Meta-Analysis

. 2021 Mar;30(1):e1860.

doi: 10.1002/mpr.1860. Epub 2020 Oct 22.

Depression prevalence based on the Edinburgh Postnatal Depression Scale compared to Structured Clinical Interview for DSM DIsorders classification: Systematic review and individual participant data meta-analysis

Anita Lyubenova¹, Dipika Neupane^{1

2}, Brooke Levis^{1

2

3}, Yin Wu^{1

2

4}, Ying Sun¹, Chen He^{1

2}, Ankur Krishnan¹, Parash M Bhandari^{1

2}, Zelalem Negeri^{1

2}, Mahrukh Imran¹, Danielle B Rice^{1

5}, Marleine Azar^{1

2}, Matthew J Chiovitti¹, Nazanin Saadat¹, Kira E Riehm^{1

6}, Jill T Boruff⁷, John P A Ioannidis^{8

9

10

11}, Pim Cuijpers¹², Simon Gilbody¹³, Lorie A Kloda¹⁴, Scott B Patten^{15

16

17}, Ian Shrier^{1

2

18}, Roy C Ziegelstein¹⁹, Liane Comeau²⁰, Nicholas D Mitchell^{21

22}, Marcello Tonelli²³, Simone N Vigod²⁴, Franca Aceti²⁵, Jacqueline Barnes²⁶, Amar D Bavle²⁷, Cheryl T Beck²⁸, Carola Bindt²⁹, Philip M Boyce^{30

31}, Adomas Bunevicius³², Linda H Chaudron³³, Nicolas Favez^{34

35}, Barbara Figueiredo³⁶, Lluïsa Garcia-Esteve^{37

38

39}, Lisa Giardinelli⁴⁰, Nadine Helle²⁹, Louise M Howard^{41

42}, Jane Kohlhoff^{43

44

45}, Laima Kusminskas⁴⁶, Zoltán Kozinszky⁴⁷, Lorenzo Lelli⁴⁰, Angeliki A Leonardou⁴⁸, Valentina Meuti²⁵, Sandra N Radoš⁴⁹, Purificación N García^{37

50}, Susan J Pawlby⁴¹, Chantal Quispel⁵¹, Emma Robertson-Blackmore⁵², Tamsen J Rochat^{53

54}, Deborah J Sharp⁵⁵, Bonnie W M Siu⁵⁶, Alan Stein^{57

58}, Robert C Stewart^{59

60}, Meri Tadinac⁶¹, S Darius Tandon⁶², Iva Tendais³⁶, Annamária Töreki⁶³, Anna Torres-Giménez^{37

38

39}, Thach D Tran⁶⁴, Kylee Trevillion⁴¹, Katherine Turner⁶⁵, Johann M Vega-Dienstmaier⁶⁶, Andrea Benedetti^{2

