BACKGROUND AND PURPOSE:

• Edinburgh Postnatal Depression Scale (EPDS) is used to screen for depression during pregnancy and postpartum
  • Threshold scores of ≥10 and ≥13 are most frequently used
  • Levis et al. (BMJ, 2020) evaluated EPDS for screening to detect major depression in pregnant and postpartum women

METHODS:

• Systematic review and individual participant data meta-analysis
• Data sources (from inception to 3 October 2018)
  • Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science
• Inclusion criteria
  • Datasets including EPDS scores and major depression classification based on validated diagnostic interviews
• Study design
  • Random effects meta-analysis was used to estimate EPDS sensitivity and specificity compared with
    • Semi-structured diagnostic interviews
    • Fully structured diagnostic interviews (not including MINI)
    • MINI (brief structured interview to assess common psychiatric disorders)

RESULTS:

• 58 of 83 eligible studies included individual participant data (70%)
  • 15,557 participants | 2069 with major depression
• Combined sensitivity and specificity were maximized at a cut-off value of ≥11 across all reference standards
• Among studies with a semi-structured interview
  • Cut-off value of ≥10
    • Sensitivity: 0.85 (95% CI, 0.79 to 0.90)
    • Specificity: 0.84 (95% CI, 0.79 to 0.88)
  • Cut-off value ≥11
    • Sensitivity: 0.81 (95% CI, 0.75 to 0.87)
    • Specificity: 0.88 (95% CI, 0.85 to 0.91)
  • Cut-off value of ≥13
    • Sensitivity: 0.66 (95% CI, 0.58 to 0.74)
    • Specificity: 0.95 (95% CI, 0.92 to 0.96)
• Accuracy was similar across reference standards and subgroups, including for pregnant and postpartum women

CONCLUSION:

• Sensitivity and specificity were highest using an EPDS cut-off value of ≥11 
  • ≥13 cut-off value was less sensitive but more specific
    • Decrease false positives
    • May be more useful for identifying women with more symptoms
  • Lower cut-off values can be used to avoid false negatives
• The authors include an ‘online knowledge’ screening tool to estimate the expected number of positive screens and true and false screening outcomes based on study results (see ‘Learn More – Primary Sources’ below)

Learn More – Primary Sources:

Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data

Using the EPDS to Screen for Depression in Pregnancy and Postpartum: A Practice-Based Perspective: The DEPRESSD Project

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Does Maternal Depression or Stress Affect Fetal Growth?

Can Omega-3 Supplements Ameliorate Symptoms of Postpartum Depression?

The Four Maternal Characteristics that Predict Postpartum Depression Severity

PHQ-9 Meta-Analysis: How Accurate is this Questionnaire for Depression Screening?