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

Research output: Contribution to journalArticlepeer-review

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 languageEnglish
Pages (from-to)835-844
Number of pages10
Journal The Canadian Journal of Psychiatry (CJP)
Issue number12
Publication statusPublished - Dec 2020


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