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

Abstract

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).

Validation of the anxiety subscale of the Spanish version of the Edinburgh Postnatal Depression Scale (EPDS-A)

“…Therefore, it is necessary to continue studying the functioning of Item 10 and assess its validity for detecting self-injury risk in the perinatal period. Some authors advocate eliminating Item 10 from the EPDS and assessing suicidal ideation through other tools ( 57 ). As many health professionals have difficulties exploring suicidal ideation, this decision could constitute an obstacle to its detection.…”

Exploring the Impact of Maternal Early Life Adversity on Interoceptive Sensibility in Pregnancy: Implications for Prenatal Depression

“…The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item scale intended to measure depressive symptoms (Cox et al, 1987), validated for use in both pregnant and non-pregnant women (Bergink et al, 2011;Cox et al, 1996). We excluded one item of the EPDS that assessed suicidality, as per common practice in studies without clinical follow-up, and the 9-and 10-item versions are highly correlated (Qiu et al, 2023). We calculated the total score using the sum of scores for each response to the 9-items, resulting in a maximum total score (of 27).…”