Cited by 518Maternal Mental Health During Pregnancy and PostpartumAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychometric Methodologies and Testing

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Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners

Matthey, Stephen, Barnett, Bryanne, Kavanagh, David J., Howie, Pauline·2001·Journal of Affective Disorders

DOI 10.1016/s0165-0327(00)00236-6

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Abstract

Background The Edinburgh Postnatal Depression Scale (EPDS) has been validated and used extensively in screening for depression in new mothers, both in English speaking and non-English speaking communities. While some studies have reported the use of the EPDS with fathers, none have validated it for this group, and thus the appropriate cut-off score for screening for depression or anxiety caseness for this population is not known.Methods Couples were recruited antenatally and interviewed at six weeks postpartum. EPDS scores and distress caseness (depression or anxiety disorders) for 208 fathers and 230 mothers were determined using the Diagnostic Interview Schedule.Results Analyses of the EPDS for fathers using distress caseness (depression or anxiety disorders) as the criterion shows that a cut-off of 5/6 has optimum receiver operating characteristics. Furthermore acceptable reliability (split-half and internal consistency) and validity (concurrent) coefficients were obtained. For mothers the optimum cut-off screening value to detect distress caseness was 7/8. Item analysis revealed that fathers endorsed seven of the ten items at lower rates to mothers, with the most significant being that referring to crying.Conclusions The EPDS is a reliable and valid measure of mood in fathers. Screening for depression or anxiety disorders in fathers requires a two point lower cut-off than screening for depression or anxiety in mothers, and we recommend this cut-off to be 5/6.

