Abstract
Aims: This study used a large database to develop a reliable and valid shortened form of the Edinburgh Postnatal Depression Scale (EPDS), a self-report questionnaire used for depression screening in pregnancy and postpartum, based on objective criteria. Methods: Item responses from the 10-item EPDS were obtained from 5157 participants (765 major depression cases) from 22 primary screening accuracy studies that compared the EPDS to the Structured Clinical Interview for DSM (SCID). Unidimensionality of the EPDS latent construct was verified using confirmatory factor analysis, and an item response theory model was fit. Optimal test assembly (OTA) methods identified a maximally informative shortened form for each possible scale length between 1 and 9 items. The final shortened form was selected based on pre-specified validity and reliability criteria and non-inferiority of screening accuracy of the EPDS as compared to the SCID. Results: A 5-item short form of the EPDS (EPDS-Dep-5) was selected. The EPDS-Dep-5 had a Cronbach's alpha of 0.82. Sensitivity and specificity of the EPDS-Dep-5 for a cutoff of 4 or greater were 0.83 (95% CI, 0.73, 0.89) and 0.86 (95% CI, 0.80, 0.90) and were statistically non-inferior to the EPDS. The correlation of total scores with the full EPDS was high (r = 0.91). Conclusion: The EPDS-Dep-5 is a valid short form with minimal loss of information when compared to the full-length EPDS. The EPDS-Dep-5 was developed with OTA methods using objective, pre-specified criteria, but the approach is data-driven and exploratory. Thus, there is a need to replicate results of this study in different populations.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 348-362 |
| Number of pages | 15 |
| Journal | Acta Psychiatrica Scandinavica |
| Volume | 143 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 2021 |
Funding
This study was funded by the Canadian Institutes of Health Research (CIHR, KRS-140994). Dr. Levis was supported by a Fonds de recherche du Qu\u00E9bec-Sant\u00E9 (FRQS) Postdoctoral Training Fellowship. Drs. Thombs and Benedetti were supported by FRQS researcher salary awards. Dr. Wu was supported by a FRQS Postdoctoral Training Fellowship. Mr. Bhandari was supported by a studentship from the Research Institute of the McGill University Health Centre. Ms. Neupane was supported by G.R. Caverhill Fellowship from the Faculty of Medicine, McGill University. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. Ms. Azar was supported by a FRQS Masters Training Award. The primary study by Barnes et al was supported by a grant from the Health Foundation (1665/608). The primary study by Beck et al was supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation and the University of Connecticut Research Foundation. The primary study by Helle et al was supported by the Werner Otto Foundation, the Kroschke Foundation, and the Feindt Foundation. The primary study by de Figueiredo et al was supported by Funda\u00E7\u00E3o de Amparo \u00E0 Pesquisa do Estado de S\u00E3o Paulo. The primary study by Tendais et al was supported under the project POCI/SAU-ESP/56397/2004 by the Operational Program Science and Innovation 2010 (POCI 2010) of the Community Support Board III and by the European Community Fund FEDER. This primary study by Green et al was supported by a grant from the Duke Global Health Institute (453-0751). The primary study by Kettunen et al was supported with an Annual EVO Financing (Special government subsidies from the Ministry of Health and Welfare, Finland) by North Karelia Central Hospital and P\u00E4ij\u00E4t-H\u00E4me Central Hospital. The primary study by Phillips et al was supported by a scholarship from the National Health and Medical and Research Council (NHMRC). The primary study by Naki\u0107 Rado\u0161 et al was supported by the Croatian Ministry of Science, Education, and Sports (134-0000000-2421). The primary study by Rochat et al was supported by grants from the University of Oxford (HQ5035), the Tuixen Foundation (9940), the Wellcome Trust (082384/Z/07/Z and 071571), and the American Psychological Association. Dr. Rochat receives salary support from a Wellcome Trust Intermediate Fellowship (211374/Z/18/Z). The primary study by Smith-Nielsen et al was supported by a grant from the charitable foundation Tryg Foundation (Grant ID no 107616). The primary study by Prenoveau et al was supported by The Wellcome Trust (grant number 071571). The primary study by Stewart et al