Southern California CSUF DNP Consortium California State University, Fullerton California State University, Long Beach California State University, Los Angeles ADAPTATION OF THE EDINBURGH POSTPARTUM DEPRESSION SCALE FOR VIETNAMESE AMERICANS A DOCTORAL PROJECT Submitted in Partial Fulfillment of the Requirements For the degree of DOCTOR OF NURSING PRACTICE By Thu Anh Pham Doctoral Project Committee: Beth Keely, PhD, RN, Project Chair Margaret Brady, PhD, RN, CPNP-PC, Committee Member 2015 Copyright Thu Anh Pham 2015 © ii ABSTRACT The purpose of this project was to translate and adapt an existing postpartum depression tool, the Edinburgh Postnatal Depression Scale (EPDS), into Vietnamese for use with Vietnamese Americans This project required a two-stage approach The first stage focused on the translation process, which emphasized cultural sensitivity and linguistic appropriateness while retaining the sensitivity of the instrument The second stage involved a pilot study to test the validity and applicability of the translated instrument A total of 34 women returning for a 6-week postpartum checkup at two community clinics were recruited and completed two questionnaires Data collected via the Vietnamese EPDS was compared with the Vietnamese Depression Scale (VDS), a validated depression instrument for the Vietnamese population A correlation coefficient, r = 935, indicated that the two measures (VEPDS and VDS) were highly correlated A cut-off score of 9/10 on the VEPDS was used as the benchmark for suspected postpartum depression The prevalence of postpartum depression among Vietnamese American women in this project was 29% Factors that significantly predicted depression in the Vietnamese women were being unemployed, being single, having some college education, and having a complication during pregnancy The results indicated that the VEPDS was applicable and beneficial to use for screening for postpartum depression among Vietnamese American women iii TABLE OF CONTENTS ABSTRACT iii LIST OF TABLES vi LIST OF FIGURES vii DEDICATION viii ACKNOWLEDGMENTS xix BACKGROUND Needs Assessment and Problem Statement Purpose of the Project Conceptual Framework LITERATURE REVIEW METHODS 14 Ethical Considerations Translation and Cross-Cultural Adaptation Process Tool Development Pilot Study Pilot Study Setting Instruments Demographic Survey Vietnamese EPDS (VEPDS) Vietnamese Depression Scale (VDS) Procedure for Data Collection Data Analysis 14 15 17 18 18 18 19 19 19 20 20 21 RESULTS 22 DISCUSSION AND RECOMMENDATION 29 Limitations 31 Clinical Implications 31 iv Conclusions 32 Clinical Practice Change 33 REFERENCES 34 APPENDIX A: TABLES OF EVIDENCE 37 APPENDIX B: EDINBURG POSTNATAL DEPRESSION SCALE (EPDS) 54 APPENDIX C: CONSENT FOR PARTICIPATION IN PILOT STUDY 56 APPENDIX D: DEMOGRAPHIC DATA SURVEY 58 APPENDIX E: VIETNAMESE EDINBURG POSTNATAL DEPRESSION SCALE (VEPDS) 59 v LIST OF TABLES Table Page Basic Demographics of Survey Sample 23 Vietnamese Edinburg Postpartum Depression Scale (VEPDS) Internal Consistency Calculation: Cronbach’s Alpha Results 26 Correlation Between Vietnamese Edinburg Postpartum Depression Scale (VEPDS) and Vietnamese Depression Scale (VDS) 27 Explanation of the Vietnamese Edinburg Postpartum Depression Scale (VEPDS) Score by Regression Model 28 vi LIST OF FIGURES Figure Page Perceptions of Vietnamese American child-bearing women about postpartum depression Percentage and frequency distributions for the Vietnamese Edinburg Postpartum Depression Scale (VEPDS) 25 vii DEDICATION To my husband, Hoang Nguyen, and my children, Harrison, Ruth, Hope, Jacob, and Faith, whose love, concern, and encouragement have never ceased throughout this project viii ACKNOWLEDGMENTS This project would have not been accomplished without the help of many individuals who guided and supported my efforts from beginning to end I express my immense gratitude to my project committee, Dr Keely and Dr Brady They provided guidance, knowledge, and encouragement throughout I could not have asked for more competent and supportive faculty I am particularly indebted to those who assisted me in the data collection process, especially Phuong Pham, BSN, RN I am thankful to Phuong for her support throughout the data collection process Finally, I am most appreciative of my husband, Dr Hoang Nguyen, for his expert consultation on the tool development process I am extremely grateful for his continuous input and support throughout the process of this project ix BACKGROUND Needs Assessment and Problem Statement Postpartum depression (PPD) is a significant mental illness that can affect every childbearing woman, regardless of race, ethnicity, or background PPD refers to a constellation of depressive symptoms that occur after childbirth The American Psychiatric Association (APA) describes PPD in the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) as depression that occurs within the first weeks after delivery (APA, 2013) Symptoms of PPD are decreased appetite, insomnia, fatigue, loss of pleasure, and, in some serious cases, thoughts of suicide (Miller & LaRusso, 2011) This mental illness is reported to be the leading cause of maternal morbidity and mortality in new mothers (Clay & Seehusen, 2004) PPD affects not only the mother and infant but all members of the family (Camp, 2013) The Centers for Disease Control and Prevention (CDC) conducted a survey regarding depression among women of reproductive age in the United States and found that 19% had experienced postpartum depression (CDC, 2010) However, there is insufficient information about this illness among various Asian and Pacific Islander racial/ethnic groups Vietnamese Americans (VAs) are one of the fastest-growing minority populations in the United States According to 2010 census data, the VA population experienced a 38% increase in growth in the past 10 years Approximately 50% of VAs reside in California, with the majority residing in Orange County (U.S Bureau of the Census, 2010) Even though there is a growing number of VAs, there are insufficient data on the prevalence of PPD in this population, most likely due to lack of a culturally appropriate 47 48 49 50 51 52 53 54 APPENDIX B EDINBURG POSTNATAL DEPRESSION SCALE (EPDS) 55 56 APPENDIX C CONSENT FOR PARTICIPATION IN PILOT STUDY I volunteer to participate in a research project conducted by Thu Pham from California State University of Long Beach I understand that the project is designed to