Methodological restrictions within a birth cohort study examining maternal mood symptoms and postpartum depression
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CORRESPONDENCE
Methodological restrictions within a birth cohort study examining maternal mood symptoms and postpartum depression Alexandra Maduro1 · Frank Elgar1,2 · Ilya Demchenko3 · Andrea Carboni‑Jiménez1 · Noor Mady1 · Fama Tounkara1 · Ram P. Sapkota1,4 · Alain Brunet1,4 Received: 17 June 2020 / Accepted: 6 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
To the Editor, We write to comment on “Maternal mood symptoms in pregnancy and postpartum depression: association with exclusive breastfeeding in a population-based birth cohort” [1]. This study evaluated the associations between maternal mood symptoms during pregnancy and exclusive breastfeeding at 3 months postpartum, and between exclusive breastfeeding at 3 months and maternal depression at 12 months postpartum in a large birth cohort (n = 4,231) in Pelotas, Brazil. Our first concern is with the assessment of mood symptoms by a single question: “During pregnancy, did you have depression or nervous problems?” Single-question assessments can lead to underreporting [2]. Moreover, “depression” and “nervous problems” were left undefined. This approach may have misrepresented the true prevalence of women experiencing such symptoms. When using singleitem measures to assess mood, it is recommended to show This correspondence refers to an article previously published in Social Psychiatry and Psychiatric Epidemiology. The original article can be found here: https://link.springer.com/artic le/10.1007/s00127-019-01827-2.
convergent validity with a reliable scale [3], but it appears that this step was not taken. The Edinburgh Postpartum Depression Scale (EPDS) [4] was used to identify cases. The typical cut-off score on the EPDS to indicate the possibility of postpartum depression is 13, contrary to the cut-off score of 10 used. Furthermore, because some EPDS items assess anxiety and not depression (e.g., “I have been anxious or worried for no good reason”) or events that can normally occur when caring for an infant (e.g., “Things have been getting on top of me”), verifying its factor structure in this sample would have been important. Farías-Antúnez et al. cite a validation study of a Portuguese version of the EPDS involving mothers from the Pelotas birth cohort study [5]. That study showed that the specificity of the EPDS when using a cut-off score of 10 was low (65%). Additionally, a recent systematic review assessing the reliability and validity of the EPDS in low- and middleincome countries concluded that most non-English language versions of the EPDS do not meet the criteria necessary to formally validate the instrument [6], which calls into question its validity and cultural appropriateness for Brazil. This could have compromised participants’ interpretations of the
* Alexandra Maduro [email protected]
Alain Brunet [email protected]
Frank Elgar [email protected]
1
Ilya Demchenko [email protected]
Department of Psychiatry, McGill University, Montreal, Canada
2
Andrea Carboni‑Ji
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