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

the Depression Screening Data (DEPRESSD) EPDS Group

doi:10.1038/s41598-023-29114-w

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

the Depression Screening Data (DEPRESSD) EPDS Group

Research output: Contribution to Journal › Article › Academic › peer-review

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).

Original language	English
Article number	4026
Pages (from-to)	1-12
Number of pages	12
Journal	Scientific Reports
Volume	13
Early online date	10 Mar 2023
DOIs	https://doi.org/10.1038/s41598-023-29114-w
Publication status	Published - 2023

Bibliographical note

Funding Information:
This study was funded by the Canadian Institutes of Health Research (CIHR, KRS-140994). Dr. Qiu was supported by a scholarship from the China Scholarship Council. Drs. Wu and Levis were supported by Fonds de recherche du Québec—Santé (FRQ-S) Postdoctoral Training Fellowships. Dr. Benedetti was supported by a Fonds de recherche du Québec – Santé (FRQS) researcher salary award. Dr. Thombs was supported by a Tier 1 Canada Research Chair. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. The primary study by Alvarado et al. was supported by the Ministry of Health of Chile. The primary study by Barnes et al. was supported by a grant from the Health Foundation (1665/608). The primary study by Beck et al. was supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation and the University of Connecticut Research Foundation. The primary study by Helle et al. was supported by the Werner Otto Foundation, the Kroschke Foundation, and the Feindt Foundation. The primary study by Figueira et al. was supported by the Brazilian Ministry of Health and by the National Counsel of Technological and Scientific Development (CNPq) (Grant no.403433/2004-5). The primary study by Couto et al. was supported by the National Counsel of Technological and Scientific Development (CNPq) (Grant no. 444254/2014-5) and the Minas Gerais State Research Foundation (FAPEMIG) (Grant no. APQ-01954-14). The primary study by Chorwe-Sungani et al. was supported by the University of Malawi through grant QZA-0484 NORHED 2013. The primary study by de Figueiredo et al. was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo. The primary study by Tissot et al. was supported by the Swiss National Science Foundation (grant 32003B 125493). The primary study by Fernandes et al. was supported by grants from the Child: Care Health and Development Trust and the Department of Psychiatry, University of Oxford, Oxford, UK, and by the Ashok Ranganathan Bursary from Exeter College, University of Oxford. Dr. Fernandes is supported by a University of Southampton National Institute for Health Research (NIHR) academic clinical fellowship in Paediatrics. The primary study by van Heyningen et al. was supported by the Medical Research Council of South Africa (fund no. 415865), Cordaid Netherlands (Project 103/10002 G Sub 7) and the Truworths Community Foundation Trust, South Africa. Dr. van Heyningen was supported by the National Research Foundation of South Africa and the Harry Crossley Foundation. VHYTHE001/1232209. The primary study by Tendais et al. was supported under the project POCI/SAU-ESP/56397/2004 by the Operational Program Science and Innovation 2010 (POCI 2010) of the Community Support Board III and by the European Community Fund FEDER. The primary study by Fisher et al. was supported by a grant under the Invest to Grow Scheme from the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs. The primary study by Green et al. was supported by a grant from the Duke Global Health Institute (453-0751). The primary study by Howard et al. was supported by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Numbers RP-PG-1210-12002 and RP-DG-1108-10012) and by the South London Clinical Research Network. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The primary study by Kettunen et al. was supported with an Annual EVO Financing (Special government subsidies from the Ministry of Health and Welfare, Finland) by North Karelia Central Hospital and Päijät-Häme Central Hospital. The primary study by Phillips et al. was supported by a scholarship from the National Health and Medical and Research Council (NHMRC). The primary study by Roomruangwong et al. was supported by the Ratchadaphiseksomphot Endowment Fund 2013 of Chulalongkorn University (CU-56-457-HR). The primary study by Martínez et al. was supported by Iniciativa Científica Milenio, Chile, process # IS130005 and by Fondo Nacional de Desarrollo Científico y Tecnológico, Chile, process # 1130230. The primary study by Nakić Radoš et al. was supported by the Croatian Ministry of Science, Education, and Sports (134-0000000-2421). The primary study by Usuda et al. was supported by Grant-in-Aid for Young Scientists (A) from the Japan Society for the Promotion of Science (primary investigator: Daisuke Nishi, MD, PhD), and by an Intramural Research Grant for Neurological and Psychiatric Disorders from the National Center of Neurology and Psychiatry, Japan. The primary study by Pawlby et al. was supported by a Medical Research Council UK Project Grant (number G89292999N). The primary study by Rochat et al. was supported by grants from the University of Oxford (HQ5035), the Tuixen Foundation (9940), the Wellcome Trust (082384/Z/07/Z and 071571), and the American Psychological Association. Dr. Rochat receives salary support from a Wellcome Trust Intermediate Fellowship (211374/Z/18/Z). The primary study by Rowe et al. was supported by the diamond Consortium, beyondblue Victorian Centre of Excellence in Depression and Related Disorders. The primary study by Comasco et al. was supported by funds from the Swedish Research Council (VR: 521-2013-2339, VR:523-2014-2342), the Swedish Council for Working Life and Social Research (FAS: 2011-0627), the Marta Lundqvist Foundation (2013, 2014), and the Swedish Society of Medicine (SLS-331991). The primary study by Smith-Nielsen et al. was supported by a grant from the charitable foundation Tryg Foundation (Grant ID no 107616). The primary study by Prenoveau et al. was supported by The Wellcome Trust (grant number 071571). The primary study by Stewart et al. was supported by Professor Francis Creed’s Journal of Psychosomatic Research Editorship fund (BA00457) administered through University of Manchester. The primary study by Su et al. was supported by grants from the Department of Health (DOH94F044 and DOH95F022) and the China Medical University and Hospital (CMU94-105, DMR-92-92 and DMR94-46). The primary study by Tandon et al. was funded by the Thomas Wilson Sanitarium. The primary study by Tran et al. was supported by the Myer Foundation who funded the study under its Beyond Australia scheme. Dr. Tran was supported by an early career fellowship from the Australian National Health and Medical Research Council. The primary study by Vega-Dienstmaier et al. was supported by Tejada Family Foundation, Inc, and Peruvian-American Endowment, Inc. The primary study by Yonkers et al. was supported by a National Institute of Child Health and Human Development grant (5 R01HD045735). No other authors reported funding for primary studies or for their work on this study. No funder had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Publisher Copyright:
© 2023, The Author(s).

