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

Abstract

Objective To evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnant and postpartum women. Design Individual participant data meta-analysis. Data sources Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (from inception to 3 October 2018). Eligibility criteria for selecting studies Eligible 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. Results Individual 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. Conclusions An 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. Registration PROSPERO (CRD42015024785).

Pregnancy during the pandemic: the impact of COVID-19-related stress on risk for prenatal depression

“…Concerningly, compared to historical levels of prenatal depression, the discrepancy in depressive symptoms during COVID-19 that we observed in pregnant women is even greater than has been found when comparing general population samples during COVID-19 to prepandemic samples. In the full sample of 725 pregnant women that we surveyed in March-May 2020, over 40% reported symptoms indicating possible depression when using a cutoff score of ≥ 11 on the EPDS (Levis et al, 2020). In comparison, a systematic review of studies including over 35,000 women conducted in developed countries prior to the pandemic found that the average rate of prenatal depression was 17% (Underwood, Waldie, D'Souza, Peterson, & Morton, 2016).…”

“…Whereas participants in the pre-pandemic cohort completed a modified version of the EPDS in which they were asked to report on their symptoms "during pregnancy," participants in the COVID-19 cohort were asked to report on their symptoms in the "past 7 days." According to a recent meta-analysis, the EPDS has high sensitivity and specificity for detecting depression in pregnant women at a cut-off score of ≥ 11 (Levis, Negeri, Sun, Benedetti, & Thombs, 2020). Internal consistency of the EPDS quantified with Cronbach's ⍺ was good in both cohorts (pre-pandemic cohort=.89, COVID-19 cohort=.85).…”

“…The EPDS is a self-report questionnaire consisting of 10 items assessing symptoms of depression measured on a 4-point scale, yielding total scores ranging from 0 to 30 where higher scores indicate more severe symptoms. The EPDS has high sensitivity and specificity for detecting depression in pregnant women at a cut-off score of ⩾11 (Levis, Negeri, Sun, Benedetti, & Thombs, 2020 ). Whereas we asked women in the pre-pandemic cohort to reflect on their symptoms ‘during your pregnancy,’ we asked women in the COVID-19 cohort to reflect on their symptoms ‘during the last 7 days.’ Internal consistency of the EPDS was good in both cohorts (Cronbach's α: pre-pandemic cohort = 0.89, COVID-19 cohort = 0.85).…”

Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study

“…The depression level is the sum score of all the items, and higher scores indicate greater symptom severity. A threshold of 13 or more will be used to identify clinically significant symptoms [ 37 ]. Although a number of cut-off points have been used in different populations [ 38 ], maximum accuracy with a probable diagnosis of depressive disorder has been shown at this cut-off point in reviews of international EPDS validation studies [ 36 – 39 ].…”

Shortening the Edinburgh postnatal depression scale using optimal test assembly methods: Development of the EPDS‐Dep‐5

“…Second, for each candidate short form, an optimal cutoff score was selected using Youden's J statistic (sensitivity + specificity −1). 50,51 The bivariate random-effects model was fit using the lme4 package. 52 Third, two non-inferiority tests were conducted for each of the 9 candidate forms to compare sensitivity and specificity, separately, to the full-length form.…”