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Lyubenova A, Neupane D, Levis B, Wu Y, Sun Y, He C, Krishnan A, Bhandari PM, Negeri Z, Imran M, Rice DB, Azar M, Chiovitti MJ, Saadat N, Riehm KE, Boruff JT, Ioannidis JPA, Cuijpers P, Gilbody S, Kloda LA, Patten SB, Shrier I, Ziegelstein RC, Comeau L, Mitchell ND, Tonelli M, Vigod SN, Aceti F, Barnes J, Bavle AD, Beck CT, Bindt C, Boyce PM, Bunevicius A, Chaudron LH, Favez N, Figueiredo B, Garcia-Esteve L, Giardinelli L, Helle N, Howard LM, Kohlhoff J, Kusminskas L, Kozinszky Z, Lelli L, Leonardou AA, Meuti V, Radoš SN, García PN, Pawlby SJ, Quispel C, Robertson-Blackmore E, Rochat TJ, Sharp DJ, Siu BWM, Stein A, Stewart RC, Tadinac M, Tandon SD, Tendais I, Töreki A, Torres-Giménez A, Tran TD, Trevillion K, Turner K, Vega-Dienstmaier JM, Benedetti A, Thombs BD. Depression prevalence based on the Edinburgh Postnatal Depression Scale compared to Structured Clinical Interview for DSM DIsorders classification: Systematic review and individual participant data meta-analysis. Int J Methods Psychiatr Res 2021; 30:e1860. [PMID: 33089942 PMCID: PMC7992289 DOI: 10.1002/mpr.1860] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/28/2020] [Accepted: 10/13/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Estimates of depression prevalence in pregnancy and postpartum are based on the Edinburgh Postnatal Depression Scale (EPDS) more than on any other method. We aimed to determine if any EPDS cutoff can accurately and consistently estimate depression prevalence in individual studies. METHODS We analyzed datasets that compared EPDS scores to Structured Clinical Interview for DSM (SCID) major depression status. Random-effects meta-analysis was used to compare prevalence with EPDS cutoffs versus the SCID. RESULTS Seven thousand three hundred and fifteen participants (1017 SCID major depression) from 29 primary studies were included. For EPDS cutoffs used to estimate prevalence in recent studies (≥9 to ≥14), pooled prevalence estimates ranged from 27.8% (95% CI: 22.0%-34.5%) for EPDS ≥ 9 to 9.0% (95% CI: 6.8%-11.9%) for EPDS ≥ 14; pooled SCID major depression prevalence was 9.0% (95% CI: 6.5%-12.3%). EPDS ≥14 provided pooled prevalence closest to SCID-based prevalence but differed from SCID prevalence in individual studies by a mean absolute difference of 5.1% (95% prediction interval: -13.7%, 12.3%). CONCLUSION EPDS ≥14 approximated SCID-based prevalence overall, but considerable heterogeneity in individual studies is a barrier to using it for prevalence estimation.
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Affiliation(s)
- Anita Lyubenova
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,School of Primary, Centre for Prognosis Research, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Ying Sun
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Chen He
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Parash M Bhandari
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Zelalem Negeri
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Matthew J Chiovitti
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Nazanin Saadat
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Kira E Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jill T Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada
| | - John P A Ioannidis
- Department of Medicine, Stanford University, Stanford, California, USA.,Department of Health Research and Policy, Stanford University, Stanford, California, USA.,Department of Biomedical Data Science, Stanford University, Stanford, California, USA.,Department of Statistics, Stanford University, Stanford, California, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, EMGO Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Simon Gilbody
- Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK
| | - Lorie A Kloda
- Library, Concordia University, Montréal, Québec, Canada
| | - Scott B Patten
- Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada.,Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, Alberta, Canada
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Liane Comeau
- International Union for Health Promotion and Health Education, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada
| | - Nicholas D Mitchell
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simone N Vigod
- Women's College Hospital and Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Franca Aceti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Jacqueline Barnes
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Amar D Bavle
- Department of Psychiatry, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
| | - Cheryl T Beck
- University of Connecticut School of Nursing, Mansfield, Connecticut, USA
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philip M Boyce
- Discipline of Psychiatry, Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Psychiatry, Westmead Hospital, Sydney, New South Wales, Australia
| | - Adomas Bunevicius
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Linda H Chaudron
- Departments of Psychiatry, Pediatrics, Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Nicolas Favez
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,IUP, University of Lausanne, Lausanne, Switzerland
| | | | - Lluïsa Garcia-Esteve
- Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.,Vulnerability, Psychopathology and Gender Research Group, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Lisa Giardinelli
- Department of Health Sciences, Psychiatry Unit, University of Florence, Firenze, Italy
| | - Nadine Helle
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Louise M Howard
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Jane Kohlhoff
- School of Psychiatry, University of New South Wales, Kensington, New South Wales, Australia.,Ingham Institute, Liverpool, New South Wales, Australia.,Karitane, Carramar, New South Wales, Australia
| | | | - Zoltán Kozinszky
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Lorenzo Lelli
- Department of Health Sciences, Psychiatry Unit, University of Florence, Firenze, Italy
| | - Angeliki A Leonardou
- First Department of Psychiatry, Women's Mental Health Clinic, Athens University Medical School, Athens, Greece
| | - Valentina Meuti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Sandra N Radoš
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
| | - Purificación N García
- Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.,Psychology Service, Regidoria de Polítiques de Gènere, Ajuntament de Terrassa, Terrassa, Spain
| | - Susan J Pawlby
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Chantal Quispel
- Department of Obstetrics and Gynaecology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | | | - Tamsen J Rochat
- MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa.,Human and Social Development Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Deborah J Sharp
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bonnie W M Siu
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Robert C Stewart
- Division of Psychiatry, University of Edinburgh, Edinburgh, Scotland, UK.,Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - Meri Tadinac
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - S Darius Tandon
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Iva Tendais
- School of Psychology, University of Minho, Braga, Portugal
| | | | - Anna Torres-Giménez
- Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.,Vulnerability, Psychopathology and Gender Research Group, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Thach D Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kylee Trevillion
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katherine Turner
- Epilepsy Center-Child Neuropsychiatry Unit, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy
| | | | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada.,Department of Psychology, McGill University, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada.,Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada.,Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada
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