Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis
Thombs, B.D.; Levis, B.; Lyubenova, A.; Neupane, D.; Negeri, Z.; Wu, Y.; Sun, Y.; He, C.; Krishnan, A.; Vigod, S.N.; Bhandari, P.M.; Imran, M.; Rice, D.B.; Azar, M.; Chiovitti, M.J.; Saadat, N.; Riehm, K.E.; Boruff, J.T.; Cuijpers, P.; Gilbody, S.; Ioannidis, J.P.A.; Kloda, L.A.; Patten, S.B.; Shrier, I.; Ziegelstein, R.C.; Comeau, L.; Mitchell, N.D.; Tonelli, M.; Barnes, J.; Beck, C.T.; Bindt, C.; Figueiredo, B.; Helle, N.; Howard, L.M.; Kohlhoff, J.; Kozinszky, Z.; Leonardou, A.A.; Radoš, S.N.; Quispel, C.; Rochat, T.J.; Stein, A.; Stewart, R.C.; Tadinac, M.; Tandon, S.D.; Tendais, I.; Töreki, A.; Tran, T.D.; Trevillion, K.; Turner, K.; Vega Dienstmaier, Johann Martín; Benedetti, A.
Date:
2020
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.
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