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“modified optimum cut-off scores during pregnancy (Murray & Cox, 1990), in fathers ( Matthey et al, 2001 ), and in a number of ethnocultural communities (O’Hara, 1994).”
Background
Effects of an intervention program on maternal and paternal parenting stress after preterm birth: A randomized trial
Castel, S., Creveuil, C., Beunard, A., Blaizot, X., Proia, N., & Guillois, B. (2016) · Early Human Development · doi:10.1016/j.earlhumdev.2016.05.007 · Cited by 60
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Background
The evaluation of tailored and web‐based information for new fathers
Fletcher, R. J., Vimpani, G., Russell, G., & Keatinge, D. (2008) · Child Care Health and Development · doi:10.1111/j.1365-2214.2008.00811.x · Cited by 60
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Influential
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Background
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“…tools such as the Edinburgh Postnatal Depression Scale (EPDS) (56) may be used for screening, referring to cut-oﬀ scores identiﬁed for the fathers (57) or using the Perinatal Assessment of Paternal Aﬀectivity (PAPA) (58), one of the few that evaluates not only the anxious and depressive…”
Method
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Kerstis, B., Engström, G., Edlund, B., & Aarts, C. (2013) · Scandinavian Journal of Public Health · doi:10.1177/1403494812472006 · Cited by 59
“Another limitation is that EPDS has sparingly been validated on men [22] and, to our knowledge, only on men from Australia.”
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“All the studies included measures of depression compared to the reference test; three of the studies also assess generalized anxiety disorder, panic disorder, or its comorbidities (Massoudi et al., 2013; Matthey et al., 2001; Tran et al., 2012).”
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“Even though the EDS was originally designed to assess postpartum depression, later evidence showed that it is also valid for use in other (male and female) strata (Becht et al., 2001; Cox et al., 1996; Matthey et al., 2001; Nyklicek et al., 2004).”
Background
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“, 1987), developed for mothers, has been validated in fathers also (Matthey et al., 2001; Edmondson et al., 2010; Lai et al., 2010; Loscalzo et al., 2015) using lower cut-off scores to detect major depression and anxiety disorders in the latter.”
Background
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Method
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“The EPDS has been demonstrated to be a valid tool to identify depression among fathers (Edmondson et al., 2010; Lai et al., 2010; Loscalzo et al., 2015; Massoudi et al., 2013; Matthey et al., 2001; Tran et al., 2012).”
BackgroundMethodResultInfluential
Postpartum Depression in Men.
Scarff, J. R. (2019) · PubMed Central · Cited by 49
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“Data analyses Descriptive statistics and frequencies were calculated to examine levels of paternal depressive symptoms at 15 and 21 weeks into the postnatal period based on an optimal cutoff of ≥ 10 for fathers recommended by Matthey et al. (2001).”
BackgroundMethodInfluential
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“The Edinburgh Postnatal Depression Scale (EPDS; Cox, Holden, & Sagovsky, 1987) has been used widely as a screening tool for perinatal depression in mothers (beyondblue, 2009; Buist et al., 2002; Matthey et al. 2001; Phillips, Charles, Sharpe, & Matthey, 2009).”
Method
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“The secondary outcome was improvement in fathers’ parenting capacities.”
Background
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“However, Matthey et al [42], in the only study to have validated the EPDS in fathers, found the optimal cut-off score for men to be 2 points lower than for women.”
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“The EPDS had satisfactory internal consistency for men (Cronbach’s a 1⁄4 .81; Matthey et al., 2001) and women (Cronbach’s a 1⁄4 .”
BackgroundMethodInfluential
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“Although t was originally created to screen for depressive symptoms in mothers, the EPDS has also been validated for fathers [19].”
Background
Developing a common metric for depression across adulthood: Linking PROMIS depression with the Edinburgh Postnatal Depression Scale.
Blackwell, C. K., Tang, X., Elliott, A., Thomes, T., Louwagie, H., Gershon, R. C., Schalet, B. D., & Cella, D. F. (2021) · Psychological Assessment · doi:10.1037/pas0001009 · Cited by 43
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“This scale was originally designed for use with mothers but has been validated in fathers (44) as well as racial/ethnic minorities (45).”
BackgroundMethod
Inpatient treatment of women with postpartum psychiatric disorders – the role of the male partners
Grube, M. (2005) · Archives of Women s Mental Health · doi:10.1007/s00737-005-0087-7 · Cited by 42
“Matthey et al. (2001) detected depression and anxiety disorders in male partners of new mothers with the help of the Edinburgh postnatal depression scale.”
Method
The impact of diagnosed fetal anomaly, diagnostic severity and prognostic ambiguity on parental depression and traumatic stress: a prospective longitudinal cohort study
