The cultural suitability of the Edinburgh Postnatal Depression Scale (EPDS) examined through lived experiences of Aboriginal Australian mothers and midwives

Ai Wen Chan

Despite Australian perinatal initiatives and policies, Aboriginal1 Australian women continue to face significant health and mental health disparities compared to non-Aboriginal counterparts. Perinatal mental health is of particular importance given the implications for mother, child, and family. This study explored cultural attitudes toward, and experiences of, the Edinburgh Postnatal Depression Scale (EPDS). Thirteen antenatal Perth-based Aboriginal mothers and ten non-Aboriginal midwives were interviewed. Midwives expressed some reservations about using the EPDS and reported adapting the current Australian guidelines of the EPDS by using it as a prompt for conversation. Mothers (n = 9/13) reported generally favourable views of this adapted EPDS implementation, especially when empathic and non-judgemental midwives facilitated stronger relationships with mothers. However, it was unclear how much variability there was in implementation between practitioners and consequently, how this non-standard EPDS was implemented with each mother. Moreover, demand characteristics of the interviews resulted in a range of acquiescent-style and socially desirable responses. The presence of response biases most likely reflected the power imbalance in the relationship between mothers, clinicians, and researchers. These underlying forces appeared to influence how mothers responded to being questioned by researchers, and raised questions about whether mother’s responses to the EPDS by practitioners could be influenced in the same way. The observations of midwives in these interviews were congruent with these concerns. In the absence of any other culturally suitable tool for use in this context, this conversational adaptation of EPDS that focuses on client-midwife relationship and an individualised approach to antenatal care was suggested. However, validation through a closer examination of demand characteristics, in parallel with the development of more suitable alternatives should be prioritised. Both researchers and clinical practitioners should be aware of and attend to these deeper challenges in working with Aboriginal mothers, possibly perpetuated by a post-colonisation dominance narrative.

The cultural suitability of the Edinburgh Postnatal Depression Scale (EPDS) examined through lived experiences of Aboriginal Australian mothers and midwives

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