New Measure to Screen Deaf Women for Perinatal Depression

Approximately 1 million women in the U.S. have profound hearing loss and use American Sign Language (ASL) as their primary language. Many providers are unfamiliar with the unique linguistic and cultural needs of the Deaf community, therefore Deaf women experience major obstacles to receiving effective physical and mental healthcare. For example, failure to provide ASL interpreters or translations from written English is a common communication barrier that prevents Deaf women from receiving health-related treatment and information. In 2017, Drs. Melissa Anderson, Kelly Wolf Craig, and Nancy Byatt were awarded a 1-year pilot project grant for their Creating the Capacity to Screen Deaf Women for Perinatal Depression project. The primary goal of this project was to translate the Edinburgh Postnatal Depression Scale (EPDS) from written English to American Sign Language (ASL). Using the new ASL EPDS, the team aimed to recruit 50 Deaf perinatal women from across the United States to conduct depression screening interviews. This brief describes the study, its results and future plans

Creating the Capacity to Screen Deaf Women for Perinatal Depression: A Pilot Study

OBJECTIVE: Compared to hearing women, Deaf female sign language users receive sub-optimal maternal health care and report more dissatisfaction with their prenatal care experiences. As healthcare providers begin to regularly screen for perinatal depression, validated screening tools are not accessible to Deaf women due to severe disparities in English literacy and health literacy. DESIGN AND SETTING: We conducted a one-year, community-engaged pilot study to create an initial American Sign Language (ASL) translation of the Edinburgh Postnatal Depression Scale (EPDS); conduct videophone screening interviews with Deaf perinatal women from across the United States; and perform preliminary statistical analyses of the resulting pilot data. PARTICIPANTS: We enrolled 36 Deaf perinatal women between 5 weeks gestation up to one year postpartum. MEASUREMENTS AND FINDINGS: Results supported the internal consistency of the full ASL EPDS, but did not provide evidence of internal consistency for the anxiety or depression subscales when presented in our ASL format. Participants reported a mean total score of 5.6 out of 30 points on the ASL EPDS (SD = 4.2). Thirty-one percent of participants reported scores in the mild depression range, six percent in the moderate range, and none in the severe range. KEY CONCLUSIONS AND IMPLICATIONS: Limitations included small sample size, a restricted range of depression scores, non-normality of our distribution, and lack of a fully-standardized ASL EPDS administration due to our interview approach. Informed by study strengths, limitations, and lessons learned, future efforts will include a larger, more robust psychometric study to inform the development of a Computer-Assisted Self-Interviewing version of the ASL EPDS with automated scoring functions that hearing, non-signing medical providers can use to screen Deaf women for perinatal depression