Validity evidence of the Edinburgh Postnatal Depression Scale: an integrative review
DOI:
https://doi.org/10.15343/0104-7809.202549e17312025IKeywords:
Postpartum Depression, Mental Health, Women, Validation Study, PsychometricsAbstract
The prevalence of common mental disorders, including depression, post-traumatic stress disorder, obsessive-compulsive disorder, and a variety of anxiety disorders, represents a major global burden of disease in both high- and low-income countries. This study aimed to identify validity evidence of the Edinburgh Postnatal Depression Scale (EPDS) tested in puerperal women. An integrative review was conducted using the PICO strategy to construct the research question: What validity evidence is available for the Edinburgh Postnatal Depression Scale in puerperal women? The databases searched were PubMed, CINAHL, Embase, Scielo Org., and SCOPUS. Screening was carried out in Rayyan, following the PRISMA 2020 flowchart. Searches were conducted from october to november 2022. Based on inclusion criteria, 17 studies were selected for analytical synthesis. The Edinburgh Postnatal Depression Scale is widely recognized as the gold standard for detecting postpartum depression in women worldwide. This instrument allows the identification of depression risk through different cutoff scores. Understanding how the EPDS functions and its limitations is essential for its effective use across diverse contexts, ensuring accurate screening and early identification of cases requiring specialized follow-up.
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Evidências de validade da Edinburgh Postnatal Depression Scale: revisão integrativa
References
Sultan P, Ando K, Elkhateb R, et al. Assessment of Patient-Reported Outcome Measures for Maternal Postpartum Depression Using the Consensus-Based Standards for the Selection of Health Measurement Instruments Guideline: A Systematic Review. JAMA Netw Open [Internet]. 2022 [citado 2025 ago 29];5(6):e2214885. Available from: https://doi.org/10.1001/jamanetworkopen.2022.14885
Howard LM, Khalifeh H. Perinatal mental health: a review of progress and challenges. World Psychiatry. 2020; 19(3):313-327. doi:10.1002/ wps.20769
Gelaye B, et al. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry. 2016;3(10):973-982. doi:10.1016/S2215-0366(16)30284-X.
Dennis CL, et al. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry. 2017;210(5):315-323. doi:10.1192/bjp.bp.116.187179
Maternal, Newborn and Infant Clinical Outcome Review Programme. Saving Lives, Improving Mothers’ Care: Lessons Learned to Inform Maternity Care From the UK and Ireland Confidential Enquiries Into Maternal Deaths and Morbidity 2017-19. Mothers and Babies: Reducing Risk Through Audits and Confidential Enquiries Across the UK; 2021. Available from: https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2021/MBRRACE-UK_Maternal_Report_2021_-FINAL-_WEB_VERSION.pdf.
Sultan P, Ando K, Elkhateb R, et al. Assessment of Patient-ReportedOutcomeMeasures for Maternal Postpartum Depression Usingthe Consensus-Based Standards for theSelection of Health Measurement Instruments Guideline: A Systematic Review. JAMA Netw Open. 2022;5(6):E2214885. doi:10.1001/jamanetworkopen.2022.14885
McAllister-Williams RH, Arango C, Blier P, et al. The identification, assessment and management of difficult-to-treat depression: an international consensus statement. J Affect Disord. 2020;267:264-282. doi:10.1016/j.jad.2020.02.023.
Abel KM, et al. Prevalence of maternal mental illness among children and adolescents in the UK between 2005 and 2017: a national retrospective cohort analysis. Lancet Public Health. 2019;4(6):291-300. doi:10.1016/S2468-2667(19)30059-3.
Montazeri A, Torkan B, Omidvari S. The Edinburgh Postnatal Depression Scale (EPDS): translation and validationstudy of theIranianversion. BMC Psychiatry. 2007; 7: 11. doi:10.1186/1471-244X-7-11.
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry. 1987;150(6):782–6.doi:10.1192/bjp.150.6.782.
