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

Journal article

Objective: To evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnancy and postpartum.

Design: Individual participant data meta-analysis.

Data Sources: Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science were searched (inception – October 3, 2018).

Eligibility criteria for selecting studies: Eligible datasets included EPDS scores and major depression classification via validated diagnostic interviews. Bivariate random-effects meta-analysis was used to estimate EPDS sensitivity and specificity compared to 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%], 2,069 cases). Combined sensitivity and specificity was maximized at cutoff  11 across reference standards. Among studies with a semi-structured interview (36 studies, 9,066 participants, 1,330 cases), sensitivity and specificity (95% CI) were 0.85 (0.79 to 0.90) and 0.84 (0.79 to 0.88) for cutoff  10, 0.81 (0.75 to 0.87) and 0.88 (0.85 to 0.91) for cutoff  11, and 0.66 (0.58 to 0.74) and 0.95 (0.92 to 0.96) for cutoff  13. Accuracy was similar across reference standards and subgroups, including for women in pregnancy and postpartum.

Conclusions: An EPDS cutoff of  11 maximized combined sensitivity and specificity; a cutoff of ≥ 13 was less sensitive but more specific. To identify women in pregnancy and postpartum with higher symptom levels, a cutoff of 13 or greater could be used. Lower cutoffs could be used if the intention is to avoid false negatives and identify most patients who meet diagnostic criteria.

Authors: Levis, B; Negeri, Z; Ying, S; Andrea, B; Thombs, BD

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: BMJ: British Medical Journal
• Volume: 371
• Issue: 2020
• Article number: m4022
• Publication date: 2020-11-11
• Acceptance date: 2020-09-10
• DOI: 10.1136/bmj.m4022
• EISSN: 1473-4257
• ISSN: 0959-535X
• Language: English
• Keywords: FFR