Identification of depression and anxiety during pregnancy: A systematic review and meta‐analysis of test accuracy

Abstract

IntroductionDepression and anxiety are significant contributors to maternal perinatal morbidity and a range of negative child outcomes. This systematic review and meta‐analysis aimed to review and assess the diagnostic test accuracy of selected screening tools (Edinburgh Postnatal Depression Scale [EPDS], EPDS‐3A, Patient Health Questionnaire [PHQ‐9]‐, PHQ‐2, Matthey Generic Mood Question [MGMQ], Generalized Anxiety Disorder scale [GAD‐7], GAD‐2, and the Whooley questions) used to identify women with antenatal depression or anxiety in Western countries.Material and methodsOn January 16, 2023, we searched 10 databases (CINAHL, Cochrane Library, CRD Database, Embase, Epistemonikos, International HTA Database, KSR Evidence, Ovid MEDLINE, PROSPERO and PsycINFO); the references of included studies were also screened. We included studies of any design that compared case‐identification with a relevant screening tool to the outcome of a diagnostic interview based on the Diagnostic and Statistical Manual of Mental Disorders, fourth or fifth edition (DSM‐IV or DSM‐5), or the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD‐10). Diagnoses of interest were major depressive disorder and anxiety disorders. Two authors independently screened abstracts and full‐texts for relevance and evaluated the risk of bias using QUADAS‐2. Data extraction was performed by one person and checked by another team member for accuracy. For synthesis, a bivariate model was used. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Registration: PROSPERO CRD42021236333.ResultsWe screened 8276 records for eligibility and included 16 original articles reporting on diagnostic test accuracy: 12 for the EPDS, one article each for the GAD‐2, MGMQ, PHQ‐9, PHQ‐2, and Whooley questions, and no articles for the EPDS‐3A or GAD‐7. Most of the studies had moderate to high risk of bias. Ten of the EPDS articles provided data for synthesis at cutoffs ≥10 to ≥14 for diagnosing major depressive disorder. Cutoff ≥10 gave the optimal combined sensitivity (0.84, 95% confidence interval [CI]: 0.75–0.90) and specificity (0.87, 95% CI: 0.79–0.92).ConclusionsFindings from the meta‐analysis suggest that the EPDS alone is not perfectly suitable for detection of major depressive disorder during pregnancy. Few studies have evaluated the other instruments, therefore, their usefulness for identification of women with depression and anxiety during pregnancy remains very uncertain. At present, case‐identification with any tool may best serve as a complement to a broader dialogue between healthcare professionals and their patients.

Factors associated with depression during pregnancy in women receiving high- and low-risk prenatal care: a predictive model

“…The most commonly used standardized tool for this purpose is the Edinburgh Postnatal Depression Scale (EPDS), a self-report screening instrument used with various cutoff scores to detect signs of risk or a high probability of a major depressive disorder diagnosis. However, such results are more precisely applicable to the postnatal period, and a review on this topic ( 26 ) indicated that, in the assessment of pregnant women, the EPDS result should be associated with a clinical evaluation by a specialized professional. Building on this premise, the use of the PRIME-MD in evaluating depressive symptoms in pregnant women becomes a more favorable possibility as it contains within its structure the DSM-III diagnostic criteria for major depressive disorder, serving as a guide for specialized clinical interviews.…”