World Health Organization. WHO recommendations on maternal and newborn care for a positive postnatal experience: web annexes. Geneva: World Health Organization; 2022. Available from: https://apps.who.int/iris/handle/10665/352612.
Sambrook MS, Cairns L, Pullen LSW, Opondo C, Fellmeth G, Alderdice F. Validated tools to identify common mental disorders in the perinatal period: A systematic review of systematic reviews. J Affect Disord.2022;298:634-643.doi:10.1016/j.jad.2021.11.011.
Ferreira CR, Sanches MFTV, Matos GPNBR, RebustiniF, Domingues MARC. Instruments for evaluating social support networks for Brazilian elderlypeople: a scoping review. Concilium. 2024; 24(7): 432–451.doi:10.53660/CLM-3223-24G24.
Whittemore R, Knafl K. The integrative review: update methodology. J Adv Nurs. 2005;52(5):546-553. doi:10.1111/j.1365-2648.2005.03621.x.
Mourad Ouzzani, Hossam Hammady, Zbys Fedorowicz e Ahmed Elmagarmid. Rayyan — um aplicativo web e móvel para revisões sistemáticas. Revisões Sistemáticas (2016) 5:210, doi: 10.1186/s13643-016-0384-4.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.
Mokkink LB et al. COSMIN Risk of Bias checklist for systematic reviews of Patient Reported Outcome Measures. Qual. Life Res. 2018; 27(5): 1171-79. doi:10.1007/s11136-017-1765-4.
American Educational Research Association, American Psychological Association, National Council on Measurement in Education. Standards for educational and psychological testing. Washington, DC: Author; 1999.
Smith-Nielsen J, Matthey S, Lange T, et al. Validation of the Edinburgh Postnatal Depression Scale against both DSM-5 and ICD-10 diagnostic criteria for depression. BMC Psychiatry. 2018;18:393. doi:10.1186/s12888-018-1965-7.
Boran P, Waqas A, Aşkan ÖÖ et al. Screening of postpartum depression among new mothers in Istanbul: a psychometricevaluation of theTurkish Edinburgh Postnatal Depression Scale. BMC Res Notes. 2020;13:355.doi:10.1186/s13104-020-05196-x.
Greena EP, Tuli H, Kwobah E, Menya D, Chesire I, Schmidt C. Developing and validating a perinatal depression screening tool in Kenya blending Western criteriawith local idioms: A mixedmethodsstudy. J Affect Disord. 2018; 228:49-59.doi:10.1016/j.jad.2017.11.027.
Smith-Nielsen J, Matthey S, Lange T, et al. Validation of the Edinburgh Postnatal Depression Scale against both DSM-5 and ICD-10 diagnostic criteria for depression. BMC Psychiatry. 2018;18:393. doi:10.1186/s12888-018-1965-7.
Albuquerque MR, Corrêa H, Couto TC, Santos W, et al. A proposal for a new Brazilian six-item version of the Edinburgh Postnatal Depression Scale. Trends Psychiatry Psychother. 2017;39(1):29-33. doi:10.1590/2237-6089-2016-0056. doi.10.1590/2237-6089-2016-0056.
Syam M, Qasim E, Kadrianti et al. Factor structure of the Edinburgh postnatal depression scale Indonesian Version. Med Clin Pract.2021;4:100238. doi:10.1016/j.mcpsp.2021.100238
Hartley CM, Barroso N, Rey Y, Pettit JW, Bagner DM. Factor Structure and Psychometric Properties of English and Spanish Versions of the Edinburgh Postnatal Depression Scale AmongHispanicWomen in a Primary Care Setting. J. Clin. Psychol. 2014;70:1240-50. doi:10.1002/ jclp.22101.
Toreki A, Andó B, Dudas RB, Dweik D, Janka Z, Kozinszky Z, Keresztúri A. Validation of the Edinburgh Postnatal Depression Scale as a screening tool for postpartum depression in a clinical sample in Hungary. Midwifery. 2014; 30(8):911-8. doi: 10.1016/j.midw.2014.02.008.
