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 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

Jewish General Hospital
McGill University
Keele University
University of Toronto
Johns Hopkins Bloomberg School of Public Health
University of Amsterdam
University of York
Stanford University
Concordia University
University of Calgary
Johns Hopkins University School of Medicine
Universite de Montreal
University of Alberta
Alberta Health Services
University of Calgary
Birkbeck, University of London
School of Nursing
University Medical Center Hamburg-Eppendorf
University of Minho
King’s College London
South London and Maudsley NHS Foundation Trust
University of New South Wales
Ingham Institute for Applied Medical Research
Karitane
Blekinge Hospital
Athens University Medical School
Catholic University of Croatia
Albert Schweitzer Ziekenhuis
the Wits Reproductive Health and HIV Institute
Human Sciences Research Council of South Africa
University of Oxford
University of the Witwatersrand, Johannesburg
University of Edinburgh
Malawi Epidemiology and Intervention Research Unit
University of Zagreb
Northwestern University Feinberg School of Medicine
MTA-SZTE “Lendület” Mycobiome Research Group
Monash University
San Paolo Hospital
Universidad Peruana Cayetano Heredia, Facultad de Medicina Alberto Hurtado
McGill University Health Centre

Research output: Contribution to journal › Review article › peer-review

14 Scopus citations

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.

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

Keywords

epidemiology
evidence-based medicine
obstetrics and gynecology
psychiatry
statistics and research methods

Access to Document

10.1177/0706743720934959

Cite this

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. Canadian Journal of Psychiatry, 65(12), 835-844. https://doi.org/10.1177/0706743720934959

@article{676391ab07714550bd0f8e179ba670d8,

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 {\textquotedblleft}feelings consistent with postpartum depression{\textquotedblright} 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.",

keywords = "epidemiology, evidence-based medicine, obstetrics and gynecology, psychiatry, statistics and research methods",

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",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2020.",

year = "2020",

month = dec,

doi = "10.1177/0706743720934959",

language = "Ingl{\'e}s",

volume = "65",

pages = "835--844",

journal = "Canadian Journal of Psychiatry",

issn = "0706-7437",

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', Canadian Journal of Psychiatry, 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.

KW - epidemiology

KW - evidence-based medicine

KW - obstetrics and gynecology

KW - psychiatry

KW - statistics and research methods

UR - https://www.scopus.com/pages/publications/85093952352

U2 - 10.1177/0706743720934959

DO - 10.1177/0706743720934959

M3 - Artículo de revisión

C2 - 33104415

AN - SCOPUS:85093952352

SN - 0706-7437

VL - 65

SP - 835

EP - 844

JO - Canadian Journal of Psychiatry

JF - Canadian Journal of Psychiatry

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

Abstract

Keywords

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