Perinatal depression in a cross-cultural perspective: how useful is assesment through Edinburgh Postnatal Depression Scale in developing countries?

Perinatal mood disorders are shown to be relevant risk factors for the women's wellbeing, therefore special attention to this time of adjustment is clinically relevant. In a cross-cultural perspective, there is a wide variability in the way each culture expresses psychological distress and depressive symptoms. For example, in Africa depression is expressed mainly through somatic symptoms (sleeping problems, eating problems and weight fluctuation, pain). In Asia and particularly in Vietnamese culture, emotions are considered weaknesses of the mind, therefore complaining is rare. The EPDS is a self-report questionnaire and it is one of the most used instruments to identify perinatal depressive symptoms. Our curiosity was focused on 3 aspects regarding the use of EPDS in developing countries: How is it been used? Did it show to be a valid instrument? Which was the rate of symptoms detected by EPDS in different countries? At this purpose, we undertook a systematic review of the literature. The collected articles identified a high variability in the rate of perinatal depressive symptoms, even though the prevalence of depression was detected considering the EPDS alone. This high variability might be due to the different cut-off scores used, the time of the assessment, and the sample characteristics. Moreover, the prevalence of depression was significantly higher in developing countries than in western countries, most of studies reporting rates between 20% and 40%. Our preliminary consideration focus on the need to further explore the concept of perinatal depression in developing countries and the methods used for its detection. The heterogeneity of the findings might reflect in fact a miscellaneous context, but also difficulties due to the structure of the instrument. For what concern developing countries, we should note a tendency to express depressive symptoms through somatic problems. However, EPDS does not explore somatic symptoms as it has been developed in western context. Therefore, further investigations are needed in this field.