A tricky object to classify: evidence, postpartum depression and the DSM-IV.

The concept of evidence has become central in Western healthcare systems; however, few investigations have studied how the shift toward specific definitions of evidence actually occurred in practice. This paper examines a historical case in psychiatry where the debate about how to define evidence was of central importance to nosological decision making. During the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders a controversial decision was made to exclude postpartum depression (PPD) as a distinct disorder from the manual. On the basis of archival and interview data, I argue that the fundamental issues driving this decision were related to questions about what constituted suitable hierarchies of evidence and appropriate definitions of evidence. Further, although potentially buttressed by the evidence-based medicine movement, this shift toward a reliance on particular kinds of empirical evidence occurred when the dominant paradigm in American psychiatry changed from a psychodynamic approach to a research-based medical model.

'If you have a soul, you will volunteer at once': gendered expectations of duty to care during pandemics.

Duty to care has been identified as a pressing ethical issue in contemporary discussions of pandemic preparedness; however, nuanced discussions of this complicated issue are relatively limited. This article presents historical data from the experience of the 1918 influenza pandemic in Brantford, Ontario in Canada, demonstrating that, in the face of an actual pandemic, the particular construction of duty to care as both moral and gendered meant that women were placed at a greater personal risk during this time. Given that women still dominate the front lines of healthcare work, we argue that it is critical for current stakeholders to reflect on how these historical patterns may be replicated in contemporary pandemic planning and response.

Iterative generation of diagnostic categories through production and practice: the case of postpartum depression.

Examining the process undertaken to name and codify psychiatric illnesses provides important insights into how everyday healthcare practices are shaped by knowledge production processes. However, studies of illness classification often rely on an overly simplified distinction between the production of diagnostic categories and the application of those categories in practice. Drawing insight from science and technology studies, I argue that psychiatric diagnostic categories are iteratively generated through production and practice, even during the development of those categories. Through a discursive analysis of interviews, archival documents, and psychiatric literature, I identify the practical politics that enabled the creation of the postpartum depression (PPD) modifier in the Diagnostic and Statistical Manual of Mental Disorders, version four (DSM-IV). In addition, I demonstrate how the overarching discourses of evidence-based decision-making and biomedicine shaped the development of the postpartum modifier, and draw together comments made by interview participants regarding the administrative value of a PPD-related category in the DSM. These remarks suggest that, in their practice, researchers and clinicians also take into consideration their own knowledge about DSM production processes, providing further support for the argument that diagnostic categories are iteratively generated.

Precarious beginnings: Gendered risk discourses in psychiatric research literature about postpartum depression.

The transition to motherhood in western society is particularly informed by risk-based scientific and medical discourses and, as a result, women are especially subject to rationalities and practices that are employed in the name of risk. The aim of this article is to examine the gendered risk discourses that are embedded in one aspect of medicalized mothering - the postpartum period. This article interrogates three key elements of the discursive construction of postpartum depression (PPD) in contemporary psychiatric research literature (approximately 1980-2007). Specifically, I examine how risk-based reasoning is incorporated into the concepts of the postpartum triad and the high-risk mother, and how arguments about why PPD is a 'significant social problem' create a tension between the rights of the mother and those of the child. By placing women in a position to manage certain types of risks related to the postpartum period, these discourses serve to responsibilize women and structure their subjectivities in gendered ways.This analysis contributes to a growing literature that investigates how assumptions about gender, race, class and sexuality are produced and re-produced through the notion of risk.

Applying new techniques to an old ally: a qualitative validation study of the Edinburgh Postnatal Depression Scale.

PURPOSE: To present the results of a study that used cognitive interviewing techniques to interview pregnant and postpartum women about their experience of completing the Edinburgh Postnatal Depression Scale. BACKGROUND: Most large-scale initiatives that screen women for depression during pregnancy and the first 3-6 months postpartum use the Edinburgh Postnatal Depression Scale. The scale is a 10-item instrument that is commonly self-administered and has been extensively validated using quantitative methods. However, the authors could find no published research that applied newer in-depth methods for assessing comprehension and interpretation to the scale. PARTICIPANTS AND METHODS: The design was an in-depth, qualitative instrument validation study. A total of nine pregnant and postpartum women who were referred for psychiatric care completed the Edinburgh Postnatal Depression Scale and then were interviewed about their experiences. Cognitive interviewing techniques were used to generate an in-depth examination of how women understood and interpreted the items, and to explore meaning, acceptability, and disclosure issues. RESULTS: Overall, participants felt that the instrument was straightforward, easy to read, and relatively simple to answer. It is important to note that eight of the nine participants had completed some post-secondary education and, thus, participant's average literacy level was relatively high. Women identified minor concerns or expressed interpretive differences on six of the ten Edinburgh Postnatal Depression Scale items. These six items are examined in detail. CONCLUSION: The results suggest that it may be useful for the Edinburgh Postnatal Depression Scale to be administered in the context of a discussion about a woman's mental health concerns, which could involve asking her for more details about her responses to particular items that have been identified in this study as potentially problematic. This will help ensure that practitioners are accurately interpreting a woman's answers to the items on the scale.