Diagnostic accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for detecting major depression in pregnant and postnatal women: protocol for a systematic review and individual patient data meta-analyses
Open accessAbstract
Introduction: Studies of the diagnostic accuracy of depression screening tools often used data-driven methods to select optimal cut-offs. Typically, these studies report results from a small range of cut-off points around whatever cut-off score is identified as most accurate. When published data are combined in meta-analyses, estimates of accuracy for different cut-off points may be based on data from different studies, rather than data from all studies for each cut-off point. Thus, traditional meta-analyses may exaggerate accuracy estimates. Individual patient data (IPD) meta-analyses synthesise data from all studies for each cut-off score to obtain accuracy estimates. The 10-item Edinburgh Postnatal Depression Scale (EPDS) is commonly recommended for depression screening in the perinatal period. The primary objective of this IPD meta-analysis is to determine the diagnostic accuracy of the EPDS to detect major depression among women during pregnancy and in the postpartum period across all potentially relevant cut-off scores, accounting for patient factors that may influence accuracy (age, pregnancy vs postpartum). Methods and analysis: Data sources will include Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science. Studies that include a diagnosis of major depression based on a validated structured or semistructured clinical interview administered within 2 weeks of (before or after) the administration of the EPDS will be included. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Bivariate random-effects meta-analysis will be conducted for the full range of plausible cut-off values. Analyses will evaluate data from pregnancy and the postpartum period separately, as well as combining data from all women in a single model. Ethics and dissemination: This study does not require ethics approval. Dissemination will include journal articles and presentations to policymakers, healthcare providers and researchers. Systematic review registration: PROSPERO 2015:CRD42015024785.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The IPDMA was registered in PROSPERO (CRD42015024785), a protocol was published, and results were reported following PRISMA-DTA and PRISMA-IPD guidelines.
“This IPDMA was registered in PROSPERO (CRD42015024785), a protocol was published,20 and the results were reported following PRISMA-DTA (preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies)21 and PRISMA-IPD (preferred reporting items for systematic review and meta-analyses of individual participant data)22 guidelines.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823 · see citing works
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042 · cited 1× · see citing works
“39 44 Results will be reported in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.(45) 46 To conduct the meta-analysis, primary data sets will be sought that allow comparisons of EPDS scores to diagnoses of major depression.”
MethodPreferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859 · see citing works
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763 · cited 1× · see citing works
“R is the ratio of the estimated SD of the pooled sensitivity from the random effects model to the estimated SD of the pooled sensitivity from the fixed effects model.(56) We will explore underlying reasons for heterogeneity using patient-level (eg, age) and study-level factors (eg, QUADAS-2 risk of bias ratings).”
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164 · see citing works
Self-citationWang, G., Ma, R., Qiao, G., Wada, K., Aizawa, Y., & Satoh, T. (2015) · Integrative Medicine International · doi:10.1159/000368408 · Cited by 18,759 · see citing works
QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies
Whiting, P. F., Rutjes, A. W. S., Westwood, M. E., Mallett, S., Deeks, J. J., Reitsma, J. B., Leeflang, M. M. G., Sterne, J. A. C., Bossuyt, P. M. M., & the QUADAS-2 Group* (2011) · Annals of Internal Medicine · doi:10.7326/0003-4819-155-8-201110180-00009 · Cited by 14,199 · see citing works
Lost in knowledge translation: Time for a map?
Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W., & Robinson, N. (2006) · Journal of Continuing Education in the Health Professions · doi:10.1002/chp.47 · Cited by 4,705 · see citing works
Perinatal Depression: A Systematic Review of Prevalence and Incidence
Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000183597.31630.db · Cited by 3,282 · see citing works
Clinical Prediction Models: A Practical Approach to Development, Validation, and Updating
Steyerberg, E. W. (2019) · Statistics for Biology and Health · doi:10.1007/978-3-030-16399-0 · Cited by 3,281 · see citing works
Rates and risk of postpartum depression – a meta-analysis
O'hara, M. W., & Swain, A. M. (1996) · International Review of Psychiatry · doi:10.3109/09540269609037816 · Cited by 3,116 · see citing works
Internal validation of predictive models
Steyerberg, E. W., Harrell, F. E., Borsboom, G. J. J. M., Eijkemans, M. J. C., Vergouwe, Y., & Habbema, J. D. F. (2001) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(01)00341-9 · Cited by 2,746 · cited 1× · see citing works
“Internal validation will be assessed via the bootstrap method, which is preferable to split sample validation approaches (eg, developing the model in half the sample and evaluating it in the other half).(68) Although there are advantages to external validation, given the wide range of study populations that will be us…”
MethodWittchen, H.-U. (1994) · Journal of Psychiatric Research · doi:10.1016/0022-3956(94)90036-1 · Cited by 2,348 · see citing works
