Article type
Year
Abstract
Background: The Edinburgh Postnatal Depression Scale (EPDS) is recommended for depression screening in pregnancy and postpartum. Cutoffs of ≥ 10 or ≥ 13 are commonly used to detect possible depression, but the only previous meta-analysis found that a cutoff of ≥ 12 maximized combined sensitivity and specificity. That meta-analysis, however, was conducted over 10 years ago and was limited by a small number of included studies, by incomplete cutoff reporting within included studies, and by not examining accuracy by reference standard or participant subgroups, including pregnancy versus postpartum. Individual participant data meta-analysis (IPDMA), which synthesizes participant-level data from primary studies rather than summary results from study reports, has the potential to overcome these challenges.
Objectives: To evaluate EPDS accuracy for screening to detect major depression in pregnancy and postpartum using IPDMA.
Methods: Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science were searched from inception to October 3, 2018 for datasets that compared EPDS scores to major depression classification based on a validated diagnostic interview. Bivariate random-effects meta-analysis was used to estimate EPDS sensitivity and specificity compared to 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 (age, pregnant versus postpartum status, and country human development index).
Results: Individual participant data were obtained from 58 of 83 eligible studies (15,557 participants, 2,069 major depression cases). EPDS ≥ 11 maximized combined sensitivity and specificity (81%, 88%). For commonly used cutoffs, sensitivity and specificity were 85% and 84% for EPDS ≥ 10 and 66% and 95% for EPDS ≥ 13. Accuracy was similar across reference standards and subgroups, including for women in pregnancy and postpartum.
Conclusions: An EPDS cutoff of ≥ 11 maximized combined sensitivity and specificity; a cutoff of ≥ 13 was less sensitive but more specific. To identify women in pregnancy and postpartum with higher symptom levels, a cutoff of 13 or greater could be used. Lower cutoffs could be used if the intention is to avoid false negatives and identify most patients who meet diagnostic criteria.
Patient or healthcare consumer involvement: There was no direct patient or consumer involvement in this project. However, clinicians considering screening for depression with the EPDS can refer to our web-based knowledge translation tool: depressionscreening100.com/epds, which estimates expected numbers of positive screens and true and false screening outcomes based on results from the present IPDMA.
Objectives: To evaluate EPDS accuracy for screening to detect major depression in pregnancy and postpartum using IPDMA.
Methods: Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science were searched from inception to October 3, 2018 for datasets that compared EPDS scores to major depression classification based on a validated diagnostic interview. Bivariate random-effects meta-analysis was used to estimate EPDS sensitivity and specificity compared to 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 (age, pregnant versus postpartum status, and country human development index).
Results: Individual participant data were obtained from 58 of 83 eligible studies (15,557 participants, 2,069 major depression cases). EPDS ≥ 11 maximized combined sensitivity and specificity (81%, 88%). For commonly used cutoffs, sensitivity and specificity were 85% and 84% for EPDS ≥ 10 and 66% and 95% for EPDS ≥ 13. Accuracy was similar across reference standards and subgroups, including for women in pregnancy and postpartum.
Conclusions: An EPDS cutoff of ≥ 11 maximized combined sensitivity and specificity; a cutoff of ≥ 13 was less sensitive but more specific. To identify women in pregnancy and postpartum with higher symptom levels, a cutoff of 13 or greater could be used. Lower cutoffs could be used if the intention is to avoid false negatives and identify most patients who meet diagnostic criteria.
Patient or healthcare consumer involvement: There was no direct patient or consumer involvement in this project. However, clinicians considering screening for depression with the EPDS can refer to our web-based knowledge translation tool: depressionscreening100.com/epds, which estimates expected numbers of positive screens and true and false screening outcomes based on results from the present IPDMA.