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Review
. 2016 Nov 15:205:335-343.
doi: 10.1016/j.jad.2016.08.014. Epub 2016 Aug 16.

Summary diagnostic validity of commonly used maternal major depression disorder case finding instruments in the United States: A meta-analysis

Arthur H Owora  1 , Hélène Carabin  2 , Jessica Reese  3 , Tabitha Garwe  4
Affiliations
Review

Summary diagnostic validity of commonly used maternal major depression disorder case finding instruments in the United States: A meta-analysis

Arthur H Owora et al. J Affect Disord. .

Abstract

Introduction: Major Depression Disorder (MDD) is common among mothers of young children. However, its detection remains low in primary-care and community-based settings in part due to the uncertainty regarding the validity of existing case-finding instruments. We conducted meta-analyses to estimate the diagnostic validity of commonly used maternal MDD case finding instruments in the United States.

Methods: We systematically searched three electronic bibliographic databases PubMed, PsycINFO, and EMBASE from 1994 to 2015 to identify relevant published literature. Study eligibility and quality were evaluated using the Standards for the Reporting of Diagnostic Accuracy studies and Quality Assessment of Diagnostic Accuracy Studies guidelines, respectively. Pooled sensitivity and specificity of case-finding instruments were generated using Bayesian hierarchical summary receiver operating models.

Results: Overall, 1130 articles were retrieved and 74 articles were selected for full-text review. Twelve articles examining six maternal MDD case-finding instruments met the eligibility criteria and were included in our meta-analyses. Pooled sensitivity and specificity estimates were highest for the BDI-II (91%; 95% Bayesian Credible Interval (BCI): 68%; 99% and 89%; 95% BCI: 62%; 98% respectively) and EPDS10 (74%; 95% BCI: 46%; 91% and 97%; 95% BCI: 84%; 99% respectively) during the antepartum and postpartum periods respectively.

Limitation: No meta-regression was conducted to examine the impact of study-level characteristics on the results.

Discussion: Diagnostic performance varied among instruments and between peripartum periods. These findings suggest the need for a judicious selection of maternal MDD case-finding instruments depending on the study population and target periods of assessment.

Keywords: Bayesian meta-analysis; Case-finding instrument; Diagnostic performance; Major depression disorder; Misclassification error.

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Conflict of interest statement

Competing interests

None.

None of the contributing authors and I have any conflict of interest in this subject or any financial interest. The opinions expressed are those of the authors and do not necessarily reflect those of the Oklahoma University Health Sciences Center.

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram of literature search and study selection process.
Fig. 2
Fig. 2
Hierarchical Summary Receiver Operator Curve (HSROC) plot for the EPDS10. Each open triangle represents each study in the meta-analysis. The curve is the regression line that summarizes the overall diagnostic accuracy. The pooled sensitivity and specificity estimate is based on the assumption of conditional independence and use of perfect reference standards.
Fig. 3
Fig. 3
Hierarchical Summary Receiver Operator Curve (HSROC) plot for the BDI-II. Each open triangle represents each study in the meta-analysis. The curve is the regression line that summarizes the overall diagnostic accuracy. The pooled sensitivity and specificity estimate is based on the assumption of conditional independence and use of perfect reference standards.
Fig. 4
Fig. 4
Hierarchical Summary Receiver Operator Curve (HSROC) plot for the CESD20/R. Each open triangle represents each study in the meta-analysis. The curve is the regression line that summarizes the overall diagnostic accuracy. The pooled sensitivity and specificity estimate is based on the assumption of conditional independence and use of perfect reference standards.
Fig. 5
Fig. 5
Hierarchical Summary Receiver Operator Curve (HSROC) plot for the PHQ9. Each open triangle represents each study in the meta-analysis. The curve is the regression line that summarizes the overall diagnostic accuracy. The pooled sensitivity and specificity estimate is based on the assumption of conditional independence and use of perfect reference standards.
Fig. 6
Fig. 6
a. Hierarchical Summary Receiver Operator Curve (HSROC) plot for the HDRS17. Each open triangle represents each study in the meta-analysis. The curve is the regression line that summarizes the overall diagnostic accuracy. The pooled sensitivity and specificity estimate is based on the assumption of conditional independence and use of perfect reference standards. b. Hierarchical Summary Receiver Operator Curve (HSROC) plot for the HDRS21. Each open triangle represents each study in the meta-analysis. The curve is the regression line that summarizes the overall diagnostic accuracy. The pooled sensitivity and specificity estimate is based on the assumption of conditional independence and use of perfect reference standards.
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