67

68}, Brett D Thombs^{1

2

4

5

68

69

70}

Affiliations

¹ Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.
² Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.
³ School of Primary, Centre for Prognosis Research, Community and Social Care, Keele University, Keele, Staffordshire, UK.
⁴ Department of Psychiatry, McGill University, Montréal, Québec, Canada.
⁵ Department of Psychology, McGill University, Montréal, Québec, Canada.
⁶ Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
⁷ Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada.
⁸ Department of Medicine, Stanford University, Stanford, California, USA.
⁹ Department of Health Research and Policy, Stanford University, Stanford, California, USA.
¹⁰ Department of Biomedical Data Science, Stanford University, Stanford, California, USA.
¹¹ Department of Statistics, Stanford University, Stanford, California, USA.
¹² Department of Clinical, Neuro and Developmental Psychology, EMGO Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
¹³ Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK.
¹⁴ Library, Concordia University, Montréal, Québec, Canada.
¹⁵ Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta, Canada.
¹⁶ Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada.
¹⁷ Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, Alberta, Canada.
¹⁸ Department of Family Medicine, McGill University, Montréal, Québec, Canada.
¹⁹ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²⁰ International Union for Health Promotion and Health Education, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada.
²¹ Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
²² Alberta Health Services, Edmonton, Alberta, Canada.
²³ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
²⁴ Women's College Hospital and Research Institute, University of Toronto, Toronto, Ontario, Canada.
²⁵ Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
²⁶ Department of Psychological Sciences, Birkbeck, University of London, London, UK.
²⁷ Department of Psychiatry, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India.
²⁸ University of Connecticut School of Nursing, Mansfield, Connecticut, USA.
²⁹ Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³⁰ Discipline of Psychiatry, Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
³¹ Department of Psychiatry, Westmead Hospital, Sydney, New South Wales, Australia.
³² Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.
³³ Departments of Psychiatry, Pediatrics, Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA.
³⁴ Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
³⁵ IUP, University of Lausanne, Lausanne, Switzerland.
³⁶ School of Psychology, University of Minho, Braga, Portugal.
³⁷ Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.
³⁸ Vulnerability, Psychopathology and Gender Research Group, Barcelona, Spain.
³⁹ August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain.
⁴⁰ Department of Health Sciences, Psychiatry Unit, University of Florence, Firenze, Italy.
⁴¹ Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
⁴² South London and Maudsley NHS Foundation Trust, London, UK.
⁴³ School of Psychiatry, University of New South Wales, Kensington, New South Wales, Australia.
⁴⁴ Ingham Institute, Liverpool, New South Wales, Australia.
⁴⁵ Karitane, Carramar, New South Wales, Australia.
⁴⁶ Private Practice, Hamburg, Germany.
⁴⁷ Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.
⁴⁸ First Department of Psychiatry, Women's Mental Health Clinic, Athens University Medical School, Athens, Greece.
⁴⁹ Department of Psychology, Catholic University of Croatia, Zagreb, Croatia.
⁵⁰ Psychology Service, Regidoria de Polítiques de Gènere, Ajuntament de Terrassa, Terrassa, Spain.
⁵¹ Department of Obstetrics and Gynaecology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands.
⁵² Halifax Health, Graduate Medical Education, Daytona Beach, Florida, USA.
⁵³ MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa.
⁵⁴ Human and Social Development Programme, Human Sciences Research Council, Pretoria, South Africa.
⁵⁵ Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK.
⁵⁶ Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.
⁵⁷ Department of Psychiatry, University of Oxford, Oxford, UK.
⁵⁸ MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁵⁹ Division of Psychiatry, University of Edinburgh, Edinburgh, Scotland, UK.
⁶⁰ Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi.
⁶¹ Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia.
⁶² Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
⁶³ Department of Emergency, University of Szeged, Szeged, Hungary.
⁶⁴ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁶⁵ Epilepsy Center-Child Neuropsychiatry Unit, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy.
⁶⁶ Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú.
⁶⁷ Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada.
⁶⁸ Department of Medicine, McGill University, Montréal, Québec, Canada.
⁶⁹ Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada.
⁷⁰ Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada.

PMID: 33089942
PMCID: PMC7992289
DOI: 10.1002/mpr.1860

Meta-Analysis

Depression prevalence based on the Edinburgh Postnatal Depression Scale compared to Structured Clinical Interview for DSM DIsorders classification: Systematic review and individual participant data meta-analysis

Anita Lyubenova et al. Int J Methods Psychiatr Res. 2021 Mar.

. 2021 Mar;30(1):e1860.

doi: 10.1002/mpr.1860. Epub 2020 Oct 22.

