OBJECTIVE: We sought to evaluate the psychometric properties of two widely used screening scales: the Patient Health Questionnaire (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) among pregnant Peruvian women.
METHODS: This cross-sectional study included 1517 women receiving prenatal care from February 2012 to March 2013. A structured interview was used to collect data using PHQ-9 and EPDS. We examined reliability, construct and concurrent validity between two scales using internal consistency indices, factor structures, correlations, and Cohen׳s kappa.
RESULTS: Both scales had good internal consistency (Cronbach׳s alpha>0.8). Correlation between PHQ-9 and EPDS scores was fair (rho=0.52). Based on exploratory factor analysis (EFA), both scales yielded a two-factor structure. EFA including all items from PHQ-9 and EPDS yielded four factors, namely, "somatization", "depression and suicidal ideation", "anxiety and depression", and "anhedonia". The agreement between the two scales was generally fair at different cutoff scores with the highest Cohen׳s kappa being 0.46.
CONCLUSIONS: Both the PHQ-9 and EPDS are reliable and valid scales for antepartum depression assessment. The PHQ-9 captures somatic symptoms, while EPDS detects depressive symptoms comorbid with anxiety during early pregnancy. Our findings suggest simultaneous administration of both scales may improve identification of antepartum depressive disorders in clinical settings.
Tropical rainforests of Latin America (LATAM) are one of the world's largest carbon sinks, with substantial future carbon sequestration potential and contributing a major proportion of the global supply of forest carbon credits. LATAM is poised to contribute predominantly towards high-quality forest carbon offset projects designed to reduce emissions from deforestation and forest degradation, halt biodiversity loss, and provide equitable conservation benefits to people. Thus, carbon markets, including compliance carbon markets and voluntary carbon markets continue to expand in LATAM. However, the extent of the growth and status of forest carbon markets, pricing initiatives, stakeholders, amongst others, are yet to be explored and extensively reviewed for the entire LATAM region. Against this backdrop, we reviewed a total of 299 articles, including peer-reviewed and non-scientific gray literature sources, from January 2010 to March 2023. Herein, based on the extensive literature review, we present the results and provide perspectives classified into five categories: (i) the status and recent trends of forest carbon markets (ii) the interested parties and their role in the forest carbon markets, (iii) the measurement, reporting and verification (MRV) approaches and role of remote sensing, (iv) the challenges, and (v) the benefits, opportunities, future directions and recommendations to enhance forest carbon markets in LATAM. Despite the substantial challenges, better governance structures for forest carbon markets can increase the number, quality and integrity of projects and support the carbon sequestration capacity of the rainforests of LATAM. Due to the complex and extensive nature of forest carbon projects in LATAM, emerging technologies like remote sensing can enable scale and reduce technical barriers to MRV, if properly benchmarked. The future directions and recommendations provided are intended to improve upon the existing infrastructure and governance mechanisms, and encourage further participation from the public and private sectors in forest carbon markets in LATAM.