Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis-Reference-Cited by-同舟云学术

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

Published:2020-10-26 Issue:12 Volume:65 Page:835-844
ISSN:0706-7437
Container-title:The Canadian Journal of Psychiatry
language:en
Short-container-title:Can J Psychiatry

Author:

Thombs Brett D.¹²³⁴⁵^ORCID,Levis Brooke¹²⁶,Lyubenova Anita¹,Neupane Dipika¹²,Negeri Zelalem¹²,Wu Yin¹²⁴,Sun Ying¹,He Chen¹²,Krishnan Ankur¹,Vigod Simone N.⁷,Bhandari Parash Mani¹²,Imran Mahrukh¹,Rice Danielle B.¹³,Azar Marleine¹²,Chiovitti Matthew J.¹,Saadat Nazanin¹,Riehm Kira E.¹⁸,Boruff Jill T.⁹,Cuijpers Pim¹⁰,Gilbody Simon¹¹,Ioannidis John P. A.¹²,Kloda Lorie A.¹³,Patten Scott B.¹⁴¹⁵¹⁶^ORCID,Shrier Ian¹²¹⁷^ORCID,Ziegelstein Roy C.¹⁸,Comeau Liane¹⁹,Mitchell Nicholas D.²⁰²¹,Tonelli Marcello²²,Barnes Jacqueline²³,Beck Cheryl Tatano²⁴,Bindt Carola²⁵,Figueiredo Barbara²⁶,Helle Nadine²⁵,Howard Louise M.²⁷²⁸,Kohlhoff Jane²⁹³⁰³¹,Kozinszky Zoltán³²,Leonardou Angeliki A.³³,Radoš Sandra Nakić³⁴,Quispel Chantal³⁵,Rochat Tamsen J.³⁶³⁷,Stein Alan³⁸³⁹,Stewart Robert C.⁴⁰⁴¹,Tadinac Meri⁴²,Tandon S. Darius⁴³,Tendais Iva²⁶,Töreki Annamária⁴⁴,Tran Thach D.⁴⁵,Trevillion Kylee²⁷,Turner Katherine⁴⁶,Vega-Dienstmaier Johann M.⁴⁷^ORCID,Benedetti Andrea²⁵⁴⁸

Affiliation:

1. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada

2. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada

3. Department of Psychology, McGill University, Montréal, Québec, Canada

4. Department of Psychiatry, McGill University, Montréal, Québec, Canada

5. Department of Medicine, McGill University, Montréal, Québec, Canada

6. Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Staffordshire, United Kingdom

7. Women’s College Hospital and Research Institute, University of Toronto, Ontario, Canada

8. Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

9. Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada

10. Department of Clinical, Neuro and Developmental Psychology, EMGO Institute, Vrije Universiteit Amsterdam, the Netherlands

11. Department of Health Sciences, Hull York Medical School, University of York, Heslington, York, United Kingdom

12. Department of Medicine, Department of Epidemiology and Population Health, Department of Biomedical Data Science, Department of Statistics, Stanford University, Stanford, CA, USA

13. Library, Concordia University, Montréal, Québec, Canada

14. Departments of Community Health Sciences and Psychiatry, University of Calgary, Alberta, Canada

15. Mathison Centre for Mental Health Research & Education, University of Calgary, Alberta, Canada

16. Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, Alberta, Canada

17. Department of Family Medicine, McGill University, Montréal, Québec, Canada

18. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

19. International Union for Health Promotion and Health Education, École de santé publique de l’Université de Montréal, Montréal, Québec, Canada

20. Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada

21. Alberta Health Services, Edmonton, Alberta, Canada

22. Department of Medicine, University of Calgary, Alberta, Canada

23. Department of Psychological Sciences, Birkbeck, University of London, United Kingdom

24. University of Connecticut School of Nursing, Mansfield, CT, USA

25. Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany

26. School of Psychology, University of Minho, Portugal

27. Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom

28. South London and Maudsley NHS Foundation Trust, London, United Kingdom

29. School of Psychiatry, University of New South Wales, Kensington, Australia

30. Ingham Institute, Liverpool, Australia

31. Karitane, Carramar, Australia

32. Department of Obstetrics and Gynaecology, Blekinge Hospital, Karlskrona, Sweden

33. First Department of Psychiatry, Women’s Mental Health Clinic, Athens University Medical School, Greece

34. Department of Psychology, Catholic University of Croatia, Croatia

35. Department of Obstetrics and Gynaecology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands

36. MRC/Developmental Pathways to Health Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa

37. Human and Social Development Program, Human Sciences Research Council, South Africa

38. Department of Psychiatry, University of Oxford, Oxford, United Kingdom

39. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

40. Division of Psychiatry, University of Edinburgh, Scotland

41. Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi

42. Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Croatia

43. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

44. Department of Emergency, University of Szeged, Hungary

45. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

46. Epilepsy Cter-Child Neuropsychiatry Unit, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy

47. Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú

48. Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada

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.

Funder

Canadian Institutes of Health Research

Fonds de recherche du Québec–Santé

FRQS Postdoctoral Training Fellowship

mitacs

faculty of medicine, mcgill university

Vanier Canada Graduate Scholarship

mcgill university health centre

Health Foundation

patrick and catherine weldon donaghue medical research foundation

university of connecticut

fundaçào de amparo à pesquisa do estado de são paulo