Epidemiology of women and depression
Kessler, R. (2003) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00426-3 · Cited by 2,006 · cited 1× · see citing works
“INTRODUCTION Depression is a leading cause of disability among women.(1) Although the 7–13% prevalence of major depression during pregnancy and postpartum is similar to rates among women during non-childbearing periods,(4) 6–10 perinatal depression is associated with adverse outcomes for the developing child, the moth…”
BackgroundManea, L., Gilbody, S., & McMillan, D. (2012) · Canadian Medical Association Journal · doi:10.1503/cmaj.110829 · Cited by 1,966 · see citing works
Self-citationAntenatal risk factors for postpartum depression: a synthesis of recent literature
Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2004.02.006 · Cited by 1,886 · cited 1× · see citing works
“tended pregnancy or complications in pregnancy, for example.(62) 63 Data relevant to established risk markers from primary study authors will be requested, although”
BackgroundPrevalence of Depression During Pregnancy: Systematic Review
Bennett, H. A., Einarson, A., Taddio, A., Koren, G., & Einarson, T. R. (2004) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000116689.75396.5f · Cited by 1,725 · see citing works
Meta-analysis of individual participant data: rationale, conduct, and reporting
Riley, R. D., Lambert, P. C., & Abo-Zaid, G. (2010) · BMJ · doi:10.1136/bmj.c221 · Cited by 1,701 · cited 3× · see citing works
“The IPD meta-analysis has been designed and will be conducted in accordance with best-practice standards as elaborated in the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy(43) and other key sources.(38) 39 44 Results will be reported in concordance with the Preferred Reporting Items for Systemat…”
BackgroundMethodResultInfluentialSteyerberg, E. W. (2009) · Statistics for Biology and Health · doi:10.1007/978-0-387-77244-8 · Cited by 1,491 · see citing works
Structured Clinical Interview for DSM-III-R Personality Disorders
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2012) · PsycTESTS Dataset · doi:10.1037/t07827-000 · Cited by 1,403 · see citing works
Non-psychotic mental disorders in the perinatal period
Howard, L. M., Molyneaux, E., Dennis, C.-L., Rochat, T., Stein, A., & Milgrom, J. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61276-9 · Cited by 1,328 · cited 1× · see citing works
“The 10-item Edinburgh Postnatal Depression Scale (EPDS) is the most commonly used screening tool in pregnancy and postpartum.(14) 26 27 Most existing studies of the accuracy of depression screening tools, including the EPDS,(30) however, have been conducted in samples too small to precisely estimate accuracy.”
MethodGaynes, B. N., Gavin, N., Meltzer-Brody, S., Lohr, K. N., Swinson, T., Gartlehner, G., Brody, S., & Miller, W. C. (2005) · PsycEXTRA Dataset · doi:10.1037/e439372005-001 · Cited by 1,211 · see citing works
Risk factors for depressive symptoms during pregnancy: a systematic review
Lancaster, C. A., Gold, K. J., Flynn, H. A., Yoo, H., Marcus, S. M., & Davis, M. M. (2010) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2009.09.007 · Cited by 1,208 · see citing works
Psychiatric Disorders in Pregnant and Postpartum Women in the United States
Vesga-López, O., Blanco, C., Keyes, K., Olfson, M., Grant, B. F., & Hasin, D. S. (2008) · Archives of General Psychiatry · doi:10.1001/archpsyc.65.7.805 · Cited by 1,065 · see citing works
Imputing missing covariate values for the Cox model
White, I., & Royston, P. (2009) · Statistics in Medicine · doi:10.1002/sim.3618 · Cited by 994 · see citing works
Risk factors for antenatal depression, postnatal depression and parenting stress
Leigh, B., & Milgrom, J. (2008) · BMC Psychiatry · doi:10.1186/1471-244x-8-24 · Cited by 888 · see citing works
Human Development Report 2013. The Rise of the South: Human Progress in a Diverse WorldPreprint
Malik, K. (2013) · SSRN Electronic Journal · Cited by 768 · see citing works
A Controlled Study of the Onset, Duration and Prevalence of Postnatal Depression
Cox, J., Murray, D., & Chapman, G. (1993) · The British Journal of Psychiatry · doi:10.1192/bjp.163.1.27 · Cited by 754 · see citing works
United Nations Development Programme (2013) · Human development report · doi:10.18356/a1b0c169-en · Cited by 705 · see citing works
Rich-Edwards, J. W., KLEINMAN, K. P., Abrams, A., Harlow, B. L., McLaughlin, T. J., Joffe, H., & Gillman, M. W. (2006) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2005.039370 · Cited by 617 · see citing works
O'Hara, M. W., Zekoski, E. M., Philipps, L. H., & Wright, E. J. (1990) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.99.1.3 · Cited by 610 · see citing works
O’Hara, M. W., Zekoski, E. M., Philipps, L. H. C., & Wright, E. J. (1990) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.99.1.3 · Cited by 605 · see citing works
QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies
Whiting, P. F., Rutjes, A. W., Westwood, M. E., Mallett, S., Deeks, J. J., Reitsma, J. B., Leeflang, M., Sterne, J. A. C., & Bossuyt, P. M. (2011) · Data Archiving and Networked Services (DANS) · doi:10.1059/0003-4819-155-8-201110180-00009 · Cited by 601 · see citing works
Towards systematic reviews that inform health care management and policy-making
Lavis, J. N., Davies, H. T. O., Oxman, A., Denis, J., Golden‐Biddle, K., & Ferlie, E. B. (2005) · Journal of Health Services Research & Policy · doi:10.1258/1355819054308549 · Cited by 582 · see citing works
Between- and Within-Cluster Covariate Effects in the Analysis of Clustered Data
Neuhaus, J. M., & Kalbfleisch, J. D. (1998) · Biometrics · doi:10.2307/3109770 · Cited by 528 · see citing works
Bridging the implementation gap between knowledge and action for health.
