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
Abstract Objective To evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnant and postpartum women. Design Individual participant data meta analysis. Data sources Medline, Medline In Process and Other Non Indexed Citations, PsycINFO, and Web of Science (from inception to 3 October 2018) Eligibility criteria for selecting studies Eligible datasets included EPDS scores and major depression classification based on validated diagnostic interviews. Bivariate random effects meta analysis was used to estimate EPDS sensitivity and specificity compared with semi structured, fully structured (Mini International Neuropsychiatric Interview (MINI) excluded) and MINI diagnostic interviews separately using individual participant data. One stage meta regression was used to examine accuracy by reference standard categories and participant characteristics. Results Individual participant data were obtained from 58 of 83 eligible studies (70% 15 557 of 22 788 eligible participants (68% 2069 with major depression) Combined sensitivity and specificity was maximised at a cut off value of 11 or higher across reference standards. Among studies with a semi structured interview (36 studies, 9066 participants, 1330 with major depression) sensitivity and specificity were 0.85 (95% confidence interval 0.79 to 0.90) and 0.84 (0.79 to 0.88) for a cut off value of 10 or higher, 0.81 (0.75 to 0.87) and 0.88 (0.85 to 0.91) for a cut off value of 11 or higher, and 0.66 (0.58 to 0.74) and 0.95 (0.92 to 0.96) for a cut off value of 13 or higher, respectively. Accuracy was similar across reference standards and subgroups, including for pregnant and postpartum women. Conclusions An EPDS cut off value of 11 or higher maximised combined sensitivity and specificity; a cut off value of 13 or higher was less sensitive but more specific. To identify pregnant and postpartum women with higher symptom levels, a cut off of 13 or higher could be used. Lower cut off values could be used if the intention is to avoid false negatives and identify most patients who meet diagnostic criteria. Registration PROSPERO (CRD42015024785)
BMJ