. 2015 Oct 20;5(10):e009742.

doi: 10.1136/bmjopen-2015-009742.

Diagnostic accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for detecting major depression in pregnant and postnatal women: protocol for a systematic review and individual patient data meta-analyses

Brett D Thombs¹, Andrea Benedetti², Lorie A Kloda³, Brooke Levis⁴, Kira E Riehm⁵, Marleine Azar⁴, Pim Cuijpers⁶, Simon Gilbody⁷, John P A Ioannidis⁸, Dean McMillan⁷, Scott B Patten⁹, Ian Shrier⁴, Russell J Steele¹⁰, Roy C Ziegelstein¹¹, Marcello Tonelli¹², Nicholas Mitchell¹³, Liane Comeau¹⁴, Joy Schinazi¹⁵, Simone Vigod¹⁶

Affiliations

¹ Departments of Psychiatry, McGill University, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada Department of Medicine, McGill University, Montreal, Quebec, Canada Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada Department of Psychology, McGill University, Montreal, Quebec, Canada School of Nursing, McGill University, Montreal, Quebec, Canada Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
² Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada Department of Medicine, McGill University, Montreal, Quebec, Canada Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada.
³ Library, McGill University, Montreal, Quebec, Canada.
⁴ Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
⁵ Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
⁶ Department of Clinical, Neuro, Developmental Psychology, VU-University, Amsterdam, The Netherlands.
⁷ Psychological Medicine and Health Services Research, Department of Health Sciences, Hull York Medical School University of York, York, UK.
⁸ Department of Medicine, Department of Health Research and Policy, Department of Statistics, Stanford Prevention Research Center, Stanford School of Medicine, Stanford University School of Humanities and Sciences, Stanford, California, USA.
⁹ Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
¹⁰ Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
¹¹ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹² Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹³ Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
¹⁴ Institut national de santé publique du Québec and Université de Montréal, Montreal, Quebec, Canada.
¹⁵ Public Health Department, Laval, Quebec, Canada.
¹⁶ Department of Psychiatry, Women's College Hospital and Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada.

PMID: 26486977
PMCID: PMC4620163
DOI: 10.1136/bmjopen-2015-009742

Diagnostic accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for detecting major depression in pregnant and postnatal women: protocol for a systematic review and individual patient data meta-analyses

Brett D Thombs et al. BMJ Open. 2015.

. 2015 Oct 20;5(10):e009742.

doi: 10.1136/bmjopen-2015-009742.

Authors

Affiliations

¹ Departments of Psychiatry, McGill University, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada Department of Medicine, McGill University, Montreal, Quebec, Canada Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada Department of Psychology, McGill University, Montreal, Quebec, Canada School of Nursing, McGill University, Montreal, Quebec, Canada Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
² Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada Department of Medicine, McGill University, Montreal, Quebec, Canada Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada.
³ Library, McGill University, Montreal, Quebec, Canada.
⁴ Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
⁵ Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
⁶ Department of Clinical, Neuro, Developmental Psychology, VU-University, Amsterdam, The Netherlands.
⁷ Psychological Medicine and Health Services Research, Department of Health Sciences, Hull York Medical School University of York, York, UK.
⁸ Department of Medicine, Department of Health Research and Policy, Department of Statistics, Stanford Prevention Research Center, Stanford School of Medicine, Stanford University School of Humanities and Sciences, Stanford, California, USA.
⁹ Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
¹⁰ Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
¹¹ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹² Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹³ Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
¹⁴ Institut national de santé publique du Québec and Université de Montréal, Montreal, Quebec, Canada.
¹⁵ Public Health Department, Laval, Quebec, Canada.
¹⁶ Department of Psychiatry, Women's College Hospital and Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada.

PMID: 26486977
PMCID: PMC4620163
DOI: 10.1136/bmjopen-2015-009742

Abstract

Introduction: Studies of the diagnostic accuracy of depression screening tools often used data-driven methods to select optimal cut-offs. Typically, these studies report results from a small range of cut-off points around whatever cut-off score is identified as most accurate. When published data are combined in meta-analyses, estimates of accuracy for different cut-off points may be based on data from different studies, rather than data from all studies for each cut-off point. Thus, traditional meta-analyses may exaggerate accuracy estimates. Individual patient data (IPD) meta-analyses synthesise data from all studies for each cut-off score to obtain accuracy estimates. The 10-item Edinburgh Postnatal Depression Scale (EPDS) is commonly recommended for depression screening in the perinatal period. The primary objective of this IPD meta-analysis is to determine the diagnostic accuracy of the EPDS to detect major depression among women during pregnancy and in the postpartum period across all potentially relevant cut-off scores, accounting for patient factors that may influence accuracy (age, pregnancy vs postpartum).

Methods and analysis: Data sources will include Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science. Studies that include a diagnosis of major depression based on a validated structured or semistructured clinical interview administered within 2 weeks of (before or after) the administration of the EPDS will be included. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Bivariate random-effects meta-analysis will be conducted for the full range of plausible cut-off values. Analyses will evaluate data from pregnancy and the postpartum period separately, as well as combining data from all women in a single model.

Ethics and dissemination: This study does not require ethics approval. Dissemination will include journal articles and presentations to policymakers, healthcare providers and researchers.

Systematic review registration: PROSPERO 2015:CRD42015024785.

Keywords: MENTAL HEALTH; PSYCHIATRY.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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References

1. Kessler RC. Epidemiology of women and depression . J Affect Disord 2003;74:5–13. 10.1016/S0165-0327(02)00426-3 - DOI - PubMed
1. Gaynes BN, Gavin N, Meltzer-Brody S et al. . Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes. Evidence Report/Technology Assessment No. 119. (Prepared by the RTI-University of North Carolina Evidence-based Practice Center, under Contract No. 290-02-0016.) AHRQ Publication No. 05-E006-2. Rockville, MD: Agency for Healthcare Research and Quality. February 2005. - PMC - PubMed
1. O'Hara MW, Swain AM. Rates and risk of postpartum depression-a meta-analysis . Int Rev Psychiatr 1996;8:37–54. 10.3109/09540269609037816 - DOI
1. Gavin NI, Gaynes BN, Lohr KN et al. . Perinatal depression: a systematic review of prevalence and incidence . Obstet Gynecol 2005;106:1071–83. 10.1097/01.AOG.0000183597.31630.db - DOI - PubMed
1. Bennett HA, Einarson A, Taddio A et al. . Prevalence of depression during pregnancy: systematic review . Obstet Gynecol 2004;103:698–709. 10.1097/01.AOG.0000116689.75396.5f - DOI - PubMed

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Diagnostic accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for detecting major depression in pregnant and postnatal women: protocol for a systematic review and individual patient data meta-analyses

Affiliations

Diagnostic accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for detecting major depression in pregnant and postnatal women: protocol for a systematic review and individual patient data meta-analyses

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