Abstract
In perinatal psychiatry, more has been written on and about the Edinburgh Postnatal Depression Scale (EPDS) than probably any other single area. If John Cox had patented it he would probably long ago have been able to retire. Why the interest in what is really a simple screening tool, developed for postnatal depression and subsequently expanded to antenatal depression and the woman's partner? and why an entire book?
There is no simple answer to this, but the book itself goes beyond just the scale in its excellent review of the area of perinatal psychiatry and the place of this tool in detection and treatment.
The interest in the EPDS coincides with an increasing interest in perinatal psychiatry over the last decade, partly because of marked changes in the delivery of obstetric care, as well as the building evidence of potential negative outcomes of children of depressed women and the health burden implications of this when considering WHO's projection that depression will be the leading health problem by 2020. This is a concern that is worldwide – and reflected in the EPDS having been translated into 23 languages, 20 of which are provided in this book.
This book is particularly timely, and the likely motivation for its printing is a current heated debate in perinatal psychiatry about the value of screening. The book considers the arguments against and mounts a solid case for the appropriate use of the EPDS in routine care, for the detection, not prediction, of depression. As the authors note, there are a number of studies using well-trained primary care clinicians, where as much as 50% of depression is missed without routine screening. That a small number are incorrectly identified (it has an 86% sensitivity and 78% specificity, and has been validated in Australian populations) needs to be balanced against those who would be missed, and as the authors report, studies suggest a high level of acceptability, particularly when appropriately presented.
The authors rightly discuss the need for appropriate services to manage women once they have been identified – the lack of which being one of the main arguments for not screening. They present their own experience, including feedback about the benefits for women and primary health care professionals of a plan of management, which can be adapted to differing needs.
The book is aimed at those who work in primary and obstetric care. I strongly recommend it to colleagues currently screening or contemplating doing so.