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. 2022 Jun 1;5(6):e2214885.
doi: 10.1001/jamanetworkopen.2022.14885.

Assessment of Patient-Reported Outcome Measures for Maternal Postpartum Depression Using the Consensus-Based Standards for the Selection of Health Measurement Instruments Guideline: A Systematic Review

Pervez Sultan  1 , Kazuo Ando  1 , Rania Elkhateb  2 , Ronald B George  3 , Grace Lim  4 , Brendan Carvalho  1 , Ahish Chitneni  5 , Ray Kawai  6 , Tanya Tulipan  7 , Lindsay Blake  2 , Jessica Coker  8 , James O'Carroll  1
Affiliations

Assessment of Patient-Reported Outcome Measures for Maternal Postpartum Depression Using the Consensus-Based Standards for the Selection of Health Measurement Instruments Guideline: A Systematic Review

Pervez Sultan et al. JAMA Netw Open. .

Erratum in

  • Error in Affiliations.
    [No authors listed] [No authors listed] JAMA Netw Open. 2022 Aug 1;5(8):e2229924. doi: 10.1001/jamanetworkopen.2022.29924. JAMA Netw Open. 2022. PMID: 35969405 Free PMC article. No abstract available.

Abstract

Importance: Maternal depression is frequently reported in the postpartum period, with an estimated prevalence of approximately 15% during the first postpartum year. Despite the high prevalence of postpartum depression, there is no consensus regarding which patient-reported outcome measure (PROM) should be used to screen for this complex, multidimensional construct.

Objective: To evaluate psychometric measurement properties of existing PROMs of maternal postpartum depression using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline and identify the best available patient-reported screening measure.

Evidence review: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. PubMed, CINAHL, Embase, and Web of Science were searched on July 1, 2019, for validated PROMs of postpartum depression, and an additional search including a hand search of references from eligible studies was conducted in June 2021. Included studies evaluated 1 or more psychometric measurement properties of the identified PROMs. A risk-of-bias assessment was performed to evaluate methods of each included study. Psychometric measurement properties of each PROM were rated according to COSMIN criteria. A modified Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the level of evidence supporting each rating, and a recommendation class (A, recommended for use; B, further research required; or C, not recommended) was given based on the overall quality of each included PROM.

Findings: Among 10 264 postpartum recovery studies, 27 PROMs were identified. Ten PROMs (37.0%) met the inclusion criteria and were used in 43 studies (0.4%) involving 22 095 postpartum women. At least 1 psychometric measurement property was assessed for each of the 10 validated PROMs identified. Content validity was sufficient in all PROMs. The Edinburgh Postnatal Depression Scale (EPDS) demonstrated adequate content validity and a moderate level of evidence for sufficient internal consistency (with sufficient structural validity), resulting in a recommendation of class A. The other 9 PROMs evaluated received a recommendation of class B.

Conclusions and relevance: The findings of this systematic review suggest that the EPDS is the best available patient-reported screening measure of maternal postpartum depression. Future studies should focus on evaluating the cross-cultural validity, reliability, and measurement error of the EPDS to improve understanding of its psychometric properties and utility.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Sultan is an Arline and Pete Harman Endowed Faculty Scholar of the Stanford Maternal and Child Health Research Institute. Dr George reported receiving personal fees from Octapharma USA Inc outside the submitted work. Dr Coker reported receiving grants from the National Institutes of Health (NIH), the Brain and Behavior Research Foundation, the University of Arkansas for Medical Sciences Translational Research Institute, and the Arkansas Department of Health outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Summary of the Literature Search to Identify Validation Studies for Patient-Reported Outcome Measures (PROMs) of Postpartum Depression
WHO indicates World Health Organization. aSome studies evaluated more than 1 PROM used to screen for maternal postpartum depression.
See this image and copyright information in PMC

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