Diagnostic accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for detecting major depression in pregnant and postnatal women: protocol for a systematic review and individual patient data meta-analyses

Abstract

IntroductionStudies of the diagnostic accuracy of depression screening tools often used data-driven methods to select optimal cut-offs. Typically, these studies report results from a small range of cut-off points around whatever cut-off score is identified as most accurate. When published data are combined in meta-analyses, estimates of accuracy for different cut-off points may be based on data from different studies, rather than data from all studies for each cut-off point. Thus, traditional meta-analyses may exaggerate accuracy estimates. Individual patient data (IPD) meta-analyses synthesise data from all studies for each cut-off score to obtain accuracy estimates. The 10-item Edinburgh Postnatal Depression Scale (EPDS) is commonly recommended for depression screening in the perinatal period. The primary objective of this IPD meta-analysis is to determine the diagnostic accuracy of the EPDS to detect major depression among women during pregnancy and in the postpartum period across all potentially relevant cut-off scores, accounting for patient factors that may influence accuracy (age, pregnancy vs postpartum).Methods and analysisData sources will include Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science. Studies that include a diagnosis of major depression based on a validated structured or semistructured clinical interview administered within 2 weeks of (before or after) the administration of the EPDS will be included. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Bivariate random-effects meta-analysis will be conducted for the full range of plausible cut-off values. Analyses will evaluate data from pregnancy and the postpartum period separately, as well as combining data from all women in a single model.Ethics and disseminationThis study does not require ethics approval. Dissemination will include journal articles and presentations to policymakers, healthcare providers and researchers.Systematic review registrationPROSPERO 2015:CRD42015024785.

Optimal cut‐off score of the Edinburgh Postnatal Depression Scale for major depressive episode during pregnancy in Japan

“…Large‐scale meta‐analyses have also been conducted to clarify optimal EPDS cut‐off scores during pregnancy . It is thought that a global standard cut‐off score will be indicated, although the optimal value might vary based on differences in medical systems that accept high‐risk individuals as well as on cultural differences that influence emotional expression (e.g., tendencies for over/underreporting).…”

“…9 All pregnant women at 12-24 gestational weeks who attended a maternity hospital from Large-scale meta-analyses have also been conducted to clarify optimal EPDS cut-off scores during pregnancy. 34 It is thought that a global standard cutoff score will be indicated, although the optimal value might vary based on differences in medical systems that accept high-risk individuals as well as on cultural differences that influence emotional expression (e.g., tendencies for over/underreporting). In a clinical setting, utilizing the scale based on local context is important for early detection of high-risk pregnant women so that they can receive primary care treatment.…”

Screening of postpartum depression among new mothers in Istanbul: a psychometric evaluation of the Turkish Edinburgh Postnatal Depression Scale

“…Therefore, keeping recent literature on EPDS, a minimum sample size of 50 seems to be appropriate for wide communalities. p/f (10), unidmensional factor structure and excellent criterion (0.98) [2,3,8,9].…”

Depression screening tools in persons with epilepsy: A systematic review of validated tools

“…Another limitation identified in the literature is the selection of cutpoints post hoc based on the study sample. By using a sample‐based approach to choose the cutpoints reported, there may be an overestimation in the validity of the tools due to selective reporting around cutpoints where better performance is partially due to sampling variability . Therefore, these screening tools may not work as well in practice as they do for the samples used in the studies.…”