Brett D Thombs1,2,3,4,5,6,7, Brooke Levis1,2,8, Anita Lyubenova1, Dipika Neupane1,2, Zelalem Negeri1,2, Yin Wu1,2,4, Ying Sun1, Chen He1,2, Ankur Krishnan1, Simone N Vigod9, Parash Mani Bhandari1,2, Mahrukh Imran1, Danielle B Rice1,3, Marleine Azar1,2, Matthew J Chiovitti1, Nazanin Saadat1, Kira E Riehm1,10, Jill T Boruff11, Pim Cuijpers12, Simon Gilbody13, John P A Ioannidis14, Lorie A Kloda15, Scott B Patten16,17,18, Ian Shrier1,2,19, Roy C Ziegelstein20, Liane Comeau21, Nicholas D Mitchell22,23, Marcello Tonelli24, Jacqueline Barnes25, Cheryl Tatano Beck26, Carola Bindt27, Barbara Figueiredo28, Nadine Helle27, Louise M Howard29,30, Jane Kohlhoff31,32,33, Zoltán Kozinszky34, Angeliki A Leonardou35, Sandra Nakić Radoš36, Chantal Quispel37, Tamsen J Rochat38,39, Alan Stein40,41, Robert C Stewart42,43, Meri Tadinac44, S Darius Tandon45, Iva Tendais28, Annamária Töreki46, Thach D Tran47, Kylee Trevillion29, Katherine Turner48, Johann M Vega-Dienstmaier49, Andrea Benedetti2,5,50. 1. 113635Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. 2. Department of Epidemiology, Biostatistics and Occupational Health, 5620McGill University, Montréal, Québec, Canada. 3. Department of Psychology, 5620McGill University, Montréal, Québec, Canada. 4. Department of Psychiatry, 5620McGill University, Montréal, Québec, Canada. 5. Department of Medicine, 5620McGill University, Montréal, Québec, Canada. 6. Department of Educational and Counselling Psychology, 5620McGill University, Montréal, Québec, Canada. 7. Biomedical Ethics Unit, 5620McGill University, Montréal, Québec, Canada. 8. Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Staffordshire, United Kingdom. 9. Women's College Hospital and Research Institute, University of Toronto, Ontario, Canada. 10. Department of Mental Health, Bloomberg School of Public Health, 1466Johns Hopkins University, Baltimore, MD, USA. 11. Schulich Library of Physical Sciences, Life Sciences, and Engineering, 5620McGill University, Montréal, Québec, Canada. 12. Department of Clinical, Neuro and Developmental Psychology, EMGO Institute, 1190Vrije Universiteit Amsterdam, the Netherlands. 13. Department of Health Sciences, Hull York Medical School, 8748University of York, Heslington, York, United Kingdom. 14. Department of Medicine, Department of Epidemiology and Population Health, Department of Biomedical Data Science, Department of Statistics, 10624Stanford University, Stanford, CA, USA. 15. Library, 5618Concordia University, Montréal, Québec, Canada. 16. Departments of Community Health Sciences and Psychiatry, 2129University of Calgary, Alberta, Canada. 17. Mathison Centre for Mental Health Research & Education, 2129University of Calgary, Alberta, Canada. 18. Cuthbertson & Fischer Chair in Pediatric Mental Health, 2129University of Calgary, Alberta, Canada. 19. Department of Family Medicine, 5620McGill University, Montréal, Québec, Canada. 20. Department of Medicine, 1466Johns Hopkins University School of Medicine, Baltimore, MD, USA. 21. International Union for Health Promotion and Health Education, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada. 22. Department of Psychiatry, 3158University of Alberta, Edmonton, Alberta, Canada. 23. Alberta Health Services, Edmonton, Alberta, Canada. 24. Department of Medicine, 2129University of Calgary, Alberta, Canada. 25. 215826Department of Psychological Sciences, Birkbeck, University of London, United Kingdom. 26. 7712University of Connecticut School of Nursing, Mansfield, CT, USA. 27. Department of Child and Adolescent Psychiatry, 234015University Medical Center Hamburg-Eppendorf, Germany. 28. School of Psychology, 219951University of Minho, Portugal. 29. Institute of Psychiatry, Psychology & Neuroscience, 4616King's College London, United Kingdom. 30. South London and Maudsley NHS Foundation Trust, London, United Kingdom. 31. School of Psychiatry, 7800University of New South Wales, Kensington, Australia. 32. Ingham Institute, Liverpool, Australia. 33. Karitane, Carramar, Australia. 34. 72227Department of Obstetrics and Gynaecology, Blekinge Hospital, Karlskrona, Sweden. 35. First Department of Psychiatry, Women's Mental Health Clinic, Athens University Medical School, Greece. 36. Department of Psychology, Catholic University of Croatia, Croatia. 37. Department of Obstetrics and Gynaecology, 2998Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands. 38. MRC/Developmental Pathways to Health Research Unit, Faculty of Health Sciences, 37707University of Witwatersrand, Johannesburg, South Africa. 39. Human and Social Development Program, Human Sciences Research Council, South Africa. 40. 105611Department of Psychiatry, University of Oxford, Oxford, United Kingdom. 41. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, 37707University of the Witwatersrand, Johannesburg, South Africa. 42. Division of Psychiatry, 270079University of Edinburgh, Scotland. 43. Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi. 44. Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Croatia. 45. 12244Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 46. Department of Emergency, University of Szeged, Hungary. 47. School of Public Health and Preventive Medicine, 161667Monash University, Melbourne, Victoria, Australia. 48. Epilepsy Cter-Child Neuropsychiatry Unit, 444273ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy. 49. Facultad de Medicina Alberto Hurtado, 33216Universidad Peruana Cayetano Heredia, Lima, Perú. 50. Respiratory Epidemiology and Clinical Research Unit, 5620McGill University Health Centre, Montréal, Québec, Canada.
