Perinatal depression screening by health cadres in Indonesia: EPDS or Whooley?

Abstract

Purpose This study aims to investigate the feasibility of health cadres in Indonesia to take perinatal depression screening in the community using Edinburgh Postnatal Depression Scale (EPDS) and Whooley. Design/methodology/approach The field study involved 11 health cadres (community volunteers who assist in maternal and child health) who were trained to administrate EPDS and Whooley towards 36 pregnant and postpartum mothers in a low resource urban setting for a month. A comparison of scores from both tools, the number and type of mistakes made by the cadres, and cadres perception about the tools were combined to determine the most feasible tool for cadres in identifying depression symptoms. Findings The results show both tools are comparable for screening depression symptoms in mothers; however, EPDS was better at differentiating the level of symptoms. Whooley, with two case-finding questions, is simpler for cadres, whereas the EPDS is more difficult to be computed by cadres. Cadres support the implementation of such a screening, as it provides a channel for mothers to express their negative feelings. Research limitations/implications The findings indicate Whooley is sufficient for first-level screening in the community by cadres, whereas the EPDS should be used by qualified health-care workers for further evaluation at primary health clinics. Practical implications Health cadres could potentially be trained to use standardized yet simple psychological tools. Involving trained health cadres in integrated maternal mental health services in primary health care in Surabaya, Indonesia is promising. Originality/value The use of the EPDS and the Whooley questions has not been applied in Indonesia particularly among health cadres despite their long-lasting role in primary health-care system.