Funding

This study was funded by the Canadian Institutes of Health Research (CIHR, KRS-140994). Dr. Qiu was supported by a scholarship from the China Scholarship Council. Drs. Wu and Levis were supported by Fonds de recherche du Québec—Santé (FRQ-S) Postdoctoral Training Fellowships. Dr. Benedetti was supported by a Fonds de recherche du Québec – Santé (FRQS) researcher salary award. Dr. Thombs was supported by a Tier 1 Canada Research Chair. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. The primary study by Alvarado et al. was supported by the Ministry of Health of Chile. The primary study by Barnes et al. was supported by a grant from the Health Foundation (1665/608). The primary study by Beck et al. was supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation and the University of Connecticut Research Foundation. The primary study by Helle et al. was supported by the Werner Otto Foundation, the Kroschke Foundation, and the Feindt Foundation. The primary study by Figueira et al. was supported by the Brazilian Ministry of Health and by the National Counsel of Technological and Scientific Development (CNPq) (Grant no.403433/2004-5). The primary study by Couto et al. was supported by the National Counsel of Technological and Scientific Development (CNPq) (Grant no. 444254/2014-5) and the Minas Gerais State Research Foundation (FAPEMIG) (Grant no. APQ-01954-14). The primary study by Chorwe-Sungani et al. was supported by the University of Malawi through grant QZA-0484 NORHED 2013. The primary study by de Figueiredo et al. was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo. The primary study by Tissot et al. was supported by the Swiss National Science Foundation (grant 32003B 125493). The primary study by Fernandes et al. was supported by grants from the Child: Care Health and Development Trust and the Department of Psychiatry, University of Oxford, Oxford, UK, and by the Ashok Ranganathan Bursary from Exeter College, University of Oxford. Dr. Fernandes is supported by a University of Southampton National Institute for Health Research (NIHR) academic clinical fellowship in Paediatrics. The primary study by van Heyningen et al. was supported by the Medical Research Council of South Africa (fund no. 415865), Cordaid Netherlands (Project 103/10002 G Sub 7) and the Truworths Community Foundation Trust, South Africa. Dr. van Heyningen was supported by the National Research Foundation of South Africa and the Harry Crossley Foundation. VHYTHE001/1232209. The primary study by Tendais et al. was supported under the project POCI/SAU-ESP/56397/2004 by the Operational Program Science and Innovation 2010 (POCI 2010) of the Community Support Board III and by the European Community Fund FEDER. The primary study by Fisher et al. was supported by a grant under the Invest to Grow Scheme from the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs. The primary study by Green et al. was supported by a grant from the Duke Global Health Institute (453-0751). The primary study by Howard et al. was supported by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Numbers RP-PG-1210-12002 and RP-DG-1108-10012) and by the South London Clinical Research Network. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The primary study by Kettunen et al. was supported with an Annual EVO Financing (Special government subsidies from the Ministry of Health and Welfare, Finland) by North Karelia Central Hospital and Päijät-Häme Central Hospital. The primary study by Phillips et al. was supported by a scholarship from the National Health and Medical and Research Council (NHMRC). The primary study by Roomruangwong et al. was supported by the Ratchadaphiseksomphot Endowment Fund 2013 of Chulalongkorn University (CU-56-457-HR). The primary study by Martínez et al. was supported by Iniciativa Científica Milenio, Chile, process # IS130005 and by Fondo Nacional de Desarrollo Científico y Tecnológico, Chile, process # 1130230. The primary study by Nakić Radoš et al. was supported by the Croatian Ministry of Science, Education, and Sports (134-0000000-2421). The primary study by Usuda et al. was supported by Grant-in-Aid for Young Scientists (A) from the Japan Society for the Promotion of Science (primary investigator: Daisuke Nishi, MD, PhD), and by an Intramural Research Grant for Neurological and Psychiatric Disorders from the National Center of Neurology and Psychiatry, Japan. The primary study by Pawlby et al. was supported by a Medical Research Council UK Project Grant (number G89292999N). The primary study by Rochat et al. was supported by grants from the University of Oxford (HQ5035), the Tuixen Foundation (9940), the Wellcome Trust (082384/Z/07/Z and 071571), and the American Psychological Association. Dr. Rochat receives salary support from a Wellcome Trust Intermediate Fellowship (211374/Z/18/Z). The primary study by Rowe et al. was supported by the diamond Consortium, beyondblue Victorian Centre of Excellence in Depression and Related Disorders. The