PERINATAL MOOD DISORDERS AND POSTPARTUM DEPRESSION

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Aim of the Study

Postpartum depression (PPD) is a relatively common perinatal mental illness affecting, on average, approximately 13% of postpartum women. The prevalence of PPD is reportedly significantly higher in certain peri-urban areas of South Africa. Furthermore, it is estimated that up to 50% of mothers affected by this illness go undetected. Screening mothers for symptoms of postpartum depression after the birth of their babies is important for the wellbeing of the mother, her infant, and ultimately her entire family. This study aims to address the problem of the unavailability of an Afrikaans screening measure specifically for postpartum depression. The primary objective of this study is to provide an Afrikaans version of an existing postpartum depression screening measure –the Postpartum Depression Screening Scale (PDSS). Another objective of the study was to ascertain the level of agreement between the PDSS and two other self-report screening measures for depression, specifically whether all three screening measures identified the same subgroup of mothers as having major postpartum depression.

Contextualising the Research

The majority of women adapt well to having a new baby and the demands of motherhood. A significant percentage of women are, however, affected by perinatal mental illness. Postpartum depression is one of the more common perinatal mood disorders. The prevalence estimates vary widely and depend on a number of variables, namely, the assessment measure used, the sampling procedure, diagnostic criteria employed, and the location and cultural attributes of the population. In a very poor periurban settlement near Cape Town, South Africa, a 34.7% prevalence rate for PPD was reported (Cooper, Tomlinson, Swartz, Woolgar, Murray, & Molteno, 1999). This figure is roughly three times the expected rate internationally. High levels of social adversity were endemic in this South African population and maternal PPD was associated with disturbances in the mother-infant relationship and the absence of support from the woman’s partner.

An Overview of the Research Method

Translation of the PDSS into Afrikaans was performed using a multiple translation technique: Brislin’s back-translation method advocated by Brislin (1970) and the committee approach. A combination of the committee approach and the back translation technique has often been used by researchers (Van de Vijver & Leung, 1997b). The back- translation method was selected as it is regarded to be especially useful in cross-cultural research for checking the equivalence of the translations of measures in different languages (Bracken & Barona, 1991; Prieto, 1992).

Orientation

This study is presented in nine chapters. Chapter one has covered the aim of this study, the contextualisation of the research, given an overview of the research methodology employed, and an outline of the orientation.

