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

• Published in: BMJ (Online) Vol. 371; p. m4022
• Main Authors: Levis, Brooke, Negeri, Zelalem, Sun, Ying, Benedetti, Andrea, Thombs, Brett D
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 11-11-2020; BMJ Publishing Group Ltd
• Subjects: Accuracy; Classification; Datasets; Depression, Postpartum - psychology; Depressive Disorder, Major - psychology; Female; Human Development Index; Humans; Interviews; Medical screening; Medicin och hälsovetenskap; Mental depression; Mental disorders; Mental health; Meta-analysis; Postpartum; Postpartum depression; Pregnancy; Pregnancy Complications - psychology; Prenatal Care; Psychometrics; Sensitivity and Specificity; Systematic review; Task forces; Womens health
• ISSN: 1756-1833; 0959-8138; 1756-1833
• DOI: 10.1136/bmj.m4022

AbstractObjectiveTo evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnant and postpartum women.DesignIndividual participant data meta-analysis.Data sourcesMedline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (from inception to 3 October 2018).Eligibility criteria for selecting studiesEligible 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.ResultsIndividual 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.ConclusionsAn 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.RegistrationPROSPERO (CRD42015024785).