primary study by Comasco et al. was supported by funds from the Swedish Research Council (VR: 521-2013-2339, VR:523-2014-2342), the Swedish Council for Working Life and Social Research (FAS: 2011-0627), the Marta Lundqvist Foundation (2013, 2014), and the Swedish Society of Medicine (SLS-331991). The primary study by Smith-Nielsen et al. was supported by a grant from the charitable foundation Tryg Foundation (Grant ID no 107616). The primary study by Prenoveau et al. was supported by The Wellcome Trust (grant number 071571). The primary study by Stewart et al. was supported by Professor Francis Creed’s Journal of Psychosomatic Research Editorship fund (BA00457) administered through University of Manchester. The primary study by Su et al. was supported by grants from the Department of Health (DOH94F044 and DOH95F022) and the China Medical University and Hospital (CMU94-105, DMR-92-92 and DMR94-46). The primary study by Tandon et al. was funded by the Thomas Wilson Sanitarium. The primary study by Tran et al. was supported by the Myer Foundation who funded the study under its Beyond Australia scheme. Dr. Tran was supported by an early career fellowship from the Australian National Health and Medical Research Council. The primary study by Vega-Dienstmaier et al. was supported by Tejada Family Foundation, Inc, and Peruvian-American Endowment, Inc. The primary study by Yonkers et al. was supported by a National Institute of Child Health and Human Development grant (5 R01HD045735). No other authors reported funding for primary studies or for their work on this study. No funder had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Funders	Funder number
Care Health and Development Trust
Community Support Board III
Cordaid Netherlands	103/10002 G Sub 7
Croatian Ministry of Science, Education, and Sports	134-0000000-2421
European Community Fund FEDER
Feindt Foundation
Iniciativa Científica Milenio	IS130005
Kroschke Foundation
Tejada Family Foundation
Thomas Wilson Sanitarium
Tier 1 Canada Research Chair
Truworths Community Foundation Trust
Tuixen Foundation	9940
University of Malawi	QZA-0484 NORHED 2013
University of Southampton National Institute for Health Research
Vanier Canada Graduate Scholarship
Victorian Centre of Excellence in Depression and Related Disorders
charitable foundation Tryg Foundation	BA00457, 107616
National Institute of Child Health and Human Development	5 R01HD045735
National Institute of Child Health and Human Development
Patrick and Catherine Weldon Donaghue Medical Research Foundation
American Psychological Association	211374/Z/18/Z
American Psychological Association
Duke Global Health Institute, Duke University	453-0751
Duke Global Health Institute, Duke University
University of Connecticut
Märta Lundqvists Stiftelse
Wellcome Trust	071571, 082384/Z/07/Z
Wellcome Trust
Keble College, University of Oxford
Canadian Institutes of Health Research	KRS-140994
Canadian Institutes of Health Research
Fonds de Recherche du Québec - Santé
National Institute for Health and Care Research	RP-DG-1108-10012, RP-PG-1210-12002
National Institute for Health and Care Research
Department of Health and Social Care	DOH95F022, DOH94F044
Department of Health and Social Care
Health Foundation	1665/608
Health Foundation
University of Oxford	HQ5035
University of Oxford
University of Manchester
National Health and Medical Research Council
Myer Foundation
National Research Foundation
South African Medical Research Council	415865
South African Medical Research Council
Japan Society for the Promotion of Science
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung	32003B 125493
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
Canada Research Chairs
Fundação de Amparo à Pesquisa do Estado de São Paulo
Forskningsrådet för Arbetsliv och Socialvetenskap	2011-0627
Forskningsrådet för Arbetsliv och Socialvetenskap
Fondo Nacional de Desarrollo Científico y Tecnológico	1130230
Fondo Nacional de Desarrollo Científico y Tecnológico
Chulalongkorn University	CU-56-457-HR
Chulalongkorn University
Canadian HIV Trials Network, Canadian Institutes of Health Research
Conselho Nacional de Desenvolvimento Científico e Tecnológico	444254/2014-5, 403433/2004-5
Conselho Nacional de Desenvolvimento Científico e Tecnológico
Vetenskapsrådet	521-2013-2339, VR:523-2014-2342
Vetenskapsrådet
China Medical University Hospital	DMR-92-92, DMR94-46, CMU94-105
China Medical University Hospital
Harry Crossley Foundation	VHYTHE001/1232209, POCI/SAU-ESP/56397/2004
Harry Crossley Foundation
China Scholarship Council
Fundação de Amparo à Pesquisa do Estado de Minas Gerais	APQ-01954-14
Fundação de Amparo à Pesquisa do Estado de Minas Gerais
Ministry of Health of the People's Republic of China
Department of Families, Housing, Community Services and Indigenous Affairs
Ministério da Saúde
Medical Research Council Canada	G89292999N
Medical Research Council Canada
Svenska Läkaresällskapet	SLS-331991
Svenska Läkaresällskapet
National Center of Neurology and Psychiatry
Werner Otto Stiftung