Kheirabadi GR, Maracy MR, Akbaripour S, Masaeli N. Psychometric properties and diagnostic accuracy of the Edinburgh Postnatal Depression Scale in a sample of Iranian women. Iran J Med Sci. 2012;37(1):32-38.Avaliable from: https://pubmed.ncbi.nlm.nih.gov/23115428/
Lee King PA. Replicability of structural models of the Edinburgh Postnatal Depression Scale (EPDS) in a community sample of postpartum African American womenwithlowsocioeconomic status. Arch Womens Ment Health. 2012;15:77–86. doi: 10.1007/s00737-012-0260-8.
Reichenheim ME, Moraes CL, Oliveira AS, Lobato G. Revisiting the dimensional structure of the Edinburgh Postnatal Depression Scale (EPDS): empirical evidence for a general factor. BMC Med Res Methodol. 2011;11:93.doi:10.1186/1471-2288-11-93
Montazeri A, Torkan B, Omidvari S. The Edinburgh Postnatal Depression Scale (EPDS): translation and validationstudy of theIranianversion. BMC Psychiatry. 2007; 7: 11. doi:10.1186/1471-244X-7-11.
Santos IS, Matijasevich A, Tavares BF, Barros AJ, Botelho IP, Lapolli C, et al. Validation of the Edinburgh Postnatal Depression Scale (EPDS) in a sample of mothers from the 2004 Pelotas Birth Cohort Study. Cad Saude Publica. 2007;23(11):2577-2588. doi:10.1590/s0102- 311x2007001100005.
Santos IS, Matijasevich A, Tavares BF, et al. Comparing validity of Edinburgh scale and SRQ20 in screening for post-partum depression. Clin Pract Epidemiol Ment Health. 2007;3:18. doi:10.1186/1745-0179-3-18
Jardri R, Pelta J, Maron M, Thomas P, Delion P, Codaccioni X, et al. Predictive validation study of the Edinburgh Postnatal Depression Scale in the first week after delivery and risk analysis for postnatal depression. J Affect Disord. 2006;93(1-3):169-176. doi:10.1016/j.jad.2006.03.00
Werrett J, Clifford C. Validation of the Punjabi version of the Edinburgh Postnatal Depression Scale (EPDS). Int J Nurs Stud. 2006;43(2):227- 236. doi:10.1016/j.ijnurstu.2004.12.007.
American Educational Research Association, American Psychological Association, National Council on Measurement in Education. Standards for educational and psychological testing. Washington, DC: Author; 2014.
Clifford C, Day A, Cox J, Werrett J. A cross-cultural analysis of the use of the Edinburgh Post-Natal Depression Scale (EPDS) in health visiting practice. J Adv Nurs. 1999;30(3):655-664. doi:10.1046/j.1365-2648.1999.01115.
MacDermid JC. ICF Linking and Cognitive Interviewing Are Complementary Methods for Optimizing Content Validity of Outcome Measures: An Integrated Methods Review. Front Rehabilit Sci [Internet]. 2021 [citado 2025 ago 22];2:702596. doi: doi.10.3389/fresc.2021.702596
Echevarria-Guanilo ME, Gonçalves N, Romaniski PJ. Psychometric properties of measurement instruments: conceptual basis and evaluation methods - part II. Texto Contexto Enferm [Internet]. 2019 [citado 2025 ago 22];28:e20170311. doi: 10.1590/1980-265X-tce-2017-0311
American Educational Research Association, American Psychological Association, National Council on Measurement in Education. Standards for educational and psychological testing. Washington, DC: Author; 2014.
Skodová Z, Bánovčinová Ľ, Urbanová E, Grendár M, Bašková M. Factor Structure of the Edinburgh Postnatal Depression Scale in a Sample of Postpartum Slovak Women. Int J Environ Res Public Health. 2021;18(12):6298. doi:10.3390/ijerph18126298.