gather information about sign and symptoms of depression after giving birth I will be one of approximately 50 people to fill out the questionnaire to assess for depression in this project My participation in this project is voluntary I understand that I will not be paid for my participation I may withdraw and discontinue participation at any time without penalty I understand that the questionnaire is a list of self-report symptoms of depression If however, I feel uncomfortable in any way while filling out the questionnaire, I have the right to not fill out the question Participation involves filling out three set of questionnaires It will last approximately 15 minutes I will this by myself not asking any family members I understand that researcher will not identify me by name in any reports using information obtained from the questionnaire and that my confidentiality as a participant in this study will remain secure Subsequent uses of records and data will be subject to standard data use policy which protect the anonymity of individuals and institutions I understand that this research study has been reviewed and approved by the Institutional Review Board (IRB) for study that involves human subjects: social 57 and behavioral sciences committee at California State University Long Beach For research problem and question regarding subjects the Institute Review Board can be contacted through 562-985-2502 I have read and understand the explanation provided to me I have had all of my questions answered to my satisfaction, and I voluntarily agree to participate in this study I have been given of this consent form Participant signature Participant Print Name Investigator For further information please contact: Thu Pham at thupham7lovejesus@csuf.edu Date Signature of the 58 APPENDIX D DEMOGRAPHIC DATA SURVEY Please complete the following questions about yourself: Age: _ Marital status: Single _Married Highest Educational Level: _ Employment status: _Full time _Part time _Unemployed Length of stay in America _ Preferred language _Vietnamese _English Living condition: _With in-law _With extended family Number of pregnancy Complication during pregnancy and delivery: yes _ no If yes, what is the complication? 10 Route of current delivery _Spontaneous vaginal delivery Cesarean 59 APPENDIX E VIETNAMESE EDINBURG POSTNATAL DEPRESSION SCALE (VEPDS) 60 61 [...]... asymptomatic VA women who may have PPD It was essential that the scale be relevant to this population Several measurement were used to determine the applicability of the VEPDS The changes in perception of depression and acceptance of depression symptoms by participants demonstrated the applicability of the scale The validity of the scale (the ability to identify depressive participants) was assessed... focused on adaptation and translation of the EPDS 8 Figure 1 Perceptions of Vietnamese American child-bearing women about postpartum depression screening tool for PPD The language and terminology used in the screening tool were designed to emphasize the perception of susceptibility and severity of PPD The revision process emphasized the modifiable factors mentioned to increase the validity of the screening... presented a brief description of the research project and stressed the importance of signing the consent form Privacy of the collected information was maintained by not recording any name or identifiable information on any questionnaire and by using the information collected only for this project To maintain confidentiality, the investigator was the only person to access the data The data were stored in... is Vietnamese One of the translators is a nurse practitioner and the author of this study; the other translator is a certified court translator In this process, the translators utilized the HBM approach to create the necessary conceptual and linguistic modifications to make the scale sensitive to the VA culture The resulting translations were named T1 and T2, respectively Step 2 is synthesis of the. .. key words validation of PPD screening tools and Vietnamese revealed no publications Changing the term Vietnamese to Asian produced 10 publications Searching from reference lists of the retrieved publications produced five publications related to the topic of depression in the Vietnamese population Due to the overall lack of information on validated screening tools for PPD in the Vietnamese population,... clinic for postpartum checkup and recruited them to participate in the pilot study The front office staff members were trained by the investigator to explain the study and obtain consent Participants were asked to complete the self-report VEPDS and the VDS in a private area before or while waiting for their routine postpartum check-up All forms were returned to a lock box located in the waiting areas The. .. the ability of these women to describe their symptoms of PPD to the health care provider (Nieme et al., 2013) In short, VA women are more likely participate in the screening process if they are able to complete a self-reported questionnaire in Vietnamese Unfortunately, there is currently no validated screening tool for assessing PPD in Vietnamese women (Figure 1) The HBM provided the underpinning of. .. participants were directed to a private area in the waiting room of the clinics to complete the questionnaires while waiting for their appointment They were instructed to deposit the signed informed consent in the box labeled “Consent Forms” and deposit the completed questionnaires in the box labeled “Survey.” The boxes were located in the waiting area where they could be easily seen by participants Instruments... associated with possible depression, based on the score of 10 that is the benchmark used for the EPDS The maximum possible score is 13 20 Vietnamese Depression Scale (VDS) The VDS was developed and validated by Kinzie et al (1982) for use with newly arrived Vietnamese refugees This scale was developed to help with depression diagnosis in both adult males and females This scale contains 15 items that... that Vietnamese patients usually described depression symptoms using the term neurasthenia, which is a set of complex symptoms characterized by chronic fatigue and generalized aches and pains (Nieme et al., 2013) Kinzie et al (1982) developed the Vietnamese Depression Scale (VDS) to screen for depression among Vietnamese refugees who arrived in the United State in the early 1980s They suggested that the