These findings may be explained by the different periods of application of EPDS or the different culture backgrounds.32 The load of presentation of a major depressive symptom is a culture-bound phenomenon with somatic presentation is prominent in the eastern and mental presentation in western societies,34 and this may be explained by Inhibitors,research,lifescience,medical the differences in the findings from explanatory factor analysis of this scale in different studies. Although the first validation study,13 suggested the 9/10 as the cut-off score for use of the scale in the community surveys and screening, the 12/13 threshold was

more useful in the clinic assessment of the postnatal depression.35 Berle et al.16 reported a cut-off point Inhibitors,research,lifescience,medical of 11, a sensitivity of 96%, a specificity

of 78%, and positive predictive value of 59%, and negative predictive value of 62%, which are somehow different from our results. In Spain the EPDS cut-off point was reported as 13.5 with a sensitivity of 84% and a specificity of 79%.17 A cut-off of 11/12 was reported as more suitable for screening a HA-1077 chemical structure French population,36 Inhibitors,research,lifescience,medical and a cut-off score of 8/9 with a sensitivity of 94.4% and a specificity of 87.4% was more appropriate in an Italian population.37 In the present study, the optimal sensitivity of 78%, specificity of 75%, and the area under the curve of 0.84 (CI 95%: 0.77-0.90), which was obtained by ROC curve with cut-off point of 13 in HDRS, allows the use of this score in the community screenings. Given the false positivity of EPDS and the importance Inhibitors,research,lifescience,medical of differentiating various forms of major depression by clinical interviews for different managements, our choice of cut-off point score was mandated by the need to screen mothers Inhibitors,research,lifescience,medical rather than to definite diagnosis of depression. Therefore, we propose a clinical interview for definite diagnosis of MDD in those with a score of above 12 in EPDS. The present study suffers from the fact that the prevalence rate of 18.3% for postnatal depression that we achieved is more than the average prevalence rate of 13% reported by O’hara in a meta-analysis

of 59 studies.10 This may MTMR9 be a limitation for the positive and negative predictive values of this version. However, the similarity of our prevalence rate with other studies in Iran,38 might support our findings that the rate of depression might be higher in Iran. Conclusion The findings of the present study indicate that the Persian version of the EPDS has a satisfactory reliability and factor analysis indicated by two components. Receiver operating characteristic curve analysis versus HDRS provides the score of 12 as the best cut-off point for PPD screening in Iranian society. Acknowledgment We are grateful to all participants and staff of local health centers, who helped us to conduct this study.