(2004) · Europe PMC (PubMed Central) · doi:10.1590/s0042-96862004001000005 · Cited by 527 · see citing works
Mant, J., Doust, J., Roalfe, A., Barton, P., Cowie, M., Glasziou, P., Mant, D., McManus, R., Holder, R., Deeks, J., et al. (2009) · Health Technology Assessment · doi:10.3310/hta13320 · Cited by 498 · see citing works
Earls, M. F. (2010) · PEDIATRICS · doi:10.1542/peds.2010-2348 · Cited by 498 · see citing works
Depression Screening and Patient Outcomes in Cardiovascular Care: A Systematic Review
Thombs, B. D., de Jonge, P., Coyne, J. C., Whooley, M. A., Frasure-Smith, N., Mitchell, A. J., Zuidersma, M., Eze-Nliam, C., Lima, B. B., Smith, C. G., et al. (2008) · JAMA · doi:10.1001/jama.2008.667 · Cited by 472 · cited 1× · see citing works
“Many studies have used data-driven methods to select ‘optimal’ cut-offs with these small samples and have selectively published accuracy results from high-performing cut-offs, but not other cut-offs, even when the other cut-offs are standard.(31) 32 Few studies have excluded women who are already being treated for dep…”
MethodSelf-citationBerlin, J. A., Santanna, J., Schmid, C. H., Szczech, L. A. M., & Feldman, H. I. (2002) · Statistics in Medicine · doi:10.1002/sim.1023 · Cited by 468 · see citing works
Cooper, P. J., Campbell, E. A., Day, A., Kennerley, H., & Bond, A. (1988) · British Journal of Psychiatry · doi:10.1192/bjp.152.6.799 · Cited by 425 · see citing works
Lambert, P. C., Sutton, A. J., Abrams, K. R., & Jones, D. R. (2002) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(01)00414-0 · Cited by 396 · see citing works
The Hospital Anxiety and Depression Scale: A diagnostic meta-analysis of case-finding ability
Brennan, C., Worrall-Davies, A., McMillan, D., Gilbody, S., & House, A. (2010) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.04.006 · Cited by 374 · see citing works
Self-citationHewitt, C., Gilbody, S., Brealey, S., Paulden, M., Palmer, S., Mann, R., Green, J., Morrell, J., Barkham, M., Light, K., et al. (2009) · Health Technology Assessment · doi:10.3310/hta13360 · Cited by 330 · cited 1× · see citing works
“mated via Gauss-Hermite adaptive quadrature, as described in Riley et al,(54) for the full range of plausible cut-off values, which for the EPDS will be considered cut-off scores from 9–15.(30) This approach appropriately models sensitivity and specificity simultaneously and also accounts for variation in within-study…”
MethodSelf-citationRubertsson, C., Wickberg, B., Gustavsson, P. J., & Rådestad, I. J. (2005) · Archives of Women s Mental Health · doi:10.1007/s00737-005-0078-8 · Cited by 308 · see citing works
Black, C., Clar, C., Henderson, R., MacEachern, C. F., McNamee, P., Quayyum, Z., Royle, P., & Thomas, S. (2009) · Health Technology Assessment · doi:10.3310/hta13520 · Cited by 292 · see citing works
Recommendations on screening for depression in adults
Canadian Task Force on Preventive Health Care, Joffres, M., Jaramillo, A., Dickinson, J. A., Lewin, G., Pottie, K. C., Shaw, E. A., Gorber, S. C., & Tonelli, M. A. (2013) · Canadian Medical Association Journal · doi:10.1503/cmaj.130403 · Cited by 248 · cited 1× · see citing works
“The Task Force noted that existing evidence likely overstates the accuracy of depression screening tools in practice and emphasised the need for better-quality estimates of screening tool accuracy.(29) Successfully screening for perinatal depression would require a screening tool with demonstrated accuracy.”
BackgroundSelf-citationSchmid, C. H., Stark, P. C., Berlin, J. A., Landais, P., & Lau, J. (2004) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2003.12.001 · Cited by 245 · see citing works
Screening for poststroke major depression: a meta-analysis of diagnostic validity studies
Meader, N., Moe‐Byrne, T., Llewellyn, A., & Mitchell, A. J. (2013) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2012-304194 · Cited by 197 · see citing works
Simmonds, M. C., & Higgins, J. P. T. (2006) · Statistics in Medicine · doi:10.1002/sim.2768 · Cited by 194 · see citing works
Searching for Clinical Prediction Rules in MEDLINE
Ingui, B. J., & Rogers, M. A. M. (2001) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2001.0080391 · Cited by 184 · see citing works
Changing Directions Changing Lives: The Mental health Strategy for Canada
(2012) · PsycEXTRA Dataset · doi:10.1037/e504192013-001 · Cited by 184 · see citing works
Stewart, D. E. (2011) · New England Journal of Medicine · doi:10.1056/nejmcp1102730 · Cited by 183 · see citing works
Should meta-analysts search Embase in addition to Medline?