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Access to Document

10.1038/s41598-023-29114-w

Persistent URL (handle)

Persistent link

Cite this

@article{d388ab3cca4e49d48a3ee5ab0479189e,

title = "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).",

author = "Xia Qiu and Yin Wu and Ying Sun and Brooke Levis and Jizhou Tian and Boruff, \{Jill T.\} and Pim Cuijpers and Ioannidis, \{John P.A.\} and Sarah Markham and Ziegelstein, \{Roy C.\} and Vigod, \{Simone N.\} and Andrea Benedetti and Thombs, \{Brett D.\} and Chen He and Ankur Krishnan and Bhandari, \{Parash Mani\} and Dipika Neupane and Zelalem Negeri and Mahrukh Imran and Rice, \{Danielle B.\} and Marleine Azar and Chiovitti, \{Matthew J.\} and Simon Gilbody and Kloda, \{Lorie A.\} and Patten, \{Scott B.\} and Mitchell, \{Nicholas D.\} and Rub{\'e}n Alvarado and Jacqueline Barnes and Beck, \{Cheryl Tatano\} and Carola Bindt and Humberto Correa and Couto, \{Tiago Castro e.\} and Genesis Chorwe-Sungani and Valsamma Eapen and Nicolas Favez and Ethel Felice and Gracia Fellmeth and Michelle Fernandes and Sally Field and Barbara Figueiredo and Fisher, \{Jane R.W.\} and Green, \{Eric P.\} and Simone Honikman and Howard, \{Louise M.\} and Kettunen, \{Pirjo A.\} and Jane Kohlhoff and Zolt{\'a}n Kozinszky and Leonardou, \{Angeliki A.\} and Michael Maes and Pablo Mart{\'i}nez and Rado{\v s}, \{Sandra Naki{\'c}\} and Daisuke Nishi and Pawlby, \{Susan J.\} and Rochat, \{Tamsen J.\} and Rowe, \{Heather J.\} and Sharp, \{Deborah J.\} and Alkistis Skalkidou and Johanne Smith-Nielsen and Alan Stein and Su, \{Kuan Pin\} and Inger Sundstr{\"o}m-Poromaa and Meri Tadinac and Tandon, \{S. Darius\} and Iva Tendais and Annam{\'a}ria T{\"o}reki and Tran, \{Thach D.\} and Kylee Trevillion and Katherine Turner and V{\ae}ver, \{Mette S.\} and \{van Heyningen\}, Thandi and Vega-Dienstmaier, \{Johann M.\} and Karen Wynter and Yonkers, \{Kimberly A.\} and \{the Depression Screening Data (DEPRESSD) EPDS Group\}",

