The Social Construction of PPD: Explicit and Implicit Diagnostic Definitions In the DSM-V and Edinburgh Postnatal Depression Scale

Background and Purpose:

Postpartum depression (PPD) is experienced by women of color (38%) at two times the rate of all postpartum women (Center for American Progress, 2023); Black and Latinx women are more likely to experience depression in general due to an accumulation of stressors (Ertel et al., 2011). Black mothers with maternal depression (which, unlike PPD, encompasses depressive symptomatology occurring during the antenatal, prenatal, and postpartum periods) exhibited signs of poorer physiological functioning than Latinx and/or white mothers with maternal depression (Ertel et al., 2011).

Studies have quantitatively examined the subconstructs of the Edinburgh Postnatal Depression Scale (EPDS), finding that this widely used PPD screening tool requires adjustment when screening Black, Hispanic, and Indigenous people (Chan et al., 2020; Chiu et al., 2017). Although recommendations suggest the need for a more holistic, culturally-suitable mixed-method/integrative approach to PPD screening (Chan et al., 2020), no studies qualitatively explored the subconstructs of the EPDS and their impact on Black birthing people. Moreover, though not included in the DSM-V, a range of perinatal mood and anxiety disorders (PMAD) exist (Rai, 2015). The current study is the first known to qualitatively examine the impact of the subconstructs of the EPDS or the DSM-V.

Methods:

This study uses Critical Discourse Analysis (CDA) to examine the explicit and implicit diagnostic definition of PPD in the cases of the DSM-V and EPDS. CDA is a qualitative methodology wherein patterns and lexical choices are analyzed in sociopolitical and cultural contexts. It identifies implicit values while tracing how power structures are reified through them. This analysis explores how inequality is embedded into the manual and psychometric while also considering the pertinence of this social construction of PPD to Black birthing people.

Results:

This analysis revealed inconsistent classifications and temporal parameters, and gendered assumptions related to the DSM-V and lack of attention to social determinants of health in the EPDS. The inconsistent classification of and temporal parameters associated with the onset of PPD as well as the gendered assumptions indicated by the use of particular specifiers in the DSM-V contribute to the un(der)diagnosis and un(der)treatment of Black birthing people; furthermore, the EPDS neglects several social determinants of health, which are more likely to adversely impact Black birthing people’s mental health outcomes during the postpartum period.

Conclusions:

The findings contribute to the expansion of the discourse on Black maternal health and the development of more critical perspectives on as well as implications for future research regarding the cultural responsiveness of widely accepted psychometrics used to screen and diagnose Black birthing people. This study evidences a need for consistency in language and terminology employed in DSM-V, a need for more research and training on PPD screening with Black birthing people, and a need for development and administration of culturally-acceptable postpartum mental health screening and treatment to improve outcomes among Black birthing people. Future research should examine how Black birthing people are navigating their mental health during this period given the structural racism and the limitations implicated by these diagnostic definitions.