Sampson, M. (2003) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(03)00110-0 · Cited by 160 · cited 1× · see citing works
“that adding other databases (eg, EMBASE) when the Medline search is highly sensitive does not identify additional eligible studies.(47) The Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy(43) suggests combining concepts of the index test and the target con-”
BackgroundPublic Health Decision‐Makers' Informational Needs and Preferences for Receiving Research Evidence
Dobbins, M., Jack, S. M., Thomas, H., & Kothari, A. R. (2007) · Worldviews on Evidence-Based Nursing · doi:10.1111/j.1741-6787.2007.00089.x · Cited by 142 · see citing works
A Knowledge Transfer Strategy for Public Health Decision Makers
Dobbins, M., DeCorby, K., & Twiddy, T. (2004) · Worldviews on Evidence-Based Nursing · doi:10.1111/j.1741-6787.2004.t01-1-04009.x · Cited by 129 · see citing works
Meader, N., Mitchell, A. J., Chew-Graham, C. A., Goldberg, D. P., Rizzo, M., Bird, V. J., Kessler, D. S., Packham, J., Haddad, M., & Pilling, S. (2011) · British Journal of General Practice · doi:10.3399/bjgp11x613151 · Cited by 126 · cited 2× · see citing works
“32 Few studies have excluded women who are already being treated for depression and would not be screened in actual practice, thus exaggerating the estimated number of previously unidentified patients who would be detected by depression screening.(33) Ideally, primary studies that assess the diagnostic accuracy of the…”
BackgroundThombs, B. D., Benedetti, A., Kloda, L. A., Levis, B., Nicolau, I. A., Cuijpers, P. J., Gilbody, S. M., Ioannidis, J. P. A., McMillan, D., Patten, S. B., et al. (2014) · Systematic Reviews · doi:10.1186/2046-4053-3-124 · Cited by 124 · cited 1× · see citing works
“the first IPD meta-analysis of the diagnostic accuracy of a depression screening tool.(42) In that study, which is still in process, as of 26 July 2015, we had identified 77 eligible primary data sets.”
MethodSelf-citationDepression screening and patient outcomes in pregnancy or postpartum: A systematic review
Thombs, B. D., Arthurs, E., Coronado‐Montoya, S., Roseman, M., Delisle, V. C., Leavens, A., Levis, B., Azoulay, L., Smith, C. G., Ciofani, L., et al. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.01.006 · Cited by 123 · see citing works
Self-citationCommittee Opinion No. 453: Screening for Depression During and After Pregnancy
(2010) · Obstetrics and Gynecology · doi:10.1097/aog.0b013e3181d035aa · Cited by 123 · see citing works
Thombs, B. D., Arthurs, E., El‐Baalbaki, G., Meijer, A., Ziegelstein, R. C., & Steele, R. J. (2011) · BMJ · doi:10.1136/bmj.d4825 · Cited by 103 · see citing works
Self-citationThombs, B. D., Ziegelstein, R. C., Roseman, M., Kloda, L. A., & Ioannidis, J. P. (2014) · BMC Medicine · doi:10.1186/1741-7015-12-13 · Cited by 100 · see citing works
Self-citationDeveloping optimal search strategies for detecting sound clinical prediction studies in MEDLINE.
Wong, S. S.-L., Wilczynski, N. L., Haynes, R. B., & Ramkissoonsingh, R. (2003) · PubMed · Cited by 100 · see citing works
Does depression screening improve depression outcomes in primary care?
Thombs, B. D., & Ziegelstein, R. C. (2014) · BMJ · doi:10.1136/bmj.g1253 · Cited by 98 · see citing works
Self-citationMeta‐analysis of diagnostic test studies using individual patient data and aggregate data
Riley, R. D., Dodd, S. R., Craig, J. V., Thompson, J. R., & Williamson, P. R. (2008) · Statistics in Medicine · doi:10.1002/sim.3441 · Cited by 98 · cited 5× · see citing works
“provide individual patient data in the main metaanalysis.(54) If there are a large number of studies that do not contribute primary data, this analysis may become”
BackgroundMethodInfluentialThe Course of Postpartum Psychiatric Disorders in Women and Their Partners
Zelkowitz, P., & Milet, T. H. (2001) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-200109000-00002 · Cited by 97 · see citing works
Whitley, R., & Kirmayer, L. J. (2008) · Social Science & Medicine · doi:10.1016/j.socscimed.2007.09.014 · Cited by 95 · see citing works
Depression Screening and Patient Outcomes in Cancer: A Systematic Review
Meijer, A., Roseman, M., Milette, K., Coyne, J. C., Stefanek, M. E., Ziegelstein, R. C., Arthurs, E., Leavens, A., Palmer, S. C., Stewart, D. E., et al. (2011) · PLoS ONE · doi:10.1371/journal.pone.0027181 · Cited by 84 · see citing works
Self-citationZelkowitz, P., & Milet, T. H. (1996) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.105.2.281 · Cited by 77 · see citing works
Stewart, D. E. (2012) · Obstetric Anesthesia Digest · doi:10.1097/01.aoa.0000422687.34124.5c · Cited by 73 · see citing works
Guideline concordance of treatment for depressive disorders in Canada
Duhoux, A., Fournier, L., Nguyen, C. T., Roberge, P., & Beveridge, R. (2008) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-008-0444-8 · Cited by 68 · see citing works
Zelkowitz, P., & Milet, T. H. (1996) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.105.2.281 · Cited by 64 · see citing works
Use of systematic reviews in the development of new provincial public health policies in Ontario
Dobbins, M., Thomas, H., O’Brien, M. A., & Duggan, M. (2004) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462304001278 · Cited by 57 · cited 1× · see citing works
“reports of systematic review and meta-analyses for healthcare managers and policymakers.(74) 76 Dissemination will include publication of results in high-impact medical”
BackgroundA failed attempt to conduct an individual patient data meta-analysis
Jaspers, G. J., & Degraeuwe, P. L. J. (2014) · Systematic Reviews · doi:10.1186/2046-4053-3-97 · Cited by 42 · cited 1× · see citing works
“In some circumstances, the inability to obtain enough primary data may make it impossible to reasonably conduct an IPD meta-analysis.(40) 41 Currently, our team is conducting an IPD meta-analysis of the Patient Health Questionnaire depression screening tool, which is”
MethodRiley, R. D. (2014) · Journal of Biometrics & Biostatistics · doi:10.4172/2155-6180.1000196 · Cited by 38 · see citing works
Duhoux, A., Fournier, L., Gauvin, L. I., & Roberge, P. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.05.097 · Cited by 30 · see citing works
Chapter 18: Reviews of individual patient data
Tierney, J. F. (2008) · Cited by 26 · see citing works
When Is Knowledge Ripe for Primary Care?