Levis B, Negeri Z, Sun Y, Benedetti A, Thombs BD, DEPRESsion Screening Data (DEPRESSD) EPDS Group. Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data. BMJ. 2020;370:m4022. doi:10.1136/bmj.m4022.
Trizano-Hermosilla I, Alvarado JM. Best alternatives to Cronbach’s alpha reliability in realistic conditions: congeneric and asymmetrical measurements. Front Psychol. 2016;7:769. doi:10.3389/fpsyg.2016.00769
Iliescu D, Greiff S. On Consequential Validity. European Journal of Psychological Assessment [Internet]. 2021 May 1 [cited 2025 Aug 22];37(3):163–6. Available from: https://doi.org/10.1027/1015-5759/a000664
Howard LM, Khalifeh H. Perinatal mental health: a review of progress and challenges. World Psychiatry. 2020; 19(3):313-327. doi:10.1002/ wps.20769
Gelaye B, et al. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry. 2016;3(10):973-982. doi:10.1016/S2215-0366(16)30284-X.
Dennis CL, et al. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry. 2017;210(5):315-323. doi:10.1192/bjp.bp.116.187179
Maternal, Newborn and Infant Clinical Outcome Review Programme. Saving Lives, Improving Mothers’ Care: Lessons Learned to Inform Maternity Care From the UK and Ireland Confidential Enquiries Into Maternal Deaths and Morbidity 2017-19. Mothers and Babies: Reducing Risk Through Audits and Confidential Enquiries Across the UK; 2021. Available from: https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2021/MBRRACE-UK_Maternal_Report_2021_-FINAL-_WEB_VERSION.pdf.
Sultan P, Ando K, Elkhateb R, et al. Assessment of Patient-ReportedOutcomeMeasures for Maternal Postpartum Depression Usingthe Consensus-Based Standards for theSelection of Health Measurement Instruments Guideline: A Systematic Review. JAMA Netw Open. 2022;5(6):E2214885. doi:10.1001/jamanetworkopen.2022.14885
McAllister-Williams RH, Arango C, Blier P, et al. The identification, assessment and management of difficult-to-treat depression: an international consensus statement. J Affect Disord. 2020;267:264-282. doi:10.1016/j.jad.2020.02.023.
Abel KM, et al. Prevalence of maternal mental illness among children and adolescents in the UK between 2005 and 2017: a national retrospective cohort analysis. Lancet Public Health. 2019;4(6):291-300. doi:10.1016/S2468-2667(19)30059-3.
Montazeri A, Torkan B, Omidvari S. The Edinburgh Postnatal Depression Scale (EPDS): translation and validationstudy of theIranianversion. BMC Psychiatry. 2007; 7: 11. doi:10.1186/1471-244X-7-11.
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry. 1987;150(6):782–6.doi:10.1192/bjp.150.6.782.
World Health Organization. WHO recommendations on maternal and newborn care for a positive postnatal experience: web annexes. Geneva: World Health Organization; 2022. Available from: https://apps.who.int/iris/handle/10665/352612.
Sambrook MS, Cairns L, Pullen LSW, Opondo C, Fellmeth G, Alderdice F. Validated tools to identify common mental disorders in the perinatal period: A systematic review of systematic reviews. J Affect Disord.2022;298:634-643.doi:10.1016/j.jad.2021.11.011.
Ferreira CR, Sanches MFTV, Matos GPNBR, RebustiniF, Domingues MARC. Instruments for evaluating social support networks for Brazilian elderlypeople: a scoping review. Concilium. 2024; 24(7): 432–451.doi:10.53660/CLM-3223-24G24.
Whittemore R, Knafl K. The integrative review: update methodology. J Adv Nurs. 2005;52(5):546-553. doi:10.1111/j.1365-2648.2005.03621.x.
Mourad Ouzzani, Hossam Hammady, Zbys Fedorowicz e Ahmed Elmagarmid. Rayyan — um aplicativo web e móvel para revisões sistemáticas. Revisões Sistemáticas (2016) 5:210, doi: 10.1186/s13643-016-0384-4.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.
