The EPDS and Australian Indigenous women: A systematic review of the literature

Problem: The Edinburgh Postnatal Depression Scale (EPDS) is considered the gold standard in perinatal mental health screening and the Australian Clinical Practice Guidelines recommend universal use. However, screening rates are four times lower with Indigenous Australian women compared to non-Indigenous women. Difficulties have been reported using the EPDS in this context.

Background: Evidence demonstrates the link between perinatal mental health and maternal and child outcomes. Indigenous Australian maternal and child health and wellbeing outcomes remain unacceptably poor across all measured parameters and reported psychological distress and child removal rates are increasing.

Methods: A systematic literature review was conducted to assess the effectiveness, validity, reliability, and cultural safety of the EPDS in the Indigenous Australian context and identify the availability and suitability of any adaptations.

Findings: The EPDS has not been validated for use with Indigenous Australian women.

Discussion: The findings and limitations identified in this review are consistent with concerns in other countries about the cross-cultural use of the EPDS and its sensitivity in predicting risk for postnatal depression amongst Indigenous women. Where adaptations of the EPDS have been used there has been no psychometric and cultural validation beyond the remote communities in which they were developed.

Conclusions: There is no evidence to demonstrate that the EPDS in its current form and application is suitable for screening with Indigenous Australian women. Urgent work is required to evaluate and/or develop culturally meaningful screening tools that are predictive of risk for social and emotional wellbeing and perinatal mental distress in this context.