Unacceptability of routine screening for postnatal depression was related to the screening process, the intrusiveness of questions, and the stigma of disease

摘要

Screening for postnatal depression has become established practice in the UK, and the EPDS is a commonly used screening tool. The study by Shakespeare ef al is the first direct exploration of women's experiences of being screened for postnatal depression.Slightly iess than half the sample found screening acceptable, but the study focused on the 53% who were judged to have found screening an unacceptable experience. It would have been illuminating to know what all participants felt about screening, but the authors report that those who found it acceptable had little to say about their experiences. However, the feelings and opinions of those who did not find it acceptable are important because they provide useful information about service delivery.Central to these women's experiences appears to be the desire for a more human experience, one that involves the health visitor spending time establishing a relationship with the woman to facilitate disclosure of the postnatal experience. The choice of setting was also perceived to contribute to acceptability of the experience. Attention to these details, as well as adequate information about the purpose of the EPDS, could result in the EPDS more accurately reflecting women's mental health.Of great concern is the disclosure that some women deliberately provided socially desirable responses to the EPDS rather than revealing their interior truths. This finding is consistent with another study that identified discrepancies between EPDS scores and women's self reported feelings of depression.1 The behaviour appears to be related to the stigma of a positive screening result and the potential effects of a diagnosis of postnatal depression. Such a diagnosis is perceived as a threat to the family.The findings of the study by Shakespeare et al reinforce that not all women find routine screening acceptable and that the relationship with the HV appears to be of vital importance to accurate screening for postnatal depression.