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Screening for postpartum depression with the Edinburgh Postnatal Depression Scale (EPDS): an ethical analysis.

Krantz, Ingela LU ; Eriksson, Bo; Lundquist-Persson, Cristina; Ahlberg, Beth Maina and Nilstun, Tore LU (2008) In Scandinavian Journal of Public Health 36(2). p.211-216
Abstract
AIMS: To assess the Edinburgh Postnatal Depression Scale (EPDS), a self-administered questionnaire created to screen for symptoms of postpartum depression in the community, from an epidemiological and ethical perspective. Screening, as the practice of investigating apparently healthy individuals to detect unrecognised disease or its precursors, has interpretation problems and is complicated by deliberations on probabilities for something to occur, on which the scientific community is unanimous. METHODS: Our ethical analysis is made using a framework with two different dimensions, the ethical principles autonomy and beneficence and the affected persons. To balance the ethical costs and the ethical benefits of EPDS an analogy with the... (More)
AIMS: To assess the Edinburgh Postnatal Depression Scale (EPDS), a self-administered questionnaire created to screen for symptoms of postpartum depression in the community, from an epidemiological and ethical perspective. Screening, as the practice of investigating apparently healthy individuals to detect unrecognised disease or its precursors, has interpretation problems and is complicated by deliberations on probabilities for something to occur, on which the scientific community is unanimous. METHODS: Our ethical analysis is made using a framework with two different dimensions, the ethical principles autonomy and beneficence and the affected persons. To balance the ethical costs and the ethical benefits of EPDS an analogy with the assessment of pharmaceutics is used. RESULTS: In this article we argue that routine EPDS screening of Swedish postpartum women would lead to considerable ethical problems due to the weak scientific foundation of the screening instrument. Despite a multitude of published studies, the side-effects in terms of misclassifications have not been considered carefully. The EPDS does not function very well as a routine screening instrument. The dualism created is too reductive and fails to recognize the plurality of difference that exists in the social word. CONCLUSIONS: Public health authorities should not advocate screening of unproved value. Screening is not just a medical issue but also an ethical one. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Sweden: epidemiology, Mass Screening: methods, Mass Screening: ethics, Mass Screening: adverse effects, Postpartum: diagnosis, Depression, Postpartum: epidemiology
in
Scandinavian Journal of Public Health
volume
36
issue
2
pages
211 - 216
publisher
Taylor & Francis
external identifiers
  • WOS:000255067200014
  • PMID:18519287
  • Scopus:40549085047
ISSN
1651-1905
DOI
10.1177/1403494807085392
language
English
LU publication?
yes
id
d01c2368-ee6a-4d2e-988c-056f8437dbcc (old id 1169317)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18519287?dopt=Abstract
date added to LUP
2008-07-02 15:09:05
date last changed
2016-10-13 04:26:07
@misc{d01c2368-ee6a-4d2e-988c-056f8437dbcc,
  abstract     = {AIMS: To assess the Edinburgh Postnatal Depression Scale (EPDS), a self-administered questionnaire created to screen for symptoms of postpartum depression in the community, from an epidemiological and ethical perspective. Screening, as the practice of investigating apparently healthy individuals to detect unrecognised disease or its precursors, has interpretation problems and is complicated by deliberations on probabilities for something to occur, on which the scientific community is unanimous. METHODS: Our ethical analysis is made using a framework with two different dimensions, the ethical principles autonomy and beneficence and the affected persons. To balance the ethical costs and the ethical benefits of EPDS an analogy with the assessment of pharmaceutics is used. RESULTS: In this article we argue that routine EPDS screening of Swedish postpartum women would lead to considerable ethical problems due to the weak scientific foundation of the screening instrument. Despite a multitude of published studies, the side-effects in terms of misclassifications have not been considered carefully. The EPDS does not function very well as a routine screening instrument. The dualism created is too reductive and fails to recognize the plurality of difference that exists in the social word. CONCLUSIONS: Public health authorities should not advocate screening of unproved value. Screening is not just a medical issue but also an ethical one.},
  author       = {Krantz, Ingela and Eriksson, Bo and Lundquist-Persson, Cristina and Ahlberg, Beth Maina and Nilstun, Tore},
  issn         = {1651-1905},
  keyword      = {Sweden: epidemiology,Mass Screening: methods,Mass Screening: ethics,Mass Screening: adverse effects,Postpartum: diagnosis,Depression,Postpartum: epidemiology},
  language     = {eng},
  number       = {2},
  pages        = {211--216},
  publisher    = {ARRAY(0x974d5d8)},
  series       = {Scandinavian Journal of Public Health},
  title        = {Screening for postpartum depression with the Edinburgh Postnatal Depression Scale (EPDS): an ethical analysis.},
  url          = {http://dx.doi.org/10.1177/1403494807085392},
  volume       = {36},
  year         = {2008},
}