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

Research output: Contribution to journalReview articlepeer-review

8 Scopus citations


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 (US)
Pages (from-to)835-844
Number of pages10
JournalCanadian Journal of Psychiatry
Issue number12
StatePublished - Dec 2020


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

ASJC Scopus subject areas

  • Psychiatry and Mental health


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