Oftedal, A., Bekkhus, M., Haugen, G. N., Czajkowski, N. O., & Kaasen, A. (2022) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.14453 · Cited by 41
Comparisons of different instruments to measure blues and to predict depressive symptoms 2 months postpartum: a study of new mothers and fathers
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Associations of paternal postpartum depressive symptoms and infant development in a Chinese longitudinal study
Ip, P., Li, T. M. H., Chan, K. L., Ting, A., Chan, C. Y., Koh, Y. W., Ho, F. K. W., & Lee, A. M. (2018) · Infant Behavior and Development · doi:10.1016/j.infbeh.2018.08.002 · Cited by 41
Differential susceptibility to fathers' care and involvement: the moderating effect of infant reactivity
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“Although the EPDS was developed to screen for depression in women postnatally, it has also been validated in men (Matthey, Barnett, Kavanagh, & Howie, 2001 ).”
Method
Motion and emotion: depression reduces psychomotor performance and alters affective movements in caregiving interactions
Young, K. S., Parsons, C. E., Stein, A., & Kringelbach, M. L. (2015) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2015.00026 · Cited by 38
“The EPDS has been validated for use with women outside the postnatal period (Cox et al., 1996) and fathers (Matthey et al., 2001).”
BackgroundMethodInfluential
Predictive Factors for Depression and Anxiety in Men During the Perinatal Period: A Mixed Methods Study
Chhabra, J., Li, W. W., & McDERMOTT, B. M. (2022) · American Journal of Men s Health · doi:10.1177/15579883221079489 · Cited by 38
“Although EPDS was originally developed to assess perinatal anxiety and depression in mothers (Cox & Holden, 2003), it has been validated by researchers to assess perinatal depression and anxiety in fathers as well (Edmondson et al., 2010; Matthey et al., 2001, 2003, 2020).”
BackgroundMethod
Fathers’ postnatal depressive and anxiety symptoms: An exploration of links with paternal, maternal, infant and family factors
Luoma, I., Puura, K., Mäntymaa, M., Latva, R., Salmelin, R. K., & Tamminen, T. (2013) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2012.752034 · Cited by 38
Associations Between Postpartum Depressive Symptoms and Couples' Sexual Function and Sexual Distress Trajectories Across the Transition to Parenthood.
Dawson, S. J., Leonhardt, N. D., Impett, E., & Rosen, N. (2021) · Annals of Behavioral Medicine · doi:10.1093/abm/kaaa117 · Cited by 31
“This 10-item measure assesses depressive symptoms in the past week and is validated for use in both women and men [33, 34].”
Method
Maternal mental health mediates links between socioeconomic status and child development
Smith, T. A., Kievit, R., & Astle, D. E. (2022) · Current Psychology · doi:10.1007/s12144-022-03181-0 · Cited by 49
“This globally administered measure of depression during the perinatal period has been shown to be sensitive to changes in depression in both men and women over time (Cox, 2017; Matthey et al., 2001).”
Background
Internet administration of the Edinburgh Depression Scale
Spek, V., Nyklı́ček, I., Cuijpers, P. J., & Pop, V. J. M. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.07.003 · Cited by 37
“, 2004) and in men (Matthey et al., 2001) and renamed the EDS.”
BackgroundMethod
Survey on examining prevalence of paternal anxiety and its risk factors in perinatal period in Hong Kong: a longitudinal study
Koh, Y. W., Lee, A. M., Chan, C. Y., Fong, D., Lee, C. P., Leung, K. Y., & Tang, C. S. (2015) · BMC Public Health · doi:10.1186/s12889-015-2436-4 · Cited by 42
“The reciprocal relationship between the mental health of both parties within the couple was documented in previous studies [1, 4].”
BackgroundResult
Enhancing relationship functioning during the transition to parenthood: a cluster-randomised controlled trial
Daley-McCoy, C., Rogers, M., & Slade, P. (2015) · Archives of Women s Mental Health · doi:10.1007/s00737-015-0510-7 · Cited by 37
“This measure is also validated for new fathers (Matthey et al. 2001), as well as having good sensitivity and specificity for antenatal use (Bunevicius et al.”
BackgroundMethodInfluential
Differences in psychophysical well-being and signs of depression in couples undergoing their first consultation for assisted reproduction technology (ART): an Italian pilot study
Valoriani, V., Lotti, F., Lari, D., Miccinesi, G., Vaiani, S., Vanni, C., Coccia, M. E., Maggi, M., & Noci, I. (2015) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2015.11.041 · Cited by 34
The Dynamics of Eudaimonic Well-Being in the Transition to Parenthood: Differences Between Fathers and Mothers
Brandel, M., Melchiorri, E., & Ruini, C. (2018) · Journal of Family Issues · doi:10.1177/0192513x18758344 · Cited by 42
“Since the questionnaire is developed for women and a validation for men showed that men systematically score lower on EPDS than their female partners (Matthey et al., 2001), the measure was kept in the analyses.”
Method
Effect of couple‐based cognitive behavioural intervention on prevention of postnatal depression: multisite randomised controlled trial
Ngai, F., Wong, P., Chung, K., Chau, P., & Hui, P. (2020) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.15862 · Cited by 42
Instruments to Identify Symptoms of Paternal Depression During Pregnancy and the First Postpartum Year: A Systematic Scoping Review
