Culturally sensitive translation of the Edinburgh Postnatal Depression Scale into Marathi language to assess perinatal depression in rural Maharashtra, India

Background: Tools to screen perinatal depression are developed in English and for their effective use in culturally and linguistically diverse settings it is important to translate them appropriately, contextually adapt them, and rigorously validate them in the local populations. Marathi is the third most spoken language in India, yet there is no culturally sensitive translation of the Edinburgh Postnatal Depression Scale (EPDS) into Marathi till date. In this paper, we describe the systematic process of translation and adaptation of the EPDS into Marathi. Methods: EPDS was translated into Marathi using the following steps: forward translation, bilingual committee discussion, cognitive interviewing and pre-testing, backward translation, and comparison of the original English version with the back-translated English version (linguistic equivalence). Ten pregnant women were initially involved in cognitive interviewing and provided feedback on the Marathi version. Further, conceptual equivalence was tested with 20 non-pregnant women with bilingual skills and operational equivalence to compare self-administered and interviewer-administered version was completed with 20 pregnant women . Scatter plot, Bland-Altman plot, and Pearson's correlation coefficient were estimated to assess the relationship between the two versions: English and Marathi in case of conceptual equivalence and self-administered and interviewer-administered in case of operational equivalence. Results: Pearson's correlation coefficient between the original English version of the EPDS and the Marathi version of the EPDS was 0.99 (p