Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis.
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.
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.