The Spanish translation of the Edinburgh postnatal depression scale and the use of the word "desgraciada".

The Edinburgh Postnatal Depression Scale (EPDS), originally created in English was developed for screening postpartum women in outpatient settings as part of the 6–8 week obstetrical follow-up examination (Cox, Holden, & Sagowsky, 1987). It has been validated and used in Spanish-speaking countries including Spain (Garcia-Esteve, Ascaso, Ojuel, & Navarro, 2003), Mexico (Alvarado-Esquivel, Sifuentes-Alvarez, Salas-Martinez, & Martinez-Garcia, 2006), Peru (Vega-Dienstmaier, Mazzotti, & Campos Sanchez, 2002), and Chile (Castanon & Pinto, 2008). The Spanish version of the EPDS was initially developed in Barcelona, Spain (Garcia-Esteve et al., 2003), and subsequently validated in Mexico (Alvarado-Esquivel et al., 2006). In contrast with the version created in Spain, the Mexican one incorporated phrases and words that were more appropriate to the Mexican population (Alvarado-Esquivel et al., 2006). We have been using the EPDS as part of a study to evaluate the relationship between postnatal depression and weight gain in a Latino cohort of children as previously described (Wojcicki et al., 2011). Through the use of the translated Spanish version of the EPDS, we have found that some women respond negatively to Question 8 (“I have felt sad or miserable” or “Me he sentido triste y desgraciada”) in the 10-item questionnaire. Further probing indicated that some women found the word “desgraciada” offensive. This led to our systematic investigation of the translation of the word “desgraciada” to find out if there are different interpretations or meanings of the word based on regional location of origin in Central or South America or Mexico. In order to investigate the possibility of differences, we consulted a Latin American dictionary, a dictionary of Mexican Spanish, and the standard European Spanish dictionary to assess the translation of the word “desgraciada.” The word “desgraciada” can take on many different meanings in Spanish. According to the American Heritage Spanish Dictionary (“Desgraciada,” 1987), it can mean “unfortunate, unlucky, unhappy, unpleasant, disagreeable, wretched, or despicable.” The Pocket Oxford Spanish Dictionary (Rollin, Carvajal, & Horwood, 2009) defines it as “unhappy, ill-fated, unfortunate, unwise,” and the Random House Latin-American Spanish Dictionary (Gold, 1996) has a similar definition. Meanwhile, however, the Bilingual Dictionary of Mexican Spanish (Hamel, 2002), however, defines desgraciado as “1. Cuckold, 2. The Child of a Prostitute and 3. Rotten, wretched, son of a bitch.” These alternative definitions, particularly in the Mexican dictionary, provided some explanations for why our population of women, of which approximately 50% were of Mexican origin, was not responding appropriately to this question, with some women looking offended or hostile after reading the word desgraciada. While Alvardo-Esquivel et al. (2006) validated the EPDS for use with the Mexican population and changed some of the wording from the scale designed in Spain for the Mexican population, they did not replace the word desgraciada or alter the question that includes this word. Furthermore, they validated the question with women in Durango city, Mexico, which is in the central part of the country. Women living in southern Mexico, bordering with Guatemala or those in the most northern states may have different interpretations of certain words of the EPDS. Spanish is the second most commonly used language in the world with up to 500 million people speaking Spanish. We encourage other research teams who are using the EPDS with Latino populations in the United States to investigate possible differences in interpretation of words or phrases as there may be other significant unaccounted for intraethnic differences.