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

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. OBJECTIVETo 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 RELEVANCEThe 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.

Error in Affiliations

“…In the Original Investigation titled “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,” published June 24, 2022, the affiliation for Rania Elkhateb was changed from Library to Department of Anesthesiology at the University of Arkansas for Medical Sciences, Little Rock. This article has been corrected …”

Measuring enhanced recovery in obstetrics: a narrative review

“…Validation ongoing in translated versions and diverse populations. 24 h postpartum (ObsQoR-10 validated for up to 72 h postpartum) Outpatient Global World Health Organization Quality of Life–BREF (WHO-QOLBREF) 56 No 6 wk postpartum Pain Brief Pain Inventory-Short Form (BPI-SF) 58 No The only PROM with adequate content validity and internal consistency (low-quality evidence) Psychosocial distress Edinburgh Postnatal Depression Scale (EPDS) 59 Yes Sufficient content validity, with moderate evidence for sufficient internal consistency, which was not observed in other PROMs Anxiety: State-Trait Anxiety Inventory (STAI) No Registered with PROSPERO 2021 CRD42021260004 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260004 Sleep Bergen Insomnia Scale (BIS) 60 No Does not assess several important domains of sleep, eg, sleep duration (and efficiency), chronotype, sleep-disordered breathing, and medication use Fatigue Fatigue Assessment Scale 61 No The only PROM with adequate content validity and internal consistency Motherhood experience Postpartum bonding Questionnaire 62 Yes The only PROM with sufficient structural validity, internal consistency, and reliability PROM , patient-reported outcome measure. …”

Perinatal Depression and Beyond—Implications for Research Design and Clinical Management

“…The 2 newly published studies, Smythe et al and Sultan et al, are systematic reviews (Smythe et al also comprises a meta-analysis) dealing with the topic of perinatal mental health (ie, mental health during the time of pregnancy up to 1 year after birth). Smythe et al estimated prevalence rates of perinatal depression and anxiety in parental dyads and associated factors.…”

“…Given the paucity of dyadic studies, no prevalence estimate for anxiety could be determined. Sultan et al examined the psychometric properties of 10 existing patient-reported outcome measures for assessing maternal postpartum depression. Although all included patient-reported outcome measures demonstrated adequate content validity, only the Edinburgh Postnatal Depression Scale received a class A recommendation (recommended for use).…”

“…The personal distress and associated health care costs are high and strategies for prevention, early detection and treatment of such difficulties are called for . According to the findings of Sultan et al based on their systematic review, the Edinburgh Postnatal Depression Scale should be used to screen for and assess postpartum depression symptoms in mothers. Future research needs to focus on validating self-report measures for (expectant) fathers/coparents.…”