Screening for Postpartum Depression in American Indian/Alaska Native Women: A Comparison of Two Instruments

This review examined validation studies of the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9) to identify an appropriate postpartum depression (PPD) screening tool for American Indian and Alaska Native (AI/AN) women in the U.S. Databases were searched using: EPDS paired with psychometric properties or validation and PHQ-9 paired with PPD and psychometric properties or validation, yielding a final sample of 58 articles. Both tools have good internal consistency, but discriminative validity for detecting PPD in women from non-Western cultures is low. Positive predictive values in these women are low and diverse (EPDS [n = 21] median 67%, range 21.1-90%; PHQ-9 [n = 1] median 26%). The low predictive accuracy of both tools suggests the tools may be culturally biased.