note = "Funding Information: This study was funded by the Canadian Institutes of Health Research (CIHR, KRS-140994). Dr. Qiu was supported by a scholarship from the China Scholarship Council. Drs. Wu and Levis were supported by Fonds de recherche du Qu{\'e}bec—Sant{\'e} (FRQ-S) Postdoctoral Training Fellowships. Dr. Benedetti was supported by a Fonds de recherche du Qu{\'e}bec – Sant{\'e} (FRQS) researcher salary award. Dr. Thombs was supported by a Tier 1 Canada Research Chair. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. The primary study by Alvarado et al. was supported by the Ministry of Health of Chile. The primary study by Barnes et al. was supported by a grant from the Health Foundation (1665/608). The primary study by Beck et al. was supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation and the University of Connecticut Research Foundation. The primary study by Helle et al. was supported by the Werner Otto Foundation, the Kroschke Foundation, and the Feindt Foundation. The primary study by Figueira et al. was supported by the Brazilian Ministry of Health and by the National Counsel of Technological and Scientific Development (CNPq) (Grant no.403433/2004-5). The primary study by Couto et al. was supported by the National Counsel of Technological and Scientific Development (CNPq) (Grant no. 444254/2014-5) and the Minas Gerais State Research Foundation (FAPEMIG) (Grant no. APQ-01954-14). The primary study by Chorwe-Sungani et al. was supported by the University of Malawi through grant QZA-0484 NORHED 2013. The primary study by de Figueiredo et al. was supported by Funda{\c c}{\~a}o de Amparo {\`a} Pesquisa do Estado de S{\~a}o Paulo. The primary study by Tissot et al. was supported by the Swiss National Science Foundation (grant 32003B 125493). The primary study by Fernandes et al. was supported by grants from the Child: Care Health and Development Trust and the Department of Psychiatry, University of Oxford, Oxford, UK, and by the Ashok Ranganathan Bursary from Exeter College, University of Oxford. Dr. Fernandes is supported by a University of Southampton National Institute for Health Research (NIHR) academic clinical fellowship in Paediatrics. The primary study by van Heyningen et al. was supported by the Medical Research Council of South Africa (fund no. 415865), Cordaid Netherlands (Project 103/10002 G Sub 7) and the Truworths Community Foundation Trust, South Africa. Dr. van Heyningen was supported by the National Research Foundation of South Africa and the Harry Crossley Foundation. VHYTHE001/1232209. The primary study by Tendais et al. was supported under the project POCI/SAU-ESP/56397/2004 by the Operational Program Science and Innovation 2010 (POCI 2010) of the Community Support Board III and by the European Community Fund FEDER. The primary study by Fisher et al. was supported by a grant under the Invest to Grow Scheme from the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs. The primary study by Green et al. was supported by a grant from the Duke Global Health Institute (453-0751). The primary study by Howard et al. was supported by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Numbers RP-PG-1210-12002 and RP-DG-1108-10012) and by the South London Clinical Research Network. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The primary study by Kettunen et al. was supported with an Annual EVO Financing (Special government subsidies from the Ministry of Health and Welfare, Finland) by North Karelia Central Hospital and P{\"a}ij{\"a}t-H{\"a}me Central Hospital. The primary study by Phillips et al. was supported by a scholarship from the National Health and Medical and Research Council (NHMRC). The primary study by Roomruangwong et al. was supported by the Ratchadaphiseksomphot Endowment Fund 2013 of Chulalongkorn University (CU-56-457-HR). The primary study by Mart{\'i}nez et al. was supported by Iniciativa Cient{\'i}fica Milenio, Chile, process \# IS130005 and by Fondo Nacional de Desarrollo Cient{\'i}fico y Tecnol{\'o}gico, Chile, process \# 1130230. The primary study by Naki{\'c} Rado{\v s} et al. was supported by the Croatian Ministry of Science, Education, and Sports (134-0000000-2421). The primary study by Usuda et al. was supported by Grant-in-Aid for Young Scientists (A) from the Japan Society for the Promotion of Science (primary investigator: Daisuke Nishi, MD, PhD), and by an Intramural Research Grant for Neurological and Psychiatric Disorders from the National Center of Neurology and Psychiatry, Japan. The primary study by Pawlby et al. was supported by a Medical Research Council UK Project Grant (number G89292999N). The primary study by Rochat et al. was supported by grants from the University of Oxford (HQ5035), the Tuixen Foundation (9940), the Wellcome Trust (082384/Z/07/Z and 071571), and the American Psychological Association. Dr. Rochat receives salary support from a Wellcome Trust Intermediate Fellowship (211374/Z/18/Z). The primary study by Rowe et al. was supported by the diamond Consortium, beyondblue Victorian Centre of Excellence in Depression and Related Disorders. The primary study by Comasco et al. was supported by funds from the Swedish Research Council (VR: 521-2013-2339, VR:523-2014-2342), the Swedish Council for Working Life and Social Research (FAS: 2011-0627), the Marta Lundqvist Foundation (2013, 2014), and the Swedish Society of Medicine (SLS-331991). The primary study by Smith-Nielsen et al. was supported by a grant from the charitable foundation Tryg Foundation (Grant ID no 107616). The primary study by Prenoveau et al. was supported by The Wellcome Trust (grant number 071571). The primary study by Stewart et al. was supported by Professor Francis Creed{\textquoteright}s Journal of Psychosomatic Research Editorship fund (BA00457) administered through University of Manchester. The primary study by Su et al. was supported by grants from the Department of Health (DOH94F044 and DOH95F022) and the China Medical University and Hospital (CMU94-105, DMR-92-92 and DMR94-46). The primary study by Tandon et al. was funded by the Thomas Wilson Sanitarium. The primary study by Tran et al. was supported by the Myer Foundation who funded the study under its Beyond Australia scheme. Dr. Tran was supported by an early career fellowship from the Australian National Health and Medical Research Council. The primary study by Vega-Dienstmaier et al. was supported by Tejada Family Foundation, Inc, and Peruvian-American Endowment, Inc. The primary study by Yonkers et al. was supported by a National Institute of Child Health and Human Development grant (5 R01HD045735). No other authors reported funding for primary studies or for their work on this study. No funder had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

doi = "10.1038/s41598-023-29114-w",

language = "English",

volume = "13",

pages = "1--12",

journal = "Scientific Reports",

issn = "2045-2322",

publisher = "Nature Research",

}

TY - JOUR

T1 - Individual participant data meta-analysis to compare EPDS accuracy to detect major depression with and without the self-harm item

AU - Qiu, Xia

AU - Wu, Yin

AU - Sun, Ying

AU - Levis, Brooke

AU - Tian, Jizhou

AU - Boruff, Jill T.

AU - Cuijpers, Pim

AU - Ioannidis, John P.A.

AU - Markham, Sarah

AU - Ziegelstein, Roy C.

AU - Vigod, Simone N.

AU - Benedetti, Andrea

AU - Thombs, Brett D.

AU - He, Chen

AU - Krishnan, Ankur

AU - Bhandari, Parash Mani

AU - Neupane, Dipika

AU - Negeri, Zelalem

AU - Imran, Mahrukh

AU - Rice, Danielle B.