Abstract
OBJECTIVE: The Maternal Mental Health in Canada, 2018/2019, survey reported that 18% of 7,085 mothers who recently gave birth reported "feelings consistent with postpartum depression" based on scores ≥7 on a 5-item version of the Edinburgh Postpartum Depression Scale (EPDS-5). The EPDS-5 was designed as a screening questionnaire, not to classify disorders or estimate prevalence; the extent to which EPDS-5 results reflect depression prevalence is unknown. We investigated EPDS-5 ≥7 performance relative to major depression prevalence based on a validated diagnostic interview, the Structured Clinical Interview for DSM (SCID). METHODS: We searched Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and the Web of Science Core Collection through June 2016 for studies with data sets with item response data to calculate EPDS-5 scores and that used the SCID to ascertain depression status. We conducted an individual participant data meta-analysis to estimate pooled percentage of EPDS-5 ≥7, pooled SCID major depression prevalence, and the pooled difference in prevalence. RESULTS: A total of 3,958 participants from 19 primary studies were included. Pooled prevalence of SCID major depression was 9.2% (95% confidence interval [CI] 6.0% to 13.7%), pooled percentage of participants with EPDS-5 ≥7 was 16.2% (95% CI 10.7% to 23.8%), and pooled difference was 8.0% (95% CI 2.9% to 13.2%). In the 19 included studies, mean and median ratios of EPDS-5 to SCID prevalence were 2.1 and 1.4 times. CONCLUSIONS: Prevalence estimated based on EPDS-5 ≥7 appears to be substantially higher than the prevalence of major depression. Validated diagnostic interviews should be used to establish prevalence.
OBJECTIVE: The Maternal Mental Health in Canada, 2018/2019, survey reported that 18% of 7,085 mothers who recently gave birth reported "feelings consistent with postpartum depression" based on scores ≥7 on a 5-item version of the Edinburgh Postpartum Depression Scale (EPDS-5). The EPDS-5 was designed as a screening questionnaire, not to classify disorders or estimate prevalence; the extent to which EPDS-5 results reflect depression prevalence is unknown. We investigated EPDS-5 ≥7 performance relative to major depression prevalence based on a validated diagnostic interview, the Structured Clinical Interview for DSM (SCID). METHODS: We searched Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and the Web of Science Core Collection through June 2016 for studies with data sets with item response data to calculate EPDS-5 scores and that used the SCID to ascertain depression status. We conducted an individual participant data meta-analysis to estimate pooled percentage of EPDS-5 ≥7, pooled SCID major depression prevalence, and the pooled difference in prevalence. RESULTS: A total of 3,958 participants from 19 primary studies were included. Pooled prevalence of SCID major depression was 9.2% (95% confidence interval [CI] 6.0% to 13.7%), pooled percentage of participants with EPDS-5 ≥7 was 16.2% (95% CI 10.7% to 23.8%), and pooled difference was 8.0% (95% CI 2.9% to 13.2%). In the 19 included studies, mean and median ratios of EPDS-5 to SCID prevalence were 2.1 and 1.4 times. CONCLUSIONS: Prevalence estimated based on EPDS-5 ≥7 appears to be substantially higher than the prevalence of major depression. Validated diagnostic interviews should be used to establish prevalence.
Entities:
Keywords:
epidemiology; evidence-based medicine; obstetrics and gynecology; psychiatry; statistics and research methods
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