Berg, R. C., Solberg, B., Glavin, K., & Olsvold, N. (2022) · American Journal of Men s Health · doi:10.1177/15579883221114984 · Cited by 35
“Although we found that it appears reliable and valid, the lack of gender-specific items may lead to underdetection of symptoms in fathers (Matthey et al., 2001; Philpott et al., 2020) and it is unclear whether EPDS and the other instruments uniquely identify depressive symptoms, or a broader state of mind, characteriz…”
BackgroundMethodResultInfluential
Paternal psychological response after ultrasonographic detection of structural fetal anomalies with a comparison to maternal response: a cohort study
Kaasen, A., Helbig, A., Malt, U. F., Næs, T., Skari, H., & Haugen, G. N. (2013) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-13-147 · Cited by 35
Reliability and validity of the German version of the Maternal–Fetal Attachment Scale
Doster, A., Wallwiener, S., Müller, M., Matthies, L. M., Plewniok, K., Feller, S., Kuon, R., Sohn, C., Rom, J., Wallwiener, M., et al. (2018) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-018-4676-x · Cited by 36
“It consists of 10 items scored from 0 to 3 (normal response 0 and severe response 3) assessing depressive symptoms during the past 7 days [38].”
Background
Fathers’ experiences of depression during the perinatal period: a qualitative systematic review
Davenport, C. J., Lambie, J., Owen, C., & Swami, V. (2022) · JBI Evidence Synthesis · doi:10.11124/jbies-21-00365 · Cited by 36
Fathers with PTSD and depression in pregnancies complicated by preterm preeclampsia or PPROM
Stramrood, C. A. I., Doornbos, B., Wessel, I., van Geenen, M., Aarnoudse, J. G., van den Berg, P. P., Schultz, W. C. M. W., & van Pampus, M. G. (2012) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-012-2611-0 · Cited by 34
“3 times more likely to develop PTSD following a traumatic event than men [55]; (c) postpartum depression in men may develop following the onset of depression in women [52]; (d) women have actually experienced pregnancy, labor (pain) and obstetric interventions, while men have merely witnessed, and therefore effects of…”
Background
SMS4dads: Providing information and support to new fathers through mobile phones – a pilot study
Fletcher, R. J., May, C. D., KAY‐LAMBKIN, F. J., Gemmill, A. W., Cann, W. G., Nicholson, J. M., Rawlinson, C., Milgrom, J., Highet, N. J., Foureur, M. J., et al. (2016) · Advances in Mental Health · doi:10.1080/18387357.2016.1245586 · Cited by 35
Pathways to Parenting: Predictors of Prenatal Bonding in a Sample of Expectant Mothers and Fathers Exposed to Contextual Risk
Dayton, C. J., Brown, S., Goletz, J., Hicks, L. M., Barron, C. C., Sperlich, M., & Smith‐Darden, J. P. (2019) · Journal of Child and Family Studies · doi:10.1007/s10826-019-01343-6 · Cited by 41
Fathers massaging and relaxing their pregnant wives lowered anxiety and facilitated marital adjustment
Latifses, V., Estroff, D. B., Field, T. M., & Bush, J. P. (2005) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2005.02.004 · Cited by 34
The impact of resilience on psychological outcomes in women with threatened premature labor and spouses: a cross-sectional study in Southwest China
Nie, C., Dai, Q., Zhao, R., Dong, Y., Chen, Y., & Ren, H. (2017) · Health and Quality of Life Outcomes · doi:10.1186/s12955-017-0603-2 · Cited by 33
“It has also been validated for use in the antenatal period [37] and among men as measurement of paternal depression [38].”
Background
Increased rate of parental postpartum depression and traumatization in moderate and late preterm infants is independent of the infant's motor repertoire
Mehler, K., Mainusch, A., Hucklenbruch‐Rother, E., Hahn, M., Hünseler, C., & Kribs, A. (2014) · Early Human Development · doi:10.1016/j.earlhumdev.2014.09.008 · Cited by 33
WHEN MUM IS STRESSED, IS DAD JUST AS STRESSED? PREDICTORS OF PATERNAL STRESS IN THE FIRST SIX MONTHS OF HAVING A BABY
Seah, C. K. F., & Morawska, A. (2015) · Infant Mental Health Journal · doi:10.1002/imhj.21546 · Cited by 33
Psychosocial assessment of expectant fathers
Fletcher, R. J., Vimpani, G., Russell, G., & Sibbritt, D. W. (2008) · Archives of Women s Mental Health · doi:10.1007/s00737-008-0211-6 · Cited by 33
“In addition, 16 (5.3%) of the respondents scored above 9 on the EDS, the recommended cutoff for community samples (Buist et al. 2002), and 47 (15.5%) scored above the recommended cutoff score of 6 for males ( Matthey et al. 2001 ).”
BackgroundInfluential
Paternal depression during pregnancy and postpartum: An international Delphi study
Freitas, C. J., Williams‐Reade, J., Distelberg, B. J., Fox, C. A., & Lister, Z. D. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.05.056 · Cited by 33
Differential predictors of birth-related posttraumatic stress disorder symptoms in mothers and fathers – A longitudinal cohort study
Kress, V., von Soest, T., Kopp, M., Wimberger, P., & Garthus‐Niegel, S. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.05.058 · Cited by 32
Trajectories of Postpartum Depression in Italian First-Time Fathers
Molgora, S., Fenaroli, V., Malgaroli, M., & Saita, E. (2017) · American Journal of Men s Health · doi:10.1177/1557988316677692 · Cited by 31
Prevalence and associated factors of paternal stress, anxiety, and depression symptoms in the early postnatal period