AU - Azar, Marleine

AU - Chiovitti, Matthew J.

AU - Gilbody, Simon

AU - Kloda, Lorie A.

AU - Patten, Scott B.

AU - Mitchell, Nicholas D.

AU - Alvarado, Rubén

AU - Barnes, Jacqueline

AU - Beck, Cheryl Tatano

AU - Bindt, Carola

AU - Correa, Humberto

AU - Couto, Tiago Castro e.

AU - Chorwe-Sungani, Genesis

AU - Eapen, Valsamma

AU - Favez, Nicolas

AU - Felice, Ethel

AU - Fellmeth, Gracia

AU - Fernandes, Michelle

AU - Field, Sally

AU - Figueiredo, Barbara

AU - Fisher, Jane R.W.

AU - Green, Eric P.

AU - Honikman, Simone

AU - Howard, Louise M.

AU - Kettunen, Pirjo A.

AU - Kohlhoff, Jane

AU - Kozinszky, Zoltán

AU - Leonardou, Angeliki A.

AU - Maes, Michael

AU - Martínez, Pablo

AU - Radoš, Sandra Nakić

AU - Nishi, Daisuke

AU - Pawlby, Susan J.

AU - Rochat, Tamsen J.

AU - Rowe, Heather J.

AU - Sharp, Deborah J.

AU - Skalkidou, Alkistis

AU - Smith-Nielsen, Johanne

AU - Stein, Alan

AU - Su, Kuan Pin

AU - Sundström-Poromaa, Inger

AU - Tadinac, Meri

AU - Tandon, S. Darius

AU - Tendais, Iva

AU - Töreki, Annamária

AU - Tran, Thach D.

AU - Trevillion, Kylee

AU - Turner, Katherine

AU - Væver, Mette S.

AU - van Heyningen, Thandi

AU - Vega-Dienstmaier, Johann M.

AU - Wynter, Karen

AU - Yonkers, Kimberly A.