Mokkink LB et al. COSMIN Risk of Bias checklist for systematic reviews of Patient Reported Outcome Measures. Qual. Life Res. 2018; 27(5): 1171-79. doi:10.1007/s11136-017-1765-4.
American Educational Research Association, American Psychological Association, National Council on Measurement in Education. Standards for educational and psychological testing. Washington, DC: Author; 1999.
Smith-Nielsen J, Matthey S, Lange T, et al. Validation of the Edinburgh Postnatal Depression Scale against both DSM-5 and ICD-10 diagnostic criteria for depression. BMC Psychiatry. 2018;18:393. doi:10.1186/s12888-018-1965-7.
Boran P, Waqas A, Aşkan ÖÖ et al. Screening of postpartum depression among new mothers in Istanbul: a psychometricevaluation of theTurkish Edinburgh Postnatal Depression Scale. BMC Res Notes. 2020;13:355.doi:10.1186/s13104-020-05196-x.
Greena EP, Tuli H, Kwobah E, Menya D, Chesire I, Schmidt C. Developing and validating a perinatal depression screening tool in Kenya blending Western criteriawith local idioms: A mixedmethodsstudy. J Affect Disord. 2018; 228:49-59.doi:10.1016/j.jad.2017.11.027.
Smith-Nielsen J, Matthey S, Lange T, et al. Validation of the Edinburgh Postnatal Depression Scale against both DSM-5 and ICD-10 diagnostic criteria for depression. BMC Psychiatry. 2018;18:393. doi:10.1186/s12888-018-1965-7.
Albuquerque MR, Corrêa H, Couto TC, Santos W, et al. A proposal for a new Brazilian six-item version of the Edinburgh Postnatal Depression Scale. Trends Psychiatry Psychother. 2017;39(1):29-33. doi:10.1590/2237-6089-2016-0056. doi.10.1590/2237-6089-2016-0056.
Syam M, Qasim E, Kadrianti et al. Factor structure of the Edinburgh postnatal depression scale Indonesian Version. Med Clin Pract.2021;4:100238. doi:10.1016/j.mcpsp.2021.100238
Hartley CM, Barroso N, Rey Y, Pettit JW, Bagner DM. Factor Structure and Psychometric Properties of English and Spanish Versions of the Edinburgh Postnatal Depression Scale AmongHispanicWomen in a Primary Care Setting. J. Clin. Psychol. 2014;70:1240-50. doi:10.1002/ jclp.22101.
Toreki A, Andó B, Dudas RB, Dweik D, Janka Z, Kozinszky Z, Keresztúri A. Validation of the Edinburgh Postnatal Depression Scale as a screening tool for postpartum depression in a clinical sample in Hungary. Midwifery. 2014; 30(8):911-8. doi: 10.1016/j.midw.2014.02.008.
Kheirabadi GR, Maracy MR, Akbaripour S, Masaeli N. Psychometric properties and diagnostic accuracy of the Edinburgh Postnatal Depression Scale in a sample of Iranian women. Iran J Med Sci. 2012;37(1):32-38.Avaliable from: https://pubmed.ncbi.nlm.nih.gov/23115428/
Lee King PA. Replicability of structural models of the Edinburgh Postnatal Depression Scale (EPDS) in a community sample of postpartum African American womenwithlowsocioeconomic status. Arch Womens Ment Health. 2012;15:77–86. doi: 10.1007/s00737-012-0260-8.
Reichenheim ME, Moraes CL, Oliveira AS, Lobato G. Revisiting the dimensional structure of the Edinburgh Postnatal Depression Scale (EPDS): empirical evidence for a general factor. BMC Med Res Methodol. 2011;11:93.doi:10.1186/1471-2288-11-93
Montazeri A, Torkan B, Omidvari S. The Edinburgh Postnatal Depression Scale (EPDS): translation and validationstudy of theIranianversion. BMC Psychiatry. 2007; 7: 11. doi:10.1186/1471-244X-7-11.
