Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis

Thombs B.D.; Levis B.; Lyubenova A.; Neupane D.; Negeri Z.; Wu Y.; Sun Y.; He C.; Krishnan A.; Vigod S.N.; Bhandari P.M.; Imran M.; Rice D.B.; Azar M.; Chiovitti M.J.; Saadat N.; Riehm K.E.; Boruff J.T.; Cuijpers P.; Gilbody S.; Ioannidis J.P.A.; Kloda L.A.; Patten S.B.; Shrier I.; Ziegelstein R.C.; Comeau L.; Mitchell N.D.; Tonelli M.; Barnes J.; Beck C.T.; Bindt C.; Figueiredo B.; Helle N.; Howard L.M.; Kohlhoff J.; Kozinszky Z.; Leonardou A.A.; Radoš S.N.; Quispel C.; Rochat T.J.; Stein A.; Stewart R.C.; Tadinac M.; Tandon S.D.; Tendais I.; Töreki A.; Tran T.D.; Trevillion K.; Turner K.; Vega-Dienstmaier J.M.; Benedetti A. · Canadian Journal of Psychiatry (2020) · DOI: 10.1177/0706743720934959

Resumen

Objective: The Maternal Mental Health in Canada, 2018/2019, survey reported that 18% of 7,085 mothers who recently gave birth reported “feelings consistent with postpartum depression” based on scores ≥7 on a 5-item version of the Edinburgh Postpartum Depression Scale (EPDS-5). The EPDS-5 was designed as a screening questionnaire, not to classify disorders or estimate prevalence; the extent to which EPDS-5 results reflect depression prevalence is unknown. We investigated EPDS-5 ≥7 performance relative to major depression prevalence based on a validated diagnostic interview, the Structured Clinical Interview for DSM (SCID). Methods: We searched Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and the Web of Science Core Collection through June 2016 for studies with data sets with item response data to calculate EPDS-5 scores and that used the SCID to ascertain depression status. We conducted an individual participant data meta-analysis to estimate pooled percentage of EPDS-5 ≥7, pooled SCID major depression prevalence, and the pooled difference in prevalence. Results: A total of 3,958 participants from 19 primary studies were included. Pooled prevalence of SCID major depression was 9.2% (95% confidence interval [CI] 6.0% to 13.7%), pooled percentage of participants with EPDS-5 ≥7 was 16.2% (95% CI 10.7% to 23.8%), and pooled difference was 8.0% (95% CI 2.9% to 13.2%). In the 19 included studies, mean and median ratios of EPDS-5 to SCID prevalence were 2.1 and 1.4 times. Conclusions: Prevalence estimated based on EPDS-5 ≥7 appears to be substantially higher than the prevalence of major depression. Validated diagnostic interviews should be used to establish prevalence. © The Author(s) 2020.

Instituciones: Universidad Peruana Cayetano Heredia