AU - the Depression Screening Data (DEPRESSD) EPDS Group

N1 - Funding Information: This study was funded by the Canadian Institutes of Health Research (CIHR, KRS-140994). Dr. Qiu was supported by a scholarship from the China Scholarship Council. Drs. Wu and Levis were supported by Fonds de recherche du Québec—Santé (FRQ-S) Postdoctoral Training Fellowships. Dr. Benedetti was supported by a Fonds de recherche du Québec – Santé (FRQS) researcher salary award. Dr. Thombs was supported by a Tier 1 Canada Research Chair. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. The primary study by Alvarado et al. was supported by the Ministry of Health of Chile. The primary study by Barnes et al. was supported by a grant from the Health Foundation (1665/608). The primary study by Beck et al. was supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation and the University of Connecticut Research Foundation. The primary study by Helle et al. was supported by the Werner Otto Foundation, the Kroschke Foundation, and the Feindt Foundation. The primary study by Figueira et al. was supported by the Brazilian Ministry of Health and by the National Counsel of Technological and Scientific Development (CNPq) (Grant no.403433/2004-5). The primary study by Couto et al. was supported by the National Counsel of Technological and Scientific Development (CNPq) (Grant no. 444254/2014-5) and the Minas Gerais State Research Foundation (FAPEMIG) (Grant no. APQ-01954-14). The primary study by Chorwe-Sungani et al. was supported by the University of Malawi through grant QZA-0484 NORHED 2013. The primary study by de Figueiredo et al. was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo. The primary study by Tissot et al. was supported by the Swiss National Science Foundation (grant 32003B 125493). The primary study by Fernandes et al. was supported by grants from the Child: Care Health and Development Trust and the Department of Psychiatry, University of Oxford, Oxford, UK, and by the Ashok Ranganathan Bursary from Exeter College, University of Oxford. Dr. Fernandes is supported by a University of Southampton National Institute for Health Research (NIHR) academic clinical fellowship in Paediatrics. The primary study by van Heyningen et al. was supported by the Medical Research Council of South Africa (fund no. 415865), Cordaid Netherlands (Project 103/10002 G Sub 7) and the Truworths Community Foundation Trust, South Africa. Dr. van Heyningen was supported by the National Research Foundation of South Africa and the Harry Crossley Foundation. VHYTHE001/1232209. The primary study by Tendais et al. was supported under the project POCI/SAU-ESP/56397/2004 by the Operational Program Science and Innovation 2010 (POCI 2010) of the Community Support Board III and by the European Community Fund FEDER. The primary study by Fisher et al. was supported by a grant under the Invest to Grow Scheme from the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs. The primary study by Green et al. was supported by a grant from the Duke Global Health Institute (453-0751). The primary study by Howard et al. was supported by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Numbers RP-PG-1210-12002 and RP-DG-1108-10012) and by the South London Clinical Research Network. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The primary study by Kettunen et al. was supported with an Annual EVO Financing (Special government subsidies from the Ministry of Health and Welfare, Finland) by North Karelia Central Hospital and Päijät-Häme Central Hospital. The primary study by Phillips et al. was supported by a scholarship from the National Health and Medical and Research Council (NHMRC). The primary study by Roomruangwong et al. was supported by the Ratchadaphiseksomphot Endowment Fund 2013 of Chulalongkorn University (CU-56-457-HR). The primary study by Martínez et al. was supported by Iniciativa Científica Milenio, Chile, process # IS130005 and by Fondo Nacional de Desarrollo Científico y Tecnológico, Chile, process # 1130230. The primary study by Nakić Radoš et al. was supported by the Croatian Ministry of Science, Education, and Sports (134-0000000-2421). The primary study by Usuda et al. was supported by Grant-in-Aid for Young Scientists (A) from the Japan Society for the Promotion of Science (primary investigator: Daisuke Nishi, MD, PhD), and by an Intramural Research Grant for Neurological and Psychiatric Disorders from the National Center of Neurology and Psychiatry, Japan. The primary study by Pawlby et al. was supported by a Medical Research Council UK Project Grant (number G89292999N). The primary study by Rochat et al. was supported by grants from the University of Oxford (HQ5035), the Tuixen Foundation (9940), the Wellcome Trust (082384/Z/07/Z and 071571), and the American Psychological Association. Dr. Rochat receives salary support from a Wellcome Trust Intermediate Fellowship (211374/Z/18/Z). The primary study by Rowe et al. was supported by the diamond Consortium, beyondblue Victorian Centre of Excellence in Depression and Related Disorders. The primary study by Comasco et al. was supported by funds from the Swedish Research Council (VR: 521-2013-2339, VR:523-2014-2342), the Swedish Council for Working Life and Social Research (FAS: 2011-0627), the Marta Lundqvist Foundation (2013, 2014), and the Swedish Society of Medicine (SLS-331991). The primary study by Smith-Nielsen et al. was supported by a grant from the charitable foundation Tryg Foundation (Grant ID no 107616). The primary study by Prenoveau et al. was supported by The Wellcome Trust (grant number 071571). The primary study by Stewart et al. was supported by Professor Francis Creed’s Journal of Psychosomatic Research Editorship fund (BA00457) administered through University of Manchester. The primary study by Su et al. was supported by grants from the Department of Health (DOH94F044 and DOH95F022) and the China Medical University and Hospital (CMU94-105, DMR-92-92 and DMR94-46). The primary study by Tandon et al. was funded by the Thomas Wilson Sanitarium. The primary study by Tran et al. was supported by the Myer Foundation who funded the study under its Beyond Australia scheme. Dr. Tran was supported by an early career fellowship from the Australian National Health and Medical Research Council. The primary study by Vega-Dienstmaier et al. was supported by Tejada Family Foundation, Inc, and Peruvian-American Endowment, Inc. The primary study by Yonkers et al. was supported by a National Institute of Child Health and Human Development grant (5 R01HD045735). No other authors reported funding for primary studies or for their work on this study. No funder had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: © 2023, The Author(s).

PY - 2023

Y1 - 2023

N2 - 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).

AB - 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).

UR - https://www.scopus.com/pages/publications/85150003425

UR - https://www.scopus.com/pages/publications/85150003425#tab=citedBy

U2 - 10.1038/s41598-023-29114-w

DO - 10.1038/s41598-023-29114-w

M3 - Article

C2 - 36899016

AN - SCOPUS:85150003425

SN - 2045-2322

VL - 13

SP - 1

EP - 12

JO - Scientific Reports

JF - Scientific Reports

M1 - 4026

ER -

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

Abstract

Bibliographical note

Funding

UN SDGs

Access to Document

Persistent URL (handle)

Other files and links

Fingerprint

Cite this