Santos IS, Matijasevich A, Tavares BF, Barros AJ, Botelho IP, Lapolli C, et al. Validation of the Edinburgh Postnatal Depression Scale (EPDS) in a sample of mothers from the 2004 Pelotas Birth Cohort Study. Cad Saude Publica. 2007;23(11):2577-2588. doi:10.1590/s0102- 311x2007001100005.
Santos IS, Matijasevich A, Tavares BF, et al. Comparing validity of Edinburgh scale and SRQ20 in screening for post-partum depression. Clin Pract Epidemiol Ment Health. 2007;3:18. doi:10.1186/1745-0179-3-18
Jardri R, Pelta J, Maron M, Thomas P, Delion P, Codaccioni X, et al. Predictive validation study of the Edinburgh Postnatal Depression Scale in the first week after delivery and risk analysis for postnatal depression. J Affect Disord. 2006;93(1-3):169-176. doi:10.1016/j.jad.2006.03.00
Werrett J, Clifford C. Validation of the Punjabi version of the Edinburgh Postnatal Depression Scale (EPDS). Int J Nurs Stud. 2006;43(2):227- 236. doi:10.1016/j.ijnurstu.2004.12.007.
American Educational Research Association, American Psychological Association, National Council on Measurement in Education. Standards for educational and psychological testing. Washington, DC: Author; 2014.
Clifford C, Day A, Cox J, Werrett J. A cross-cultural analysis of the use of the Edinburgh Post-Natal Depression Scale (EPDS) in health visiting practice. J Adv Nurs. 1999;30(3):655-664. doi:10.1046/j.1365-2648.1999.01115.
MacDermid JC. ICF Linking and Cognitive Interviewing Are Complementary Methods for Optimizing Content Validity of Outcome Measures: An Integrated Methods Review. Front Rehabilit Sci [Internet]. 2021 [citado 2025 ago 22];2:702596. doi: doi.10.3389/fresc.2021.702596
Echevarria-Guanilo ME, Gonçalves N, Romaniski PJ. Psychometric properties of measurement instruments: conceptual basis and evaluation methods - part II. Texto Contexto Enferm [Internet]. 2019 [citado 2025 ago 22];28:e20170311. doi: 10.1590/1980-265X-tce-2017-0311
American Educational Research Association, American Psychological Association, National Council on Measurement in Education. Standards for educational and psychological testing. Washington, DC: Author; 2014.
Skodová Z, Bánovčinová Ľ, Urbanová E, Grendár M, Bašková M. Factor Structure of the Edinburgh Postnatal Depression Scale in a Sample of Postpartum Slovak Women. Int J Environ Res Public Health. 2021;18(12):6298. doi:10.3390/ijerph18126298.
Levis B, Negeri Z, Sun Y, Benedetti A, Thombs BD, DEPRESsion Screening Data (DEPRESSD) EPDS Group. Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data. BMJ. 2020;370:m4022. doi:10.1136/bmj.m4022.
Trizano-Hermosilla I, Alvarado JM. Best alternatives to Cronbach’s alpha reliability in realistic conditions: congeneric and asymmetrical measurements. Front Psychol. 2016;7:769. doi:10.3389/fpsyg.2016.00769
Iliescu D, Greiff S. On Consequential Validity. European Journal of Psychological Assessment [Internet]. 2021 May 1 [cited 2025 Aug 22];37(3):163–6. Available from: https://doi.org/10.1027/1015-5759/a000664
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2025-09-30
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Silva, R. C. da, Oliveira, N. de J., Silva, J. M. Q., Rosa, R. F. do N., Marques, P. F., Freitas, K. S., & Coelho, E. de A. C. (2025). Validity evidence of the Edinburgh Postnatal Depression Scale: an integrative review. O Mundo Da Saúde, 49. https://doi.org/10.15343/0104-7809.202549e17312025I
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