ACKNOWLEDGEMENTS
ABSTRACT
CHAPTER 1 INTRODUCTION
1.1 Aim of the Study
1.2 Contextualising the Research
1.3 An Overview of the Research Method
1.4 Orientation
CHAPTER 2 PERINATAL MOOD DISORDERS AND POSTPARTUM DEPRESSION
2.1 Chapter Preview
2.2 Introduction
2.3 Perinatal Mood Disorders
2.3.1 Antenatal mood and anxiety disorders
2.3.2 Postpartum blues
2.3.3 Postpartum depression
2.3.4 Obsessive-compulsive disorder occurring in the postpartum period
2.3.5 Postpartum onset of panic disorder
2.3.6 Postpartum posttraumatic stress disorder
2.3.7 Puerperal psychosis
2.3.8 Anger in the postpartum period
2.4 Postpartum Depression
2.4.1 Historical perspectives
2.4.2 Diagnosing postpartum depression
2.4.3 Symptoms of postpartum depression
2.4.3.1 Symptom overlap between the postpartum period and postpartum depression.
2.4.3.2 Symptoms of postpartum depression versus depression
2.4.3.3 Symptoms of postpartum depression
2.4.4 Prevalence of postpartum depression
2.4.5 Clinical course of postpartum depression
2.4.6 Perspectives on the etiology of postpartum depression
2.4.7 Risk factors for postpartum depression
2.4.7.1 Antenatal depression and anxiety
2.4.7.2 Past history of depression
2.4.7.3 Postpartum blues
2.4.7.4 Hormonal changes
2.4.7.5 Obstetric risk factors
2.4.7.6 Psychosocial adjustments
2.4.7.7 Self-esteem
2.4.7.8 Personality organization
2.4.7.9 Infant temperament
2.4.7.10 Sleep deprivation
2.4.7.11 Lack of support
2.4.7.12 Marital difficulties
2.4.7.13 Single parenthood
2.4.7.14 Adolescent age
2.4.7.15 Unplanned pregnancy, ambivalence about having a child
2.4.7.16 Maternal or paternal unemployment or poverty
2.4.7.17 Childcare stress
2.4.7.18 High stress levels and adverse life events
2.4.8 Consequences of postpartum depression
2.5 Conclusion
CHAPTER 3 SCREENING FOR POSTPARTUM DEPRESSION
3.1 Chapter Preview
3.2 Screening for Postpartum Depression
3.3 Screening Measures
3.3.1 The Beck Depression Inventory (BDI and BDI-II)
3.3.2 The Inventory of Depressive Symptomatology (IDS) and Quick Inventory Depressive Symptomatology (QIDS)
3.3.3 The Bromley Postnatal Depression Scale (BPDS)
3.3.4 The Edinburgh Postnatal Depression Scale (EPDS)
3.3.5 The Postpartum Depression Screening Scale (PDSS)
3.4 Conceptual Basis of the PDSS
3.5 Development of the PDSS
3.5.1 Generation of items
3.5.2 Item content validity
3.6 Psychometric Properties of the PDSS
3.6.1 Reliability
3.6.2 Validity
3.6.2.1 Confirmatory factor analysis
3.6.2.2 Item response theory
3.7 Comparative Analysis of the Performance of the PDSS with Other Depression of Instruments
3.8 Conclusion
CHAPTER 4 CROSS-CULTURAL ASSESSMENT
4.1 Chapter Preview
4.2 Cross-Cultural Assessment
4.2.1 Multicultural assessment in South Africa
4.2.1.1 Instrument development versus translation and adaptation
4.2.1.2 Progression of psychological assessment in South Africa
4.3 Culture-Fair Tests
4.4 Factors Influencing Cross-Cultural Assessment
4.4.1 Schooling
4.4.2 Language
4.4.3 Culture
4.4.4 Environmental factors
4.4.4.1 The home environment
4.4.4.2 Socio-economic status
4.4.4.3 Urbanization
4.5 Methodological Considerations in Cross-Cultural Assessment
4.5.1 Bias
4.5.1.1 Construct bias
4.5.1.2 Method bias
4.5.1.3 Item bias
4.5.2 Equivalence
4.5.2.1 Construct equivalence
4.5.2.2 Measurement unit equivalence
4.5.2.3 Scalar equivalence
4.5.2.4 Linguistic equivalence
4.6 Ethical Guidelines for Adaptation of Cross-Cultural Assessment Measures
4.7 Translating Assessment Measures
4.7.1 Techniques in translating instruments
4.7.1.1 One way or bilingual translation
4.7.1.2 Forward-translation
4.7.1.3 Modified direct translation
4.7.1.4 Parallel blind translation
4.7.1.5 Committee approach
4.7.1.6 Pilot-testing or pretest
4.7.1.7 Field-testing
4.7.1.8 Random probe
4.7.1.9 Decentering
4.7.1.10 Back-translation
4.7.2 Translation procedure
4.7.2.1 Application
4.7.2.2 Adaptation
4.7.2.3 Assembly
4.8 Conclusion
CHAPTER 5 A CULTURAL APPROACH TO PERINATAL MOOD DISORDERS
5.1 Chapter Preview
5.2 Paradigms of Mental Illness
5.3 Prevalence of PPD Across Different Cultures
5.4 Environmental and Cultural Influence on PPD Prevalence
5.5 Symptom Definition and Expression Across Cultures
5.6 Cultural Factors, Beliefs, and Rituals Associated With Pregnancy and Childbirth in South Africa
5.7 Use of PPD Screening Measures Across Different Cultures
5.8 Conclusion
CHAPTER 6 AFRIKAANS-SPEAKING SOUTH AFRICANS
6.1 Chapter Preview
6.2 Definition of Terms
6.2.1 Afrikaner
6.2.2 Culture
6.2.3 Cultural group
6.2.4 Ethnic group
6.2.5 Racial group
6.2.6 Classification group
6.3 Historical Overview
6.4 The Development of Afrikaans
6.4.1 The history of the Afrikaans language
6.4.2 The influence of other languages
6.4.3 Landmarks in the extension of the functions of Afrikaans
6.5 Linguistic Diversity in South Africa
6.6 Afrikaans-Speaking People: The Coloured – White Dichotomy
6.6.1 Classification and identification of Coloured and White Afrikaans-speakers
