Table 1.

Summary of literature.

Author (date)	Study stated purpose	Subjects/setting	Scale analyzed	Methodology	Results	Clinical implications
Carlberg et al. (2018)	Compare depression assessment and demographic factors of the EPDS and GMDS.	n = 3656 Swedish fathers	EPDS and GMDS items, the survey also contained questions covering possible risk factors related to the sociodemographic variables.	Cross-sectional design, surveys sent via letter with recruitment list being obtained through tax records.	Results suggest that neither scale alone is sufficient for depression screening in new fathers, and the decision of EPDS cutoff is extremely important.	Neither the EPDS or the GMDS may be adequate for screening. Clinician’s should be conservative in determining EPDS cut-offs when screening men for postnatal depression.
Edmondson et al. (2010)	Establish a reliable cut point for the EPDS for UK fathers and to determine its reliability by comparing it to structured clinical interviews.	Couples recruited 7 weeks after birth. Questionnaire response of couples agreed to a home visit and SCI.	EPDS, SCID, demographic characteristics.	EPDS at 7 weeks after the birth of their child. SCI conducted to correlate positive screening to SCID findings.	Fathers with depression scored higher on the EPDS than non-depressed fathers.	The EPDS had acceptable sensitivity and specificity at a cut off score of over 10. EPDS may be useful for perinatal screening for depression in men.
Lai et al. (2010)	Compare the psychometric properties of the EPDS, BDI, and PHQ-9.	n = 551 men, 8 weeks postpartum, in Hong Kong.	EPDS, BDI, and PHQ-9, validated against the SCID.	Collection of demographic data occurred immediately postnatal prior to discharge. Participants sent survey screenings at 8 weeks postpartum. Men with positive screenings invited to participate in SCID.	The EPDS was significantly more accurate at detecting postnatal depression in Chinese men than the BDI or PHQ-9.	The EPDS was recommended for postnatal depression with a cutoff score of over 10/11.
Loscalzo et al. (2015)	Contribute to the validation of the EPDS on a sample of Italian fathers and conduct factorial analysis.	Two samples. First, n = 334 fathers, 39 depressed new fathers. Second, n = 102 fathers, 22 depressed new fathers.	EPDS, the BID, and the CES-D. Demographic questions such as age, education level, and marital status.	Conducted explorative factor analysis and receiver operator characteristic analysis using samples with new fathers known to have depression.	EPDS did not appear sensitive to depression but rather to symptoms of depression and distress.	The EPDS is sensitive for screening for perinatal distress and identifying fathers in need of emotional support.
Matthey et al. (2001)	To validate the EPDS for use in fathers and to establish an acceptable cut off point.	n = 230 mothers and n = 208 fathers recruited to be diagnostically interviewed and administered the EPDS at 6 weeks postpartum.	EPDS, diagnostic interviewing.	EPDS scores were compared to caseness established with diagnostic interviewing. Item analysis was also conducted.	EPDS was valid and reliable for screening mood disorders in fathers, but item analysis revealed that fathers were significantly less likely to answer affirmatively to seven items than mothers.	Recommended a cutoff point of 5 to 6 for detection of mood disorder (anxiety or depression) in men.
Massoudi et al. (2013)	Investigate the accuracy of the EPDS for detecting anxiety and depression in new fathers. Compare the factor structure in fathers versus mothers. Validate the Swedish version of the EPDS in relation to DSM-IV criteria for major and minor depression.	n = 1014 couples were sent the EPDS and the HAD-A subscale 3 months postnatally. Fathers who scored high were asked to participate in a diagnostic interview to assess for depression or anxiety disorder.	EPDS and the anxiety subscale of the HAD scale. Questions dealing with the participants’ age, current occupation, education, native language and number of children were also included in the questionnaire.	Screening survey and structured clinical interviews were used for data collection.	The EPDS yields high sensitivity and specificity, but low positive predictive value when screening for probable major depression at the optimal cut-off score of 12 or more.	The EPDS was more sensitive to distress than depression in postnatal fathers. EPDS may be useful in screening for major depression, but those with minor depression may be missed. Neither the EPDS or HAD-A scale was recommended for use in screening for anxiety.
Nishimura et al. (2010)	This study investigated risk factors of depression in Japanese fathers at 4 weeks post‐partum using a cross‐sectional design.	Responses were obtained from mothers and fathers. There were n = 146 fathers who completed both the EPDS and the CES‐D Scale, n = 133 analyzed.	The EPDS and the CES-D were used to assess depressive symptoms.	Mothers at the 1-month postnatal check were recruited at two general hospitals and two private clinics. The two surveys were sent to the mothers and fathers.	No association between paternal and maternal depression at 4 weeks post‐partum. Paternal depression was associated with employment status, a history of receiving psychiatric treatment, and unintended pregnancy.	Providers should independently screen for depression in fathers and mothers. Additional research is needed to clarify the specific risk factors for postnatal depression in fathers.
Psouni et al. (2017)	The study had multiple aims: Investigate depressive symptoms in new fathers postnatally. Test a modified EPDS scale using items from the GMDS for an increase or decrease in sensitivity.	n = 438 cases were reviewed.	Demographic and circumstantial variables such as stressful life events, age of the father and child, occupation, education level, income, number of children, and whether the father and/or partner had previously, and at the time of the study, received professional help for mental health problems, were all examined.	Fathers were surveyed online using the BDI and GMDS scale initially. Fathers were also surveyed using a modified EPDS that incorporated items from the GMDS.	The modified EPDS with GMDS items had greater sensitivity than the EPDS alone.	Existing scales may be insufficiently sensitive to detect postnatal depression among new fathers. Additional research is needed.
Shaheen et al. (2019)	To determine the cutoff for use of EPDS for Saudi fathers and to estimate PPD prevalence.	n = 290 Saudi fathers who took the EPDS, n = 72 of which were invited to participate in SCID. Fathers were recruited by random sample from those visiting the birth registration office.	EPDS and demographic data, SCID.	Cross-sectional study with a subsample participating in further diagnostic interviewing.	The authors found a cutoff score of 8/9 was optimal to achieve sensitivity of 77.8% and specificity of 81.3%.	Adjusted prevalence was 16.6%. Authors emphasized need to screen men during the postpartum period.
Tran, et al. (2011)	To validate three existing scales for use in screening men in Vietnam for common mental health concerns in the perinatal period.	n = 231 partnered Vietnamese men were recruited.	EPDS, Zung SAS, GHQ12, SCID, modules for depression, generalized anxiety, and panic disorder, Vietnamese translations and cultural verification were given.	Translations of EPDS, Zung SAS, and the GHQ-12 were validated against SCID. Post-hoc analyses, Receiver Operating Characteristic (ROC) analyses, and Cronbach’s alpha were conducted on each scale.	While all measures had acceptable reliability, the sensitivity of the EPDS in men was significantly lower than in women.	The authors recommended that appropriately translated copies of each instrument be available to local primary care offices to conduct screenings with new fathers.