Di Florio A, Putnam K, Altemus M, Apter G, Bergink V, Bilszta J, Brock R, Buist A, Deligiannidis K M, Devouche E, Epperson C N, Guille C, Kim D, Lichtenstein P, Magnusson P K E, Martinez P, Munk-Olsen T, Newport J, Payne J, Penninx B W, O'Hara M, Robertson-Blackmore E, Roza S J, Sharkey K M, Stuart S, Tiemeier H, Viktorin A, Schmidt P J, Sullivan P F, Stowe Z N, Wisner K L, Jones I, Rubinow D R, Meltzer-Brody S
Department of Psychiatry,The University of North Carolina at Chapel Hill,Chapel Hill, NC,USA.
Department of Psychiatry,Weill Cornell Medical College,New York, NY,USA.
Psychol Med. 2017 Apr;47(5):787-799. doi: 10.1017/S0033291716002087. Epub 2016 Nov 21.
Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.
Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.
Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) 0.01), but not between European countries (∆*CFI < 0.01).
Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.
许多国家都建议对产后抑郁症进行普遍筛查。了解产后抑郁症状的披露在不同文化中是否存在差异，有助于改进检测方法，并为发病机制提供新的见解。此外，这也是评估筛查工具在研究和临床实践中普遍应用的必要步骤。在本研究中，我们试图评估爱丁堡产后抑郁量表（EPDS），这一最广泛使用的产后抑郁症筛查工具，在一个大型国际数据集中，对不同文化群体的潜在结构测量是否相同。
采用有序回归和测量不变性，以教育程度、种族/民族和大洲来衡量文化，对来自欧洲和美国的8209名新妈妈使用EPDS评估文化与抑郁症状认可之间的关联。
教育程度而非种族/民族影响产后抑郁症的报告[稳健比较拟合指数差异（∆*CFI）为0.01]，但欧洲国家之间无差异（∆*CFI < 0.01）。
研究人员和临床医生应意识到不同教育背景的女性在产后抑郁症表型表达上可能存在的潜在差异。社会文化异质性的增加以及全球化趋势，要求在对患者、研究和政策采取文化敏感的方法，这种方法除了口头表达外，还应考虑个人经历背景以及研究开展的背景。
