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. (11th November 2020)

• Record Type: Journal Article
• Authors: Levis, Brooke; Negeri, Zelalem; Sun, Ying; Benedetti, Andrea; Thombs, Brett D
• Other Names: author non-byline.; He Chen author non-byline.; Krishnan Ankur author non-byline.; Wu Yin author non-byline.; Bhandari Parash Mani author non-byline.; Neupane Dipika author non-byline.; Imran Mahrukh author non-byline.; Rice Danielle B author non-byline.; Azar Marleine author non-byline.; Sanchez Tatiana A author non-byline.; Chiovitti Matthew J author non-byline.; Saadat Nazanin author non-byline.; Riehm Kira E author non-byline.; Boruff Jill T author non-byline.; Kloda Lorie A author non-byline.; Cuijpers Pim author non-byline.; Gilbody Simon author non-byline.; Ioannidis John P A author non-byline.; McMillan Dean author non-byline.; Patten Scott B author non-byline.; Shrier Ian author non-byline.; Ziegelstein Roy C author non-byline.; Comeau Liane author non-byline.; Mitchell Nicholas D author non-byline.; Tonelli Marcello author non-byline.; Vigod Simone N author non-byline.; Aceti Franca author non-byline.; Alvarado Rubén author non-byline.; Alvarado-Esquivel Cosme author non-byline.; Bakare Muideen O author non-byline.; Barnes Jacqueline author non-byline.; Bavle Amar D author non-byline.; Beck Cheryl Tatano author non-byline.; Bindt Carola author non-byline.; Boyce Philip M author non-byline.; Bunevicius Adomas author non-byline.; Correa Humberto author non-byline.; Couto Tiago Castro e author non-byline.; Chaudron Linda H author non-byline.; Chorwe-Sungani Genesis author non-byline.; de Figueiredo Felipe Pinheiro author non-byline.; Eapen Valsamma author non-byline.; Favez Nicolas author non-byline.; Felice Ethel author non-byline.; Fellmeth Gracia author non-byline.; Fernandes Michelle author non-byline.; Field Sally author non-byline.; Figueiredo Barbara author non-byline.; Fisher Jane R W author non-byline.; Garcia-Esteve Lluïsa author non-byline.; Giardinelli Lisa author non-byline.; Green Eric P author non-byline.; Helle Nadine author non-byline.; Honikman Simone author non-byline.; Howard Louise M author non-byline.; Kettunen Pirjo A author non-byline.; Khalifa Dina Sami author non-byline.; Kohlhoff Jane author non-byline.; Kusminskas Laima author non-byline.; Kozinszky Zoltán author non-byline.; Lelli Lorenzo author non-byline.; Leonardou Angeliki A author non-byline.; Maes Michael author non-byline.; Marsay Carina Y author non-byline.; Martínez Pablo author non-byline.; Meuti Valentina author non-byline.; Nakić Radoš Sandra author non-byline.; Navarro García Purificación author non-byline.; Nishi Daisuke author non-byline.; Okitundu Luwa E-Andjafono Daniel author non-byline.; Pawlby Susan J author non-byline.; Robertson-Blackmore Emma author non-byline.; Rochat Tamsen J author non-byline.; Rowe Heather J author non-byline.; Sharp Deborah J author non-byline.; Siu Bonnie W M author non-byline.; Skalkidou Alkistis author non-byline.; Smith-Nielsen Johanne author non-byline.; Stein Alan author non-byline.; Stewart Robert C author non-byline.; Su Kuan-Pin author non-byline.; Sundström-Poromaa Inger author non-byline.; Tadinac Meri author non-byline.; Tandon S Darius author non-byline.; Tendais Iva author non-byline.; Thiagayson Pavaani author non-byline.; Töreki Annamária author non-byline.; Torres-Giménez Anna author non-byline.; Tran Thach D author non-byline.; Trevillion Kylee author non-byline.; Tungchama Friday P author non-byline.; Turner Katherine author non-byline.; Væver Mette S author non-byline.; van Heyningen Thandi author non-byline.; Vega-Dienstmaier Johann M author non-byline.; Wynter Karen author non-byline.; Yonkers Kimberly A author non-byline.;
• Is Part Of: BMJ. Volume 371(2020)
• Publication Date: 2020-11-11
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Periodicals; 610
• DOI: 10.1136/bmj.m4022
• Languages: English
• ISSNs: 0007-1447

Abstract

Abstract: Objective: To evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnant and postpartum women. Design: Individual participant data meta-analysis. Data sources: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (from inception to 3 October 2018). Eligibility criteria for selecting studies: Eligible datasets included EPDS scores and major depression classification based on validated diagnostic interviews. Bivariate random effects meta-analysis was used to estimate EPDS sensitivity and specificity compared with semi-structured, fully structured (Mini International Neuropsychiatric Interview (MINI) excluded), and MINI diagnostic interviews separately using individual participant data. One stage meta-regression was used to examine accuracy by reference standard categories and participant characteristics. Results: Individual participant data were obtained from 58 of 83 eligible studies (70%; 15 557 of 22 788 eligible participants (68%), 2069 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of 11 or higher across reference standards. Among studies with a semi-structured interview (36 studies, 9066 participants, 1330 with major depression), sensitivity and specificity were 0.85 (95% confidence interval 0.79 to 0.90) and 0.84 (0.79 to 0.88) for a cut-off value of 10 or higher, 0.81 (0.75 to 0.87) and 0.88 (0.85 to 0.91) for a cut-off value of 11 or higher, and 0.66 (0.58 to 0.74) and 0.95 (0.92 to 0.96) for a cut-off value of 13 or higher, respectively. Accuracy was similar across reference standards and subgroups, including for pregnant and postpartum women. Conclusions: An EPDS cut-off value of 11 or higher maximised combined sensitivity and specificity; a cut-off value of 13 or higher was less sensitive but more specific. To identify pregnant and postpartum women with higher symptom levels, a cut-off of 13 or higher could be used. Lower cut-off values could be used if the intention is to avoid false negatives and identify most patients who meet diagnostic criteria. Registration: PROSPERO (CRD42015024785).