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

Department of Medical Ethics, Lund University, Sweden, Department of Public Health and Clinical Medicine, Epidemiology, Umeå University, Sweden, Skaraborg Institute for Research and Development, Skövde, Sweden, ingela.krantz{at}skaraborg-institute.se

Bo Eriksson

Nordic School of Public Health, Gothenburg, Sweden

Cristina Lundquist-Persson

Skaraborg Institute for Research and Development, Skövde, Sweden, Department of Psychology, Lund University, Sweden

Beth Maina Ahlberg

Skaraborg Institute for Research and Development, Skövde, Sweden, Department of Women's and Children's Health, Uppsala University, Sweden

Tore Nilstun

Department of Medical Ethics, Lund University, Sweden

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.

Key Words: Autonomy • beneficence • EPDS • ethics • postpartum depression • public health • screening

Scandinavian Journal of Public Health, Vol. 36, No. 2, 211-216 (2008)
DOI: 10.1177/1403494807085392


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