Depression prevalence based on the Edinburgh Postnatal Depression Scale compared to Structured Clinical Interview for DSM DIsorders classification: Systematic review and individual participant data meta‐analysis
Anita Lyubenova, Dipika Neupane, Brooke Levis, Yin Wu, Ying Sun, Chen He, Ankur Krishnan, Parash Mani Bhandari, Zelalem Negeri, Mahrukh Imran, Danielle B. Rice, Marleine Azar, Matthew J. Chiovitti, Nazanin Saadat, Kira E. Riehm, Jill Boruff, John P. A. Ioannidis, Pim Cuijpers, Simon Gilbody, Lorie A. Kloda, Scott B. Patten, Ian Shrier, Roy C. Ziegelstein, Liane Comeau, Nicholas Mitchell, Marcello Tonelli, Simone N. Vigod, Franca Aceti, Jacqueline Barnes, Amar Bavle, Cheryl Tatano Beck, Carola Bindt, Philip Boyce, Adomas Bunevičius, Linda H. Chaudron, Nicolas Favez, Bárbara Figueiredo, Lluïsa García-Esteve, Lisa Giardinelli, Nadine Helle, Louise M. Howard, Jane Kohlhoff, Laima Kusminskas, Zoltán Kozinszky, Lorenzo Lelli, Angeliki Leonardou, Valentina Meuti, Sandra Nakić Radoš, Purificación Navarro García, Susan Pawlby, Chantal Quispel, Emma Robertson‐Blackmore, Tamsen Rochat, Deborah J. Sharp, Bonnie W.M. Siu, Alan Stein, Robert C. Stewart, Meri Tadinac, S. Darius Tandon, Iva Tendais, Annamária Töreki, Anna Torres‐Giménez, Thach Tran, Kylee Trevillion, Katherine Turner, Johann M. Vega‐Dienstmaier, Andrea Benedetti, Brett D. Thombs
Abstract
OBJECTIVES: Estimates of depression prevalence in pregnancy and postpartum are based on the Edinburgh Postnatal Depression Scale (EPDS) more than on any other method. We aimed to determine if any EPDS cutoff can accurately and consistently estimate depression prevalence in individual studies. METHODS: We analyzed datasets that compared EPDS scores to Structured Clinical Interview for DSM (SCID) major depression status. Random-effects meta-analysis was used to compare prevalence with EPDS cutoffs versus the SCID. RESULTS: Seven thousand three hundred and fifteen participants (1017 SCID major depression) from 29 primary studies were included. For EPDS cutoffs used to estimate prevalence in recent studies (≥9 to ≥14), pooled prevalence estimates ranged from 27.8% (95% CI: 22.0%-34.5%) for EPDS ≥ 9 to 9.0% (95% CI: 6.8%-11.9%) for EPDS ≥ 14; pooled SCID major depression prevalence was 9.0% (95% CI: 6.5%-12.3%). EPDS ≥14 provided pooled prevalence closest to SCID-based prevalence but differed from SCID prevalence in individual studies by a mean absolute difference of 5.1% (95% prediction interval: -13.7%, 12.3%). CONCLUSION: EPDS ≥14 approximated SCID-based prevalence overall, but considerable heterogeneity in individual studies is a barrier to using it for prevalence estimation.