Experiences of using the Edinburgh Postnatal Depression Scale in the context of antenatal care for Aboriginal mothers: Women and midwives' perspectives

Problem: Routine administration of the Edinburgh Postnatal Depression Scale (EPDS) is intended to promote early detection and preventative support for those who may be at risk of perinatal depression and anxiety. The cultural suitability of the EPDS has not been validated in the Aboriginal Australian context. Background: Marked differences in health outcomes and service access between Australian Aboriginal and non-Aboriginal women and infants continue to exist. Aim: This study aimed to explore the cultural validity of the EPDS through understanding the experiences of Aboriginal women and midwives. Methods: Qualitative data was drawn from semi-structured interviews/yarns with 13 Perth-based Aboriginal antenatal women and 10 non-Aboriginal midwives. Findings: Utilising a grounded theory approach, thematic analysis of verbatim transcripts revealed that, surprisingly, women expressed generally favourable views of the EPDS, especially when the relationships between women and midwives were focused on. Midwives, however, expressed reservations about administering the EPDS and used the EPDS as a conversation-starter rather than as a standardised, standalone tool. Discussion: In attempt to reconcile conflicting perspectives, analysis of recordings extended to evaluate microprocesses in the interviews. At the process level, it was clear that demand characteristics operated in some interviews, including socially desirable response biases, demand biases and acquiescent response styles. Conclusion: This highlights the need for researchers and clinicians to be trained in non-leading interview questioning techniques and in yarning methodology. Researchers and clinicians should also be aware of the cognitive biases and demand characteristics that may influence responding, likely perpetuated by dominant forces of a colonised society.

Automated summary

This study aimed to explore the cultural validity of the EPDS by understanding the experiences of Aboriginal women and midwives. The findings revealed that Aboriginal women generally had positive views of the EPDS, while midwives expressed reservations about its administration. The analysis also revealed the presence of demand characteristics in some interviews, highlighting the need for training in non-leading interview techniques.