Beaulieu, M., Proulx, M., Jobin, G., Kugler, M., Gossard, F., Denis, J., & Larouche, D. (2007) · Evaluation & the Health Professions · doi:10.1177/0163278707311870 · Cited by 24 · cited 1× · see citing works
“and conference presentations are typically not highly effective in disseminating clinical research to healthcare providers, including physicians.(77) To increase uptake of the findings from this study, a brief video and podcast will be created that is similar to the Cochrane Library podcasts (http://www.”
BackgroundStatins for people at low risk
Parish, E., Bloom, T., & Godlee, F. (2015) · BMJ · doi:10.1136/bmj.h3908 · Cited by 24 · see citing works
Mann, R., & Gilbody, S. M. (2012) · Systematic Reviews · doi:10.1186/2046-4053-1-9 · Cited by 8 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 3
- [20]National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance. London, UK: National Institute for Health and Care Excellence, 2014. 31990493
- [44]Higgins JPT, Green S Cochrane handbook for systematic reviews of interventions version 5.1.0. Chichester, UK: Wiley-Blackwell; The Cochrane Collaboration, 2011.
- [51]First MB, Spitzer RL, Gibbon M Structured clinical interview for DSM-IV Axis I Disorders—Patient Edition (SCID-I/P, Version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute, 1996.
Cited by
Sorted by citations
Perinatal mental health: a review of progress and challenges
Howard, L. M., & Khalifeh, H. (2020) · World Psychiatry · doi:10.1002/wps.20769 · Cited by 1,118 · see citing works
Levis, B., Negeri, Z., Sun, Y., Benedetti, A., & Thombs, B. D. (2020) · BMJ · doi:10.1136/bmj.m4022 · Cited by 922 · see citing works
Self-citationDepression screening tools in persons with epilepsy: A systematic review of validated tools
Gill, S. J., Lukmanji, S., Fiest, K. M., Patten, S. B., Wiebe, S., & Jetté, N. (2017) · Epilepsia · doi:10.1111/epi.13651 · Cited by 159 · see citing works
“tion in the validity of the tools due to selective reporting around cutpoints where better performance is partially due to sampling variability.(60) Therefore, these screening tools may not work as well in practice as they do for the samples used in the studies.”
Self-citationPark, S., & Kim, J. (2022) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-022-06525-0 · Cited by 133 · see citing works
“However, in most cases, only the EPDS was verified [20].”
BackgroundUsuda, K., Nishi, D., Okazaki, E., Makino, M., & Sano, Y. (2017) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12562 · Cited by 90 · see citing works
“Large-scale meta-analyses have also been conducted to clarify optimal EPDS cut-off scores during pregnancy.(34) It is thought that a global standard cutoff score will be indicated, although the optimal value might vary based on differences in medical systems that accept high-risk individuals as well as on cultural dif…”
BackgroundLevis, B., Benedetti, A., Riehm, K. E., Saadat, N., Levis, A. W., Azar, M., Rice, D. B., Chiovitti, M. J., Sanchez, T. A., Cuijpers, P., et al. (2018) · The British Journal of Psychiatry · doi:10.1192/bjp.2018.54 · Cited by 69 · see citing works
Self-citationA key for perinatal depression early diagnosis: The body dissatisfaction
Riquin, É., Lamas, C., Nicolas, I., Bigre, C. D.-L., Curt, F., Cohen, H., Legendre, G., Corcos, M., & Godart, N. T. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.11.032 · Cited by 63 · see citing works
Lyubenova, A., Neupane, D., Levis, B., Wu, Y., Sun, Y., He, C., Krishnan, A., Bhandari, P. M., Negeri, Z., Imran, M., et al. (2021) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1860 · Cited by 63 · see citing works
“The IPDMA was registered in PROSPERO (CRD42015024785), and a protocol was published (Thombs et al., 2015).”