Authors

Affiliations

¹ Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.
² Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.
³ School of Primary, Centre for Prognosis Research, Community and Social Care, Keele University, Keele, Staffordshire, UK.
⁴ Department of Psychiatry, McGill University, Montréal, Québec, Canada.
⁵ Department of Psychology, McGill University, Montréal, Québec, Canada.
⁶ Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
⁷ Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada.
⁸ Department of Medicine, Stanford University, Stanford, California, USA.
⁹ Department of Health Research and Policy, Stanford University, Stanford, California, USA.
¹⁰ Department of Biomedical Data Science, Stanford University, Stanford, California, USA.
¹¹ Department of Statistics, Stanford University, Stanford, California, USA.
¹² Department of Clinical, Neuro and Developmental Psychology, EMGO Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
¹³ Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK.
¹⁴ Library, Concordia University, Montréal, Québec, Canada.
¹⁵ Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta, Canada.
¹⁶ Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada.
¹⁷ Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, Alberta, Canada.
¹⁸ Department of Family Medicine, McGill University, Montréal, Québec, Canada.
¹⁹ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²⁰ International Union for Health Promotion and Health Education, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada.
²¹ Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
²² Alberta Health Services, Edmonton, Alberta, Canada.
²³ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
²⁴ Women's College Hospital and Research Institute, University of Toronto, Toronto, Ontario, Canada.
²⁵ Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
²⁶ Department of Psychological Sciences, Birkbeck, University of London, London, UK.
²⁷ Department of Psychiatry, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India.
²⁸ University of Connecticut School of Nursing, Mansfield, Connecticut, USA.
²⁹ Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³⁰ Discipline of Psychiatry, Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
³¹ Department of Psychiatry, Westmead Hospital, Sydney, New South Wales, Australia.
³² Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.
³³ Departments of Psychiatry, Pediatrics, Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA.
³⁴ Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
³⁵ IUP, University of Lausanne, Lausanne, Switzerland.
³⁶ School of Psychology, University of Minho, Braga, Portugal.
³⁷ Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.
³⁸ Vulnerability, Psychopathology and Gender Research Group, Barcelona, Spain.
³⁹ August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain.
⁴⁰ Department of Health Sciences, Psychiatry Unit, University of Florence, Firenze, Italy.
⁴¹ Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
⁴² South London and Maudsley NHS Foundation Trust, London, UK.
⁴³ School of Psychiatry, University of New South Wales, Kensington, New South Wales, Australia.
⁴⁴ Ingham Institute, Liverpool, New South Wales, Australia.
⁴⁵ Karitane, Carramar, New South Wales, Australia.
⁴⁶ Private Practice, Hamburg, Germany.
⁴⁷ Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.
⁴⁸ First Department of Psychiatry, Women's Mental Health Clinic, Athens University Medical School, Athens, Greece.
⁴⁹ Department of Psychology, Catholic University of Croatia, Zagreb, Croatia.
⁵⁰ Psychology Service, Regidoria de Polítiques de Gènere, Ajuntament de Terrassa, Terrassa, Spain.
⁵¹ Department of Obstetrics and Gynaecology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands.
⁵² Halifax Health, Graduate Medical Education, Daytona Beach, Florida, USA.
⁵³ MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa.
⁵⁴ Human and Social Development Programme, Human Sciences Research Council, Pretoria, South Africa.
⁵⁵ Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK.
⁵⁶ Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.
⁵⁷ Department of Psychiatry, University of Oxford, Oxford, UK.
⁵⁸ MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁵⁹ Division of Psychiatry, University of Edinburgh, Edinburgh, Scotland, UK.
⁶⁰ Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi.
⁶¹ Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia.
⁶² Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
⁶³ Department of Emergency, University of Szeged, Szeged, Hungary.
⁶⁴ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁶⁵ Epilepsy Center-Child Neuropsychiatry Unit, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy.
⁶⁶ Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú.
⁶⁷ Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada.
⁶⁸ Department of Medicine, McGill University, Montréal, Québec, Canada.
⁶⁹ Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada.
⁷⁰ Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada.

PMID: 33089942
PMCID: PMC7992289
DOI: 10.1002/mpr.1860

Abstract

Objectives: Estimates of depression prevalence in pregnancy and postpartum are based on the Edinburgh Postnatal Depression Scale (EPDS) more than on any other method. We aimed to determine if any EPDS cutoff can accurately and consistently estimate depression prevalence in individual studies.

Methods: We analyzed datasets that compared EPDS scores to Structured Clinical Interview for DSM (SCID) major depression status. Random-effects meta-analysis was used to compare prevalence with EPDS cutoffs versus the SCID.

Results: Seven thousand three hundred and fifteen participants (1017 SCID major depression) from 29 primary studies were included. For EPDS cutoffs used to estimate prevalence in recent studies (≥9 to ≥14), pooled prevalence estimates ranged from 27.8% (95% CI: 22.0%-34.5%) for EPDS ≥ 9 to 9.0% (95% CI: 6.8%-11.9%) for EPDS ≥ 14; pooled SCID major depression prevalence was 9.0% (95% CI: 6.5%-12.3%). EPDS ≥14 provided pooled prevalence closest to SCID-based prevalence but differed from SCID prevalence in individual studies by a mean absolute difference of 5.1% (95% prediction interval: -13.7%, 12.3%).

Conclusion: EPDS ≥14 approximated SCID-based prevalence overall, but considerable heterogeneity in individual studies is a barrier to using it for prevalence estimation.

Keywords: Edinburgh Postnatal Depression Scale; depression prevalence; individual participant data meta-analysis; major depression; structured clinical interview for DSM.