was supported by Professor Francis Creed's Journal of Psychosomatic Research Editorship fund (BA00457) administered through University of Manchester. The primary study by Tandon et al was funded by the Thomas Wilson Sanitarium. The primary study by Tran et al was supported by the Myer Foundation who funded the study under its Beyond Australia scheme. Dr. Tran was supported by an early career fellowship from the Australian National Health and Medical Research Council. The primary study by Vega-Dienstmaier et al was supported by Tejada Family Foundation, Inc, and Peruvian-American Endowment, Inc. No other authors reported funding for primary studies or for their work on the present study. No sponsor or funder was involved in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; or in the decision to submit the paper for publication. This study was funded by the Canadian Institutes of Health Research (CIHR, KRS\u2010140994). Dr. Levis was supported by a Fonds de recherche du Qu\u00E9bec\u2010Sant\u00E9 (FRQS) Postdoctoral Training Fellowship. Drs. Thombs and Benedetti were supported by FRQS researcher salary awards. Dr. Wu was supported by a FRQS Postdoctoral Training Fellowship. Mr. Bhandari was supported by a studentship from the Research Institute of the McGill University Health Centre. Ms. Neupane was supported by G.R. Caverhill Fellowship from the Faculty of Medicine, McGill University. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. Ms. Azar was supported by a FRQS Masters Training Award. The primary study by Barnes et al was supported by a grant from the Health Foundation (1665/608). The primary study by Beck et al was supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation and the University of Connecticut Research Foundation. The primary study by Helle et al was supported by the Werner Otto Foundation, the Kroschke Foundation, and the Feindt Foundation. The primary study by de Figueiredo et al was supported by Funda\u00E7\u00E3o de Amparo \u00E0 Pesquisa do Estado de S\u00E3o Paulo. The primary study by Tendais et al was supported under the project POCI/SAU\u2010ESP/56397/2004 by the Operational Program Science and Innovation 2010 (POCI 2010) of the Community Support Board III and by the European Community Fund FEDER. This primary study by Green et al was supported by a grant from the Duke Global Health Institute (453\u20100751). The primary study by Kettunen et al was supported with an Annual EVO Financing (Special government subsidies from the Ministry of Health and Welfare, Finland) by North Karelia Central Hospital and P\u00E4ij\u00E4t\u2010H\u00E4me Central Hospital. The primary study by Phillips et al was supported by a scholarship from the National Health and Medical and Research Council (NHMRC). The primary study by Naki\u0107 Rado\u0161 et al was supported by the Croatian Ministry of Science, Education, and Sports (134\u20100000000\u20102421). The primary study by Rochat et al was supported by grants from the University of Oxford (HQ5035), the Tuixen Foundation (9940), the Wellcome Trust (082384/Z/07/Z and 071571), and the American Psychological Association. Dr. Rochat receives salary support from a Wellcome Trust Intermediate Fellowship (211374/Z/18/Z). The primary study by Smith\u2010Nielsen et al was supported by a grant from the charitable foundation Tryg Foundation (Grant ID no 107616). The primary study by Prenoveau et al was supported by The Wellcome Trust (grant number 071571). The primary study by Stewart et al was supported by Professor Francis Creed's Journal of Psychosomatic Research Editorship fund (BA00457) administered through University of Manchester. The primary study by Tandon et al was funded by the Thomas Wilson Sanitarium. The primary study by Tran et al was supported by the Myer Foundation who funded the study under its Beyond Australia scheme. Dr. Tran was supported by an early career fellowship from the Australian National Health and Medical Research Council. The primary study by Vega\u2010Dienstmaier et al was supported by Tejada Family Foundation, Inc, and Peruvian\u2010American Endowment, Inc. No other authors reported funding for primary studies or for their work on the present study. No sponsor or funder was involved in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; or in the decision to submit the paper for publication.
Keywords
- depression
- optimal test assembly
- patient-reported outcome
- short form
ASJC Scopus subject areas
- Psychiatry and Mental health