Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis. (December 2020)

• Record Type: Journal Article
• Authors: Thombs, Brett D.; Levis, Brooke; Lyubenova, Anita; Neupane, Dipika; Negeri, Zelalem; Wu, Yin; Sun, Ying; He, Chen; Krishnan, Ankur; Vigod, Simone N.; Bhandari, Parash Mani; Imran, Mahrukh; Rice, Danielle B.; Azar, Marleine; Chiovitti, Matthew J.; Saadat, Nazanin; Riehm, Kira E.; Boruff, Jill T.; Cuijpers, Pim; Gilbody, Simon; Ioannidis, John P. A.; Kloda, Lorie A.; Patten, Scott B.; Shrier, Ian; Ziegelstein, Roy C.; Comeau, Liane; Mitchell, Nicholas D.; Tonelli, Marcello; Barnes, Jacqueline; Beck, Cheryl Tatano; Bindt, Carola; Figueiredo, Barbara; Helle, Nadine; Howard, Louise M.; Kohlhoff, Jane; Kozinszky, Zoltán; Leonardou, Angeliki A.; Radoš, Sandra Nakić; Quispel, Chantal; Rochat, Tamsen J.; Stein, Alan; Stewart, Robert C.; Tadinac, Meri; Tandon, S. Darius; Tendais, Iva; Töreki, Annamária; Tran, Thach D.; Trevillion, Kylee; Turner, Katherine; Vega-Dienstmaier, Johann M.; Benedetti, Andrea;
• Is Part Of: Canadian journal of psychiatry =. Volume 65:Number 12(2020)
• Page Start: 835
• Page End: 844
• Publication Date: 2020-12
• Subjects: epidemiology -- evidence-based medicine -- obstetrics and gynecology -- psychiatry -- statistics and research methods; Psychiatry -- Periodicals; Psychiatry -- Canada -- Periodicals; 616.8900971
• DOI: 10.1177/0706743720934959
• Languages: English
• ISSNs: 0706-7437

Abstract

Objective: The Maternal Mental Health in Canada, 2018/2019, survey reported that 18% of 7, 085 mothers who recently gave birth reported "feelings consistent with postpartum depression" based on scores ≥7 on a 5-item version of the Edinburgh Postpartum Depression Scale (EPDS-5). The EPDS-5 was designed as a screening questionnaire, not to classify disorders or estimate prevalence; the extent to which EPDS-5 results reflect depression prevalence is unknown. We investigated EPDS-5 ≥7 performance relative to major depression prevalence based on a validated diagnostic interview, the Structured Clinical Interview for DSM (SCID). Methods: We searched Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and the Web of Science Core Collection through June 2016 for studies with data sets with item response data to calculate EPDS-5 scores and that used the SCID to ascertain depression status. We conducted an individual participant data meta-analysis to estimate pooled percentage of EPDS-5 ≥7, pooled SCID major depression prevalence, and the pooled difference in prevalence. Results: A total of 3, 958 participants from 19 primary studies were included. Pooled prevalence of SCID major depression was 9.2% (95% confidence interval [CI] 6.0% to 13.7%), pooled percentage of participants with EPDS-5 ≥7 was 16.2% (95% CI 10.7% to 23.8%), and pooled difference was 8.0% (95% CI 2.9% to 13.2%). In the 19 included studies, mean and median ratios of EPDS-5 to SCID prevalence were 2.1 and 1.4 times. Conclusions: Prevalence estimated based on EPDS-5 ≥7 appears to be substantially higher than the prevalence of major depression. Validated diagnostic interviews should be used to establish prevalence.