Individual participant data meta-analysis to compare EPDS accuracy to detect major depression with and without the self-harm item

Qiu X.; Wu Y.; Sun Y.; Levis B.; Tian J.; Boruff J.T.; Cuijpers P.; Ioannidis J.P.A.; Markham S.; Ziegelstein R.C.; Vigod S.N.; Benedetti A.; Thombs B.D.; He C.; Krishnan A.; Bhandari P.M.; Neupane D.; Negeri Z.; Imran M.; Rice D.B.; Azar M.; Chiovitti M.J.; Gilbody S.; Kloda L.A.; Patten S.B.; Mitchell N.D.; Alvarado R.; Barnes J.; Beck C.T.; Bindt C.; Correa H.; Couto T.C.; Chorwe-Sungani G.; Eapen V.; Favez N.; Felice E.; Fellmeth G.; Fernandes M.; Field S.; Figueiredo B.; Fisher J.R.W.; Green E.P.; Honikman S.; Howard L.M.; Kettunen P.A.; Kohlhoff J.; Kozinszky Z.; Leonardou A.A.; Maes M.; Martínez P.; Radoš S.N.; Nishi D.; Pawlby S.J.; Rochat T.J.; Rowe H.J.; Sharp D.J.; Skalkidou A.; Smith-Nielsen J.; Stein A.; Su K.-P.; Sundström-Poromaa I.; Tadinac M.; Tandon S.D.; Tendais I.; Töreki A.; Tran T.D.; Trevillion K.; Turner K.; Væver M.S.; van Heyningen T.; Vega-Dienstmaier J.M.; Wynter K.; Yonkers K.A. · Scientific Reports (2023) · DOI: 10.1038/s41598-023-29114-w

Resumen

Item 10 of the Edinburgh Postnatal Depression Scale (EPDS) is intended to assess thoughts of intentional self-harm but may also elicit concerns about accidental self-harm. It does not specifically address suicide ideation but, nonetheless, is sometimes used as an indicator of suicidality. The 9-item version of the EPDS (EPDS-9), which omits item 10, is sometimes used in research due to concern about positive endorsements of item 10 and necessary follow-up. We assessed the equivalence of total score correlations and screening accuracy to detect major depression using the EPDS-9 versus full EPDS among pregnant and postpartum women. We searched Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science from database inception to October 3, 2018 for studies that administered the EPDS and conducted diagnostic classification for major depression based on a validated semi-structured or fully structured interview among women aged 18 or older during pregnancy or within 12 months of giving birth. We conducted an individual participant data meta-analysis. We calculated Pearson correlations with 95% prediction interval (PI) between EPDS-9 and full EPDS total scores using a random effects model. Bivariate random-effects models were fitted to assess screening accuracy. Equivalence tests were done by comparing the confidence intervals (CIs) around the pooled sensitivity and specificity differences to the equivalence margin of δ = 0.05. Individual participant data were obtained from 41 eligible studies (10,906 participants, 1407 major depression cases). The correlation between EPDS-9 and full EPDS scores was 0.998 (95% PI 0.991, 0.999). For sensitivity, the EPDS-9 and full EPDS were equivalent for cut-offs 7–12 (difference range − 0.02, 0.01) and the equivalence was indeterminate for cut-offs 13–15 (all differences − 0.04). For specificity, the EPDS-9 and full EPDS were equivalent for all cut-offs (difference range 0.00, 0.01). The EPDS-9 performs similarly to the full EPDS and can be used when there are concerns about the implications of administering EPDS item 10. Trial registration: The original IPDMA was registered in PROSPERO (CRD42015024785).

Instituciones: Universidad Peruana Cayetano Heredia