MethodSelf-citationALLEN, S. S., Allen, A. M., Lunos, S. A., & Tosun, N. L. (2016) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntw156 · Cited by 54 · see citing works
Benedetti, A., Wu, Y., Levis, B., Wilchesky, M., Boruff, J. T., Ioannidis, J. P. A., Patten, S. B., Cuijpers, P. J., Shrier, I., Gilbody, S. M., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-026598 · Cited by 54 · see citing works
Self-citationLevis, B., McMillan, D., Sun, Y., He, C., Rice, D. B., Krishnan, A., Wu, Y., Azar, M., Sanchez, T. A., Chiovitti, M. J., et al. (2019) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1803 · Cited by 49 · see citing works
Self-citationRaine, K. H., Nath, S., Howard, L. M., Cockshaw, W. D., Boyce, P. M., Sawyer, E., & Thorpe, K. J. (2019) · Infant Mental Health Journal · doi:10.1002/imhj.21825 · Cited by 47 · see citing works
“Routine perinatal mental health screening commonly focuses on self-report measures of depressive symptoms (Long, Cramer, Jenkins, Bennington, & Paulson, 2018; Matthey & Agostini, 2017; O'Hara & McCabe, 2013; Paulden, Palmer, Hewitt, & Gilbody, 2009; Thombs et al., 2015) .”
Tripathy, P. (2020) · Journal of Gynecology Obstetrics and Human Reproduction · doi:10.1016/j.jogoh.2020.101747 · Cited by 42 · see citing works
Verde, M. L., Luciano, M., Fordellone, M., Sampogna, G., Lettieri, D., Palma, M., Torella, D., Marrapodi, M. M., Vincenzo, M. D., & Torella, M. (2024) · Gynecologic and Obstetric Investigation · doi:10.1159/000536559 · Cited by 40 · see citing works
“Every woman who receives a positive EPDS screening should receive additional evaluation by a healthcare practitioner [23].”
BackgroundWu, Y., Levis, B., Ioannidis, J. P. A., Benedetti, A., & Thombs, B. D. (2020) · Psychotherapy and Psychosomatics · doi:10.1159/000509283 · Cited by 39 · see citing works
Self-citationImpact of a high Edinburgh Postnatal Depression Scale score on obstetric and perinatal outcomes
Navaratne, P., Foo, X. Y., & Kumar, S. (2016) · Scientific Reports · doi:10.1038/srep33544 · Cited by 34 · see citing works
Thombs, B. D., Benedetti, A., Kloda, L. A., Levis, B., Azar, M., Riehm, K. E., Saadat, N., Cuijpers, P. J., Gilbody, S. M., Ioannidis, J. P. A., et al. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011913 · Cited by 31 · see citing works
Self-citationQiu, X., Wu, Y., Sun, Y., Levis, B., Tian, J., Boruff, J. T., Cuijpers, P. J., Ioannidis, J. P. A., Markham, S., Ziegelstein, R. C., et al. (2023) · Scientific Reports · doi:10.1038/s41598-023-29114-w · Cited by 30 · see citing works
Self-citationEarly breastfeeding is associated with low risk of postpartum depression in Taiwanese women
Chiu, H.-C., Wang, H.-Y., Hsiao, J.-C., Tzeng, I., Yiang, G., Wu, M., & Chang, Y.-K. (2019) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443615.2019.1603216 · Cited by 25 · see citing works
“EPDS score of 10 indicates a potential risk of developing PPD (Thombs et al. 2015; Schaper et al. 1994).”
BackgroundWatson, S., Lewis, A. J., Boyce, P. M., & Galbally, M. (2018) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2018.05.013 · Cited by 24 · see citing works
“used to screen for postpartum depression (33), the most common being 12 or 13 (34), in this stud we treat depression symptoms data as continuous.”
MethodBhandari, P. M., Levis, B., Neupane, D., Patten, S. B., Shrier, I., Thombs, B. D., Benedetti, A., Sun, Y., He, C., Rice, D. B., et al. (2021) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2021.03.031 · Cited by 22 · see citing works
Self-citationMacMillan, K. K., Lewis, A. J., Watson, S., & Galbally, M. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.01.109 · Cited by 20 · see citing works
Shibata, Y., & Suzuki, S. (2018) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2018.1560413 · Cited by 19 · see citing works
Neupane, D., Levis, B., Bhandari, P. M., Thombs, B. D., & Benedetti, A. (2021) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1873 · Cited by 18 · see citing works
“A recent IPD meta‐analysis (IPDMA) found that cutoff 11 maximizes combined sensitivity and specificity (Levis et al., 2020).”
MethodInfluentialSelf-citationBoran, P., Waqas, A., Aşkan, Ö. Ö., Topçu, İ., Dogan, T., & Rahman, A. (2020) · BMC Research Notes · doi:10.1186/s13104-020-05196-x · Cited by 17 · see citing works
Thombs, B. D., Levis, B., Lyubenova, A., Neupane, D., Negeri, Z., Wu, Y., Sun, Y. B., He, C., Krishnan, A., Vigod, S. N., et al. (2020) · The Canadian Journal of Psychiatry · doi:10.1177/0706743720934959 · Cited by 16 · see citing works
“The original IPDMA was registered (PROSPERO; CRD42015024785), and a protocol was published.(13) This study was not included in the main EPDS IPDMA protocol.”
MethodSelf-citationVenkatesh, K. K., Kaimal, A. J., Castro, V. M., & Perlis, R. H. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.01.042 · Cited by 16 · see citing works
“The EPDS has the advantages of being short and easy to complete, and it has been used in many different socioeconomic and linguistic groups (Thombs et al., 2015).”
