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

^*Corresponding author for this work

Medical Social Sciences

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

11 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 (US)
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

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Canadian Institutes of Health Research (CIHR, KRS-140994). Drs. Thombs and Benedetti were supported by Fonds de recherche du Québec–Santé (FRQS) researcher salary awards. Dr. Levis was supported by a FRQS Postdoctoral Training Fellowship. Ms. Lyubenova was supported by the Mitacs Globalink Research Internship Program. Ms. Neupane was supported by G.R. Caverhill Fellowship from the Faculty of Medicine, McGill University. Dr. Wu was supported by a FRQS Postdoctoral Training Fellowship. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. Mr. Bhandari was supported by a studentship from the Research Institute of the McGill University Health Centre. 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 de Figueiredo et al. was supported by Fundação de Amparo à Pesquisa do Estado de São 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. 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 Howard et al. was supported by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Numbers RP-PG-1210-12002 and RP-DG-1108-10012) and by the South London Clinical Research Network. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. 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 Nakić Radoš et al. was supported by the Croatian Ministry of Science, Education, and Sports (134-0000000-2421). The primary study by Quispel et al. was supported by Stichting Achmea Gezondheid (grant number z-282). 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 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 views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. 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 this study.

Keywords

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

ASJC Scopus subject areas

Psychiatry and Mental health

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

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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.",

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 = "English (US)",

volume = "65",

pages = "835--844",

journal = "Canadian Journal of Psychiatry",

issn = "0706-7437",

publisher = "SAGE Publications Inc.",

number = "12",

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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

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DO - 10.1177/0706743720934959

M3 - Review article

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SN - 0706-7437

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JO - Canadian Journal of Psychiatry

JF - Canadian Journal of Psychiatry

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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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