Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis

Brett D Thombs; Brooke Levis; Anita Lyubenova; Dipika Neupane; Zelalem Negeri; Yin Wu; Ying Sun; Chen He; Ankur Krishnan; Simone N Vigod; Parash Mani Bhandari; Mahrukh Imran; Danielle B Rice; Marleine Azar; Matthew J Chiovitti; Nazanin Saadat; Kira E Riehm; Jill T Boruff; Pim Cuijpers; Simon Gilbody; John P A Ioannidis; Lorie A Kloda; Scott B Patten; Ian Shrier; Roy C Ziegelstein; Liane Comeau; Nicholas D Mitchell; Marcello Tonelli; Jacqueline Barnes; Cheryl Tatano Beck; Carola Bindt; Barbara Figueiredo; Nadine Helle; Louise M Howard; Jane Kohlhoff; Zoltán Kozinszky; Angeliki A Leonardou; Sandra Nakić Radoš; Chantal Quispel; Tamsen J Rochat; Alan Stein; Robert C Stewart; Meri Tadinac; S Darius Tandon; Iva Tendais; Annamária Töreki; Thach D Tran; Kylee Trevillion; Katherine Turner; Johann M Vega-Dienstmaier; Andrea Benedetti

doi:10.1177/0706743720934959

Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis

Brett D Thombs, Brooke Levis, Anita Lyubenova, Dipika Neupane, Zelalem Negeri, Yin Wu, Ying Sun, Chen He, Ankur Krishnan, Simone N Vigod, Parash Mani Bhandari, Mahrukh Imran, Danielle B Rice, Marleine Azar, Matthew J Chiovitti, Nazanin Saadat, Kira E Riehm, Jill T Boruff, Pim Cuijpers, Simon GilbodyJohn P A Ioannidis, Lorie A Kloda, Scott B Patten, Ian Shrier, Roy C Ziegelstein, Liane Comeau, Nicholas D Mitchell, Marcello Tonelli, Jacqueline Barnes, Cheryl Tatano Beck, Carola Bindt, Barbara Figueiredo, Nadine Helle, Louise M Howard, Jane Kohlhoff, Zoltán Kozinszky, Angeliki A Leonardou, Sandra Nakić Radoš, Chantal Quispel, Tamsen J Rochat, Alan Stein, Robert C Stewart, Meri Tadinac, S Darius Tandon, Iva Tendais, Annamária Töreki, Thach D Tran, Kylee Trevillion, Katherine Turner, Johann M Vega-Dienstmaier, Andrea Benedetti

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Abstract / Description of output

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.

Original language	English
Pages (from-to)	835-844
Number of pages	10
Journal	The Canadian Journal of Psychiatry (CJP)
Volume	65
Issue number	12
DOIs	https://doi.org/10.1177/0706743720934959
Publication status	Published - Dec 2020

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Thombs, B. D., Levis, B., Lyubenova, A., Neupane, D., Negeri, Z., Wu, Y., Sun, Y., He, C., Krishnan, A., Vigod, S. N., Bhandari, P. M., Imran, M., Rice, D. B., Azar, M., Chiovitti, M. J., Saadat, N., Riehm, K. E., Boruff, J. T., Cuijpers, P., ... Benedetti, A. (2020). Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis. The Canadian Journal of Psychiatry (CJP), 65(12), 835-844. https://doi.org/10.1177/0706743720934959

@article{9d892bec3ed64d01b290784d138aeafa,

title = "Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis",

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.",

author = "Thombs, {Brett D} and Brooke Levis and Anita Lyubenova and Dipika Neupane and Zelalem Negeri and Yin Wu and Ying Sun and Chen He and Ankur Krishnan and Vigod, {Simone N} and Bhandari, {Parash Mani} and Mahrukh Imran and Rice, {Danielle B} and Marleine Azar and Chiovitti, {Matthew J} and Nazanin Saadat and Riehm, {Kira E} and Boruff, {Jill T} and Pim Cuijpers and Simon Gilbody and Ioannidis, {John P A} and Kloda, {Lorie A} and Patten, {Scott B} and Ian Shrier and Ziegelstein, {Roy C} and Liane Comeau and Mitchell, {Nicholas D} and Marcello Tonelli and Jacqueline Barnes and Beck, {Cheryl Tatano} and Carola Bindt and Barbara Figueiredo and Nadine Helle and Howard, {Louise M} and Jane Kohlhoff and Zolt{\'a}n Kozinszky and Leonardou, {Angeliki A} and Rado{\v s}, {Sandra Naki{\'c}} and Chantal Quispel and Rochat, {Tamsen J} and Alan Stein and Stewart, {Robert C} and Meri Tadinac and Tandon, {S Darius} and Iva Tendais and Annam{\'a}ria T{\"o}reki and Tran, {Thach D} and Kylee Trevillion and Katherine Turner and Vega-Dienstmaier, {Johann M} and Andrea Benedetti",