MethodJames, K. F., Klomhaus, A. M., Elliott, T., Mensah, M. O., Jeffers, K. S., & Choi, K. R. (2023) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2023.08.002 · Cited by 15 · see citing works
Tang, W., Bao, C., Xu, L., Zhu, J., Feng, W., Zhang, W., Cong, L., Chen, L., Cheng, Q., Ding, P., et al. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00780 · Cited by 15 · see citing works
“First, the EPDS is a self-report questionnaire, and even though it is commonly used (44), based on the EPDS scores, we are only able to identify women at higher risk of perinatal depression.”
MethodHarel, D., Levis, B., Ishihara, M., Levis, A. W., Vigod, S. N., Howard, L. M., Thombs, B. D., & Benedetti, A. (2020) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13272 · Cited by 14 · see citing works
Self-citationThe EPDS and Australian Indigenous women: A systematic review of the literature
Kotz, J., Marriott, R., & Reid, C. L. (2020) · Women and Birth · doi:10.1016/j.wombi.2020.02.007 · Cited by 14 · see citing works
Verde, M. L., Luciano, M., Fordellone, M., Brandi, C., Carbone, M., Vincenzo, M. D., Lettieri, D., Palma, M., Marrapodi, M. M., Scalzone, G., et al. (2024) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-023-07344-7 · Cited by 14 · see citing works
“The EPDS effectively identifies, with good sensitivity and specificity, women susceptible to developing PPD [39].”
Vanderkruik, R. C., Raffi, E. R., Freeman, M. P., Wales, R. A., & Cohen, L. S. (2021) · PLoS ONE · doi:10.1371/journal.pone.0257065 · Cited by 11 · see citing works
Sensitivity Training for Mothers With Premature Infants: A Randomized Controlled Trial
Yu, N. K. K., Shum, K. K., Lam, Y. Y., Kwan, Q. K. L., Ng, S. Y. P., & Chan, N. T. T. (2022) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsac051 · Cited by 8 · see citing works
Fang, L.-Z., Ye, S., Sun, G., Liu, L., Xie, S.-Y., Hu, Y., Yang, Y., Fang, M.-R., & Hu, Z.-Y. (2023) · Psychology, Health & Medicine · doi:10.1080/13548506.2023.2208366 · Cited by 8 · see citing works
Negeri, Z., Levis, B., Ioannidis, J. P. A., Thombs, B. D., Benedetti, A., the DEPRESsion Screening Data (DEPRESSD) EPDS Group, Sun, Y., He, C., Krishnan, A., Wu, Y., et al. (2024) · BMC Medical Research Methodology · doi:10.1186/s12874-023-02134-w · Cited by 6 · see citing works
“A PROSPERO registration (CRD42015024785) and a published protocol [22] were available for the original IPDMA.”
MethodSelf-citationPerinatal depression screening in Australia: A position paper
Raine, K. H., Thorpe, K. J., & Boyce, P. M. (2020) · Nursing and Health Sciences · doi:10.1111/nhs.12793 · Cited by 6 · see citing works
Fatima, R., & Hania, A. (2022) · Psychiatria Danubina · doi:10.24869/psyd.2022.148 · Cited by 5 · see citing works
“As can be inferred in Table 1, the mean score for Edinburgh Depression Scale (M=11.08, Sd=5.94) was marginally higher than the normative mean from non-clinical sample (M=9.02, Sd=4.94) and the scores ranged between 0 to 27 (Thombs et al. 2015).”
ResultInfluentialPatterns of attentional bias in antenatal depression: an eye-tracking study
Xu, Y. Q., Zheng, P., Feng, W., Chen, L., Sun, S., Liu, J., Tang, W., Bao, C., Xu, L., Xu, D., et al. (2023) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2023.1288616 · Cited by 4 · see citing works
Children Exposed to IPV: Impact of Multiple Father Figures
Bullock, L., Ghazarian, S. R., Nimer, M., Signing, L., Herbell, K., Farje, D., Campbell, J. C., & Sharps, P. W. (2021) · Maternal and Child Health Journal · doi:10.1007/s10995-021-03184-6 · Cited by 4 · see citing works
Pourmirzaiee, M. A., Daniali, S. S., Riahi, R., Majidi, S., & Kelishadi, R. (2024) · International Journal of Preventive Medicine · doi:10.4103/ijpvm.ijpvm_30_24 · Cited by 3 · see citing works
“A score of 12 or higher indicates the presence of PPD. [20,21] Existing evidence supports the sufficient validity and reliability of the EPDS in the Iranian population for diagnosing PPD. [22] Information concerning maternal dietary supplements, including magnesium, was documented during the third…”
ResultMental Health Challenges in the Postpartum Period
Athanasiadi, A. (2025) · Obstetrics and gynecology. · doi:10.5772/intechopen.1008751 · Cited by 3 · see citing works
Lagatta, J. M., Malnory, M. E., Fischer, E. A., Davis, M., Radke-Connell, P., Weber, C., & Cohen, S. S. (2022) · Journal of Perinatology · doi:10.1038/s41372-021-01303-3 · Cited by 3 · see citing works
“In addition to discharge details from the infant’s health record, we recorded additional details from the health record to understand which families were using this pilot service; these details included inborn, gender, gestational age, birth weight, surgery during hospitalization, mechanical ventilation, length of sta…”
MethodPsychosocial experiences of pregnant and postpartum women living with HIV in Ibadan, Oyo State
Akinsolu, F. T., Lawale, A., Bankole, S., Adegbite, Z. O., Adewole, I. E., Abodunrin, O. R., Olagunju, M. T., Ola, O. M., Abel, C., Gambari, A. O., et al. (2025) · BMC Public Health · doi:10.1186/s12889-025-23534-1 · Cited by 2 · see citing works
“Eligible participants were pregnant and postpartum women living with HIV who also had elevated depressive symptoms, defined as an Edinburgh Postnatal Depression Scale (EPDS) [27] score of ≥ 13, and a self-reported history of partner conflict.”