PubMed Disclaimer

Conflict of interest statement

All authors have completed the ICJME uniform disclosure form and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years with the following exceptions: Dr. Tonelli declares that he has received a grant from Merck Canada, outside the submitted work. Dr. Vigod declares that she receives royalties from UpToDate, outside the submitted work. Dr. Beck declares that she receives royalties for her Postpartum Depression Screening Scale published by Western Psychological Services. Dr. Boyce declares that he receives grants and personal fees from Servier, grants from Lundbeck, and personal fees from AstraZeneca, all outside the submitted work. Dr. Howard declares that she has received personal fees from NICE Scientific Advice, outside the submitted work. No funder had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Anita Lyubenova, Dipika Neupane, Brooke Levis, Yin Wu, Jill T. Boruff, John P. A. Ioannidis, Pim Cuijpers, Simon Gilbody, Lorie A. Kloda, Scott B. Patten, Ian Shrier, Roy C. Ziegelstein, Liane Comeau, Nicholas D. Mitchell, Marcello Tonelli, Simone N. Vigod, Andrea Benedetti, and Brett D. Thombs were responsible for the study conception and design. Jill T. Boruff and Lorie A. Kloda designed and conducted database searches to identify eligible studies. Franca Aceti, Jacqueline Barnes, Amar D. Bavle, Cheryl T. Beck, Carola Bindt, Philip M. Boyce, Andrea Bunevicius, Linda H. Chaudron, Nicolas Favez, Barbara Figueiredo, Lluïsa Garcia‐Esteve, Lisa Giardinelli, Nadine Helle, Louise M. Howard, Jane Kohlhoff, Laima Kusminskas, Zoltán Kozinszky, Lorenzo Lelli, Angeliki A. Leonardou, Valentina Meuti, Sandra N. Radoš, Purificación N. García, Susan J. Pawlby, Chantal Quispel, Emma Robertson‐Blackmore, Tamsen J. Rochat, Deborah J. Sharp, Bonnie W. M. Siu, Alan Stein, Robert C. Stewart, Meri Tadinac, S. Darius Tandon, Iva Tendais, Annamária Töreki, Anna Torres‐Giménez, Thach D. Tran, Kylee Trevillion, Katherine Turner, Johann M. Vega‐Dienstmaier were responsible for collection of primary data included in this study. Anita Lyubenova, Dipika Neupane, Brooke Levis, Ying Sun, Chen He, Ankur Krishnan, Parash M. Bhandari, Zelalem Negeri, Mahrukh Imran, Danielle B. Rice, Marleine Azar, Matthew J. Chiovitti, Nazanin Saadat, Kira E. Riehm, and Brett D. Thombs contributed to the title and abstract and full‐text review processes and data extraction for the meta‐analysis. Anita Lyubenova, Dipika Neupane, Brooke Levis, Yin Wu, Andrea Benedetti, and Brett D. Thombs contributed to the data analysis and interpretation. Anita Lyubenova, Dipika Neupane, Brooke Levis, Yin Wu, Andrea Benedetti, and Brett D. Thombs contributed to drafting the manuscript. All authors provided a critical review and approved the final manuscript. Andrea Benedetti and Brett D. Thombs are guarantors.

Figures

**FIGURE 1**
Flow diagram of the study selection process. CI, confidence interval; EPDS, Edinburgh Postnatal Depression Scale; SCID, Structured Clinical Interview for DSM

**FIGURE 2**
Prevalence estimates and 95% CI based on each EPDS cutoff threshold from ≥ 9 to ≥ 14. CI, confidence interval; EPDS, Edinburgh Postnatal Depression Scale; SCID, Structured Clinical Interview for DSM

**FIGURE 3**
Dispersion of the differences between the prevalence estimates based on EPDS ≥ 14 and SCID major depression for each study, considering the study sample size. EPDS, Edinburgh Postnatal Depression Scale; SCID, Structured Clinical Interview for DSM

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Depression prevalence based on the Edinburgh Postnatal Depression Scale compared to Structured Clinical Interview for DSM DIsorders classification: Systematic review and individual participant data meta-analysis

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Depression prevalence based on the Edinburgh Postnatal Depression Scale compared to Structured Clinical Interview for DSM DIsorders classification: Systematic review and individual participant data meta-analysis

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