year = "2020",

month = dec,

doi = "10.1177/0706743720934959",

language = "English",

volume = "65",

pages = "835--844",

journal = " The Canadian Journal of Psychiatry (CJP)",

issn = "0706-7437",

publisher = "Canadian Psychiatric Association",

number = "12",

}

Thombs, BD, Levis, B, Lyubenova, A, Neupane, D, Negeri, Z, Wu, Y, Sun, Y, He, C, Krishnan, A, Vigod, SN, Bhandari, PM, Imran, M, Rice, DB, Azar, M, Chiovitti, MJ, Saadat, N, Riehm, KE, Boruff, JT, Cuijpers, P, Gilbody, S, Ioannidis, JPA, Kloda, LA, Patten, SB, Shrier, I, Ziegelstein, RC, Comeau, L, Mitchell, ND, Tonelli, M, Barnes, J, Beck, CT, Bindt, C, Figueiredo, B, Helle, N, Howard, LM, Kohlhoff, J, Kozinszky, Z, Leonardou, AA, Radoš, SN, Quispel, C, Rochat, TJ, Stein, A, Stewart, RC, Tadinac, M, Tandon, SD, Tendais, I, Töreki, A, Tran, TD, Trevillion, K, Turner, K, Vega-Dienstmaier, JM & Benedetti, A 2020, 'Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis', The Canadian Journal of Psychiatry (CJP), vol. 65, no. 12, pp. 835-844. https://doi.org/10.1177/0706743720934959

TY - JOUR

T1 - Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS

T2 - Systematic Review and Individual Participant Data Meta-analysis

AU - Thombs, Brett D

AU - Levis, Brooke

AU - Lyubenova, Anita

AU - Neupane, Dipika

AU - Negeri, Zelalem

AU - Wu, Yin

AU - Sun, Ying

AU - He, Chen

AU - Krishnan, Ankur

AU - Vigod, Simone N

AU - Bhandari, Parash Mani

AU - Imran, Mahrukh

AU - Rice, Danielle B

AU - Azar, Marleine

AU - Chiovitti, Matthew J

AU - Saadat, Nazanin

AU - Riehm, Kira E

AU - Boruff, Jill T

AU - Cuijpers, Pim

AU - Gilbody, Simon

AU - Ioannidis, John P A

AU - Kloda, Lorie A

AU - Patten, Scott B

AU - Shrier, Ian

AU - Ziegelstein, Roy C

AU - Comeau, Liane

AU - Mitchell, Nicholas D

AU - Tonelli, Marcello

AU - Barnes, Jacqueline

AU - Beck, Cheryl Tatano

AU - Bindt, Carola

AU - Figueiredo, Barbara

AU - Helle, Nadine

AU - Howard, Louise M

AU - Kohlhoff, Jane

AU - Kozinszky, Zoltán

AU - Leonardou, Angeliki A

AU - Radoš, Sandra Nakić

AU - Quispel, Chantal

AU - Rochat, Tamsen J

AU - Stein, Alan

AU - Stewart, Robert C

AU - Tadinac, Meri

AU - Tandon, S Darius

AU - Tendais, Iva

AU - Töreki, Annamária

AU - Tran, Thach D

AU - Trevillion, Kylee

AU - Turner, Katherine

AU - Vega-Dienstmaier, Johann M

AU - Benedetti, Andrea

PY - 2020/12

Y1 - 2020/12

N2 - 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.

AB - 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.

U2 - 10.1177/0706743720934959

DO - 10.1177/0706743720934959

M3 - Article

C2 - 33104415

SN - 0706-7437

VL - 65

SP - 835

EP - 844

JO - The Canadian Journal of Psychiatry (CJP)

JF - The Canadian Journal of Psychiatry (CJP)

IS - 12

ER -

Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis

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