  • S Stuart, Department of Psychological and Brain Sciences,The University of Iowa,Iowa City,IA,USA.
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  • H Tiemeier, Department of Psychiatry/Psychology,Erasmus MC,Rotterdam,The Netherlands.
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  • A Viktorin, University of Gothenburg
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  • P J Schmidt, Behavioral Endocrinology Branch,National Institute of Mental Health, National Institutes of Health, Health and Human Services,Bethesda,MD,USA.
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  • P F Sullivan, UNC Center for Women's Mood Disorder, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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  • Z N Stowe, Department of Psychiatry,University of Arkansas for Medical Sciences,Little Rock,AR,USA.
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  • K L Wisner, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine,Chicago,IL,USA.
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  • I Jones, Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, United Kingdom; Neuroscience and Mental Health Research Institute, Cardiff University, United Kingdom.
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  • D R Rubinow, UNC Center for Women's Mood Disorder, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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  • S Meltzer-Brody, UNC Center for Women's Mood Disorder, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

BACKGROUND: Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.

METHOD: Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.

RESULTS: Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) 0.01), but not between European countries (∆*CFI < 0.01).

CONCLUSIONS: Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.

Original languageEnglish
JournalPsychological Medicine
Volume47
Issue5
Pages (from-to)787-799
Number of pages13
ISSN0033-2917
DOIs
Publication statusPublished - 2017

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