Development and Validation of a Novel Culturally-Tailored Postpartum Depression Risk Scoring Scale (PDRS) in Malaysia: A Sequential Mixed-Methods Study

Abstract Purpose Postpartum depression (PPD) still underdiagnosed in many multicultural societies due to the lack of culturally sensitive screening tools. Existing instruments often overlook sociocultural stressors specific to local contexts. This study aimed to develop and validate a Postpartum Depression Risk Scoring (PDRS) scale tailored to Malaysian women, addressing the multidimensional nature of PPD risk, to enable earlier detection. Adopting this scale within 24-hour postpartum screening procedures could facilitate prompt clinical interventions. Methods A sequential mixed-methods design was employed in three phases: (1) item generation from a systematic review and qualitative synthesis; (2) expert content validation; and (3) psychometric evaluation using Partial Least Squares Structural Equation Modeling (PLS-SEM) and Confirmatory Factor Analysis (CFA) on data from 300 postpartum women recruited from two public hospitals. Discriminant validity and criterion validity were also assessed. Results The initial 31-item pool was refined to a 15-item scale encompassing three domains: biological (CR = 0.700), psychological (CR = 0.851), and social (CR = 0.693). CFA confirmed acceptable model fit (χ² = 123.595; χ²/df = 1.67; SRMR = 0.077; NFI = 0.842). Discriminant validity was supported via the Fornell–Larcker criterion. ROC analysis yielded an optimal cutoff score of 15, with a sensitivity of 71.3%, specificity of 80.2%, and an AUC of 0.781 (95% CI: 0.742–0.820), demonstrating satisfactory predictive performance. Convergent validity analysis revealed a statistically significant positive association between the PDRS and the EPDS (Kendall’s τ_b = 0.226, P < .001), indicating higher EPDS scores correspond to elevated risk classification on the PDRS. Discussion The PDRS scale is a valid and reliable tool, which captures culturally relevant risk factors for PPD among Malaysian women. Its multidimensional structure reflects the biopsychosocial complexity of PPD and addresses gaps in traditional screening practices. The scale holds potential for early identification and prevention of PPD in diverse maternal health settings.