A more rational, theory-driven approach to analysing the factor structure of the Edinburgh Postnatal Depression Scale

We endeavoured to analyze the factor structure of the Edinburgh Postnatal Depression Scale (EPDS) during a screening programme in Hungary, using exploratory (EFA) and confirmatory factor analysis (CFA), testing both previously published models and newly developed theory-driven ones, after a critical analysis of the literature. Between April 2011 and January 2015, a sample of 2967 pregnant women (between 12th and 30th weeks of gestation) and 714 women 6 weeks after delivery completed the Hungarian version of the EPDS in South-East Hungary. EFAs suggested unidimensionality in both samples. 33 out of 42 previously published models showed good and 6 acceptable fit with our antepartum data in CFAs, whilst 10 of them showed good and 28 acceptable fit in our postpartum sample. Using multiple fit indices, our theory-driven anhedonia (items 1,2) - anxiety (items 4,5) - low mood (items 8,9) model provided the best fit in the antepartum sample. In the postpartum sample, our theory-driven models were again among the best performing models, including an anhedonia and an anxiety factor together with either a low mood or a suicidal risk factor (items 3,6,10). The EPDS showed moderate within- and between-culture invariability, although this would also need to be re-examined with a theory-driven approach.