Chala, A., Bala, E. T., Lemma, D., Tefera, E. G., & Amana, I. G. (2026) · Reproductive Health · doi:10.1186/s12978-026-02346-5 · Cited by 2 · see citing works
“The probable antenatal depression was assessed using the Edinburgh’s postnatal depression scale (EPDS) with a cut-off score ≥ 13, indicating elevated depressive symptoms [10].”
Yang, Z., Guo, X., Chen, X., & Huang, J. (2024) · PLoS ONE · doi:10.1371/journal.pone.0307332 · Cited by 2 · see citing works
“…scores for perinatal depression screening, with the primary objective of determining the diagnostic accuracy of EPDS in detecting major depressive disorder in pregnant and postpartum women among all potentially relevant cut-off scores, and to consider patient factors that may affect accuracy [19].”
MethodFetal exposures and maternal mental disorders in pregnancy: a network analysis
Lewis, A. J., Zanden, B. E. V., & Galbally, M. (2025) · Journal of Developmental Origins of Health and Disease · doi:10.1017/s2040174425100093 · Cited by 2 · see citing works
Integrating Behavioral Health into Primary Care for Women
Smith, J. P., Vaden, C., Smith, W., & Ketel, C. R. (2022) · Advances in Family Practice Nursing · doi:10.1016/j.yfpn.2021.12.004 · Cited by 1 · see citing works
Wu, Y., Sun, Y. B., Liu, Y., Levis, B., Krishnan, A., He, C., Neupane, D., Patten, S. B., Cuijpers, P. J., Ziegelstein, R. C., et al. (2023) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2023.08.006 · Cited by 1 · see citing works
Self-citationAnormalidades comportamentais no puerpério
Rennó, J., & Rocha, R. (2019) · Femina · doi:10.61622/0100-7254473201907
“(40,41) A EPDS é utilizada para triagem, portanto não define o diagnósti-co nem a gravidade da doença.”
Yoshida, K., Iwayama, M., Das, P., & Howard, L. M. (2020) · Mental health and illness worldwide · doi:10.1007/978-981-10-2348-4_26
Yoshida, K., Iwayama, M., Das, P., & Howard, L. M. (2020) · Mental health and illness worldwide · doi:10.1007/978-981-10-0753-8_26-1
Omisade, O., & Good, A. (2022) · International Journal of Applied Research on Public Health Management · doi:10.4018/ijarphm.315802
Negeri, Z., Levis, B., Ioannidis, J. P. A., Thombs, B. D., & Benedetti, A. (2024) · Figshare · doi:10.6084/m9.figshare.26675450
Self-citationBoran, P., Waqas, A., Aşkan, Ö. Ö., Topçu, İ., Dogan, T., & Rahman, A. (2020) · Figshare · doi:10.6084/m9.figshare.12731392
(2020) · Femina · doi:10.61622/0100-7254488202001
- Authors
- Thombs, B. D., Benedetti, A., Kloda, L. A., Levis, B., Riehm, K. E., Azar, M., Cuijpers, P., Gilbody, S., Ioannidis, J. P. A., McMillan, D., Patten, S. B., Shrier, I., Steele, R. J., Ziegelstein, R. C., Tonelli, M., Mitchell, N., Comeau, L., Schinazi, J., & Vigod, S.
- Affiliations
- Jewish General Hospital (CA)
- McGill University Health Centre (CA)
- McGill University (CA)
- Vrije Universiteit Amsterdam (NL)
- University of York (GB)
- Stanford Medicine (US)
- University of Calgary (CA)
- Johns Hopkins University (US)
- University of Alberta (CA)
- Institut National de Santé Publique du Québec (CA)
- University of Toronto (CA)
- Corresponding author
- Thombs, Brett D
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2015-10
- Volume
- 5
- Issue
- 10
- Pages
- e009742
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC4620163
- OpenAlex
- W1815828991
- Cited by
- 57
- References
- 79
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 7 · 2023: 5 · 2022: 6 · 2021: 4 · 2020: 15 · 2019: 5 · 2018: 5 · 2017: 3 · 2016: 3
- FWCI
- 0.53
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- eScholarship@McGill (McGill) (submittedVersion, cc-by-nc)
- eScholarship@McGill (McGill) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Arthritis Society
- Canadian Institutes of Health Research (140994_1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- Edinburgh Postnatal Depression Scale, major depressive disorder, perinatal depression, postpartum depression, pregnancy, depression screening, diagnostic accuracy, cut-off values, individual patient data meta-analysis, screening tool validation
- MeSH terms
- Systematic Reviews as Topic, Major Depressive Disorder, Female, Humans, Mass Screening, Mental Health, Pregnancy, Pregnancy Complications, Psychiatric Status Rating Scales, Research Design, Meta-Analysis as Topic, Depression, Postpartum, Self Report
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
