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#Grand Rounds

How Accurate is the Edinburgh Postnatal Depression Scale for Detecting Antepartum and Postpartum Depression?

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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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Related ObG Topics:

Screening for Perinatal Depression
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?

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