6.6.2 Implications of classification
6.7 Demographic Features
6.7.1 Geographical region
6.7.2 Language
6.8 Conclusion
CHAPTER 7 RESEARCH DESIGN AND METHODOLOGY
7.1 Introduction
7.2 Primary Objective of the Research
7.3 Research Methods and Designs Used in the Study
7.3.1 Multiple translation method: Brislin’s back-translation method and the committee approach
7.3.2 Item response theory and the Rasch measurement model
7.4 Advantages of Item Response Theory and the Rasch Measurement Model over Classical Test Theory
7.4.1 Focus on item-level
7.4.2 Better construct interpretation
7.4.3 Better measurement precision across the continuum of the variable
7.4.4 Test development
7.4.5 Information on category functioning
7.4.6 Scoring methods
7.4.7 Differential item functioning
7.4.8 Administrative efficiency and item banking
7.4.9 Additivity
7.4.10 Superior reliability estimates
7.5 Participants and Sampling Procedures
7.5.1 Participants for the translating process
7.5.2 Participants for the English PPD screening process
7.5.3 Participants for the Afrikaans PPD screening process
7.6 Measures
7.6.1 Demographic questionnaire
7.6.2 The Postpartum Depression Screening Scale (PDSS)
7.6.3 The Edinburgh Postnatal Depression Scale (EPDS)
7.6.4 The Quick Inventory for Depressive Symptomatology – Self Report (QIDS-SR16)
7.7 Procedure
7.7.1 Procedure for the translation of the PDSS
7.7.2 Procedure for the translation of the QIDS-SR
7.7.3 Procedure for the screening process
7.8 Ethical Considerations
7.9 Data Analysis
7.9.1 Descriptive statistics for the PDSS
7.9.2 Qualitative data analysis
7.9.3 Quantitative data analysis
7.9.3.1 Rasch analysis
7.9.3.2 Multiple regression analysis
7.9.3.3 Correlation of PDSS, EPDS, and QIDS-SR16 total scores
CHAPTER 8 RESULTS AND DISCUSSION
8.1 Introduction
8.2 Descriptive Statistics
8.3 Results of Rasch Analysis of the English PDSS
8.3.1 Summary of English Rasch analysis: persons and items
8.3.2 Rating scale requirements: English PDSS
8.3.3 Item person construct map: English PDSS
8.3.4 Item fit: English PDSS
8.3.5 Dimensionality: English PDSS
8.3.6 Performance of English PDSS dimensions: Rasch analysis of persons and items 376
8.3.6.1 Sleeping/Eating Disturbances (SLP) dimension
8.3.6.2 Anxiety/Insecurity (ANX) dimension
8.3.6.3 Emotional Lability (ELB) dimension
8.3.6.4 Mental Confusion (MNT) dimension
8.3.6.5 Loss of Self (LOS) dimension
8.3.6.6 Guilt/Shame (GLT) dimension
8.3.6.7 Suicidal Thoughts (SUI) dimension
8.3.7 Item Fit Statistics for the PDSS Dimensions
8.3.7.1 Sleeping/Eating Disturbances (SLP) dimension
8.3.7.2 Anxiety/Insecurity (ANX) dimension
8.3.7.3 Emotional Lability (ELB) dimension
8.3.7.4 Mental Confusion (MNT) dimension
8.3.7.5 Loss of Self (LOS) dimension
8.3.7.6 Guilt/Shame (GLT) dimension
8.3.7.7 Suicidal Thoughts (SUI) dimension
8.3.8 Response category statistics: Item option and distractor frequencies for the PDSS dimensions
8.4 Results of Rasch Analysis of the Afrikaans PDSS
8.4.1 Summary of Afrikaans Rasch analysis: persons and items
8.4.2 Rating scale requirements: Afrikaans PDSS
8.4.3 Item person construct map: Afrikaans PDSS
8.4.4 Item fit: Afrikaans PDSS
8.4.5 Dimensionality: Afrikaans PDSS
8.4.6 Performance of Afrikaans PDSS dimensions: Rasch analysis of persons and items
8.4.6.1 Afrikaans Sleeping/Eating Disturbances (SLP) dimension
8.4.6.2 Afrikaans Anxiety/Insecurity (ANX) dimension
8.4.6.3 Afrikaans Emotional Lability (ELB) dimension
8.4.6.4 Afrikaans Mental Confusion (MNT) dimension
8.4.6.5 Afrikaans Loss of Self (LOS) dimension
8.4.6.6 Afrikaans Guilt/Shame (GLT) dimension
8.4.6.7 Afrikaans Suicidal Thoughts (SUI) dimension
8.4.7 Item fit statistics for the Afrikaans PDSS dimensions
8.4.7.1 Afrikaans Sleeping/Eating Disturbances (SLP) dimension
8.4.7.2 Afrikaans Anxiety/Insecurity (ANX) dimension
8.4.7.3 Afrikaans Emotional Lability (ELB) dimension
8.4.7.4 Afrikaans Mental Confusion (MNT) dimension
8.4.7.5 Afrikaans Loss of Self (LOS) dimension
8.4.7.6 Afrikaans Guilt/Shame (GLT) dimension
8.4.7.7 Afrikaans Suicidal Thoughts (SUI) dimension
8.4.8 Response category statistics: Item option and distractor frequencies for the Afrikaans PDSS dimensions
8.5 Items Marked as Difficult to Understand
8.6 Invariance and Differential Item Functioning
8.7 Results of the Analysis of Risk Factors for PPD
8.8 Results of the Comparison of the PDSS, the EPDS, and the QIDS-SR16
8.9 Discussion
8.9.1 Discussion of Rasch analysis
8.9.2 Discussion of problematic items and items with differential item functioning.
8.9.3 Discussion of the risk factors for major PPD in this study
8.9.4 Discussion of the correlation of the PDSS, the EPDS, and the QIDS-SR16.
CHAPTER 9 CONCLUSION, LIMITATIONS, AND RECOMMENDATIONS FOR FUTURE RESEARCH

GET THE COMPLETE PROJECT
The translation and validation of the Postpartum Depression Screening Scale (PDSS): towards improving screening for postpartum depression in English- and Afrikaans- speaking South African women