Philpott, L. F., Leahy‐Warren, P., Fitzgerald, S. M., & Savage, E. (2022) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.33 · Cited by 31
“A cut-off of 9 (⩾9) was used to identify fathers at risk of minor depression with a cut-off of 12 (⩾12) for major depression (Matthey et al., 2001; Massoudi et al., 2016).”
Method
Dyadic analyses on the prospective association between birth experience and parent-child-bonding: The role of postpartum depression, anxiety, and childbirth-related posttraumatic stress disorder.
Seefeld, L., von Soest, T., Dikmen-Yildiz, P., & Garthus-Niegel, S. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102748 · Cited by 30
DOES FATHERS' PRENATAL MENTAL HEALTH BEAR A RELATIONSHIP TO PARENTING STRESS AT 6 MONTHS?
Skjøthaug, T., Smith, L., Wentzel‐Larsen, T., & Moe, V. (2018) · Infant Mental Health Journal · doi:10.1002/imhj.21739 · Cited by 35
Depressive symptom contagion in the transition to parenthood: Interparental processes and the role of partner-related attachment.
Fredriksen, E., von Soest, T., Smith, L., & Moe, V. (2019) · Journal of Abnormal Psychology · doi:10.1037/abn0000429 · Cited by 30
Adoptive Gay Father Families: A Longitudinal Study of Children’s Adjustment at Early Adolescence
McConnachie, A., Ayed, N., Foley, S., Lamb, M. E., Jadva, V., Tasker, F., & Golombok, S. E. (2020) · Child Development · doi:10.1111/cdev.13442 · Cited by 37
Prevalence of perinatal depression among Japanese men: a meta-analysis
Tokumitsu, K., Sugawara, N., Maruo, K., Suzuki, T., Yasui‐Furukori, N., & Shimoda, K. (2020) · Annals of General Psychiatry · doi:10.1186/s12991-020-00316-0 · Cited by 31
“It is also known that the specificity of the EPDS is superior to that of other available scales in evaluating perinatal depression in men during the transition to parenthood [42].”
Background
Emotion Regulation Strategies and Parenting Practices among Parents of Children With Clinic-Referred Conduct Problems
Kohlhoff, J. R., Hawes, D. J., Mence, M., Russell, A. M. T., Wedgwood, L., & Morgan, S. S. J. (2016) · Parenting · doi:10.1080/15295192.2016.1184942 · Cited by 31
Postpartum Sleep in New Mothers and Fathers
Montgomery‐Downs, H. E., Stremler, R., & Insana, S. (2013) · The Open Sleep Journal · doi:10.2174/1874620901306010087 · Cited by 30
Is it me or you? First-time mothers’ attributions for postpartum sexual concerns are associated with sexual and relationship satisfaction in the transition to parenthood
Vannier, S. A., Adare, K. E., & Rosen, N. (2018) · Journal of Social and Personal Relationships · doi:10.1177/0265407517743086 · Cited by 31
The Impact of Prepartum Depression and Birth Experience on Postpartum Mother-Infant Bonding: A Longitudinal Path Analysis
Eitenmüller, P., Köhler, S., Hirsch, O., & Christiansen, H. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.815822 · Cited by 41
“82, the German EPDS version demonstrates psychometric properties as good as the original version (83).”
Background
Assessing the quality of diagnostic studies using psychometric instruments: applying QUADAS
Mann, R., Hewitt, C. E., & Gilbody, S. M. (2008) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-008-0440-z · Cited by 29
“A few days after this (mean 3 days) they were interviewed in their home [43]”
Background
Risk, resilience, and depressive symptoms in low-income African American fathers.
Bamishigbin, O. N., Schetter, C. D., Guardino, C. M., Stanton, A. L., Schäfer, P., Shalowitz, M. U., Lanzi, R. G., Thorp, J. M., & Raju, T. N. K. (2016) · Cultural Diversity & Ethnic Minority Psychology · doi:10.1037/cdp0000088 · Cited by 29
“Originally developed to measure maternal postpartum depressive symptoms, the EPDS is also a valid and reliable measure in fathers (Cronbach’s α = .81; Matthey et al., 2001).”
Adolescent antecedents of maternal and paternal perinatal depression: a 36-year prospective cohort
Thomson, K., Romaniuk, H., Greenwood, C. J., Letcher, P., Spry, E., Macdonald, J. A., McAnally, H. M., Youssef, G. J., McIntosh, J. E., Hutchinson, D. M., et al. (2020) · Psychological Medicine · doi:10.1017/s0033291720000902 · Cited by 32

Authors: Matthey, S., Barnett, B., Kavanagh, D. J., & Howie, P.
Affiliations: Sydney South West Area Health Service (AU)
The University of Queensland (AU)
The University of Sydney (AU)
Corresponding author: Matthey, Stephen
ORCID: Matthey, Stephen
Kavanagh, David J.
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2001-05
Volume: 64
Issue: 2-3
Pages: 175-184
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/s0165-0327(00)00236-6
OpenAlex: W2010925715
Cited by: 516
References: 45
Citations by year: 2026: 20 · 2025: 27 · 2024: 27 · 2023: 32 · 2022: 33 · 2021: 43 · 2020: 33 · 2019: 23 · 2018: 30 · 2017: 21 · 2016: 23 · 2015: 33 · 2014: 20 · 2013: 17 · 2012: 21
FWCI: 5.77
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Keywords: Edinburgh Postnatal Depression Scale, paternal depression, postpartum depression screening, fathers, mothers, cut-off values, screening validity, screening reliability, couples, crying
MeSH terms: Culture, Depressive Disorder, Fathers, Female, Humans, Male, Mothers, Surveys and Questionnaires, Sensitivity and Specificity, Severity of Illness Index, Reproducibility of Results, Depression, Postpartum

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Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners

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