Methods to identify postnatal depression in primary care: an integrated evidence synthesis and value of information analysis
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OBJECTIVES: To provide an overview of methods to identify postnatal depression (PND) in primary care and to assess their validity, acceptability, clinical effectiveness and cost-effectiveness, to model estimates of cost, to assess whether any method meets UK National Screening Committee (NSC) criteria and to identify areas for future research. DATA SOURCES: Searches of 20 electronic databases (including MEDLINE, CINAHL, PsycINFO, EMBASE, CENTRAL, DARE and CDSR), forward citation searching, personal communication with authors and searching of reference lists. REVIEW METHODS: A generalised linear mixed model approach to the bivariate meta-analysis was undertaken for the validation review with quality assessment using QUADAS. Within the acceptability review, a textual narrative approach was employed to synthesise qualitative and quantitative research evidence. For the clinical and cost-effectiveness reviews methods outlined by the Centre for Reviews and Dissemination and the Cochrane Collaboration were followed. Probabilistic models were developed to estimate the costs associated with different identification strategies. RESULTS: The Edinburgh Postnatal Depression Scale (EPDS) was the most frequently explored instrument across all of the reviews. In terms of test performance, postnatally the EPDS performed reasonably well: sensitivity ranged from 0.60 (specificity 0.97) to 0.96 (specificity 0.45) for major depression only; from 0.31 (specificity 0.99) to 0.91 (specificity 0.67) for major or minor depression; and from 0.38 (specificity 0.99) to 0.86 (specificity 0.87) for any psychiatric disorder. Evidence from the acceptability review indicated that, in the majority of studies, the EPDS was acceptable to women and health-care professionals when women were forewarned of the process, when the EPDS was administered in the home, with due attention to training, with empathetic skills of the health visitor and due consideration to positive responses to question 10 about self-harm. Suggestive evidence from the clinical effectiveness review indicated that use of the EPDS, compared with usual care, may lead to reductions in the number of women with depression scores above a threshold. In the absence of existing cost-effectiveness studies of PND identification strategies, a decision-analytic model was developed. The results of the base-case analysis suggested that use of formal identification strategies did not appear to represent value for money, based on conventional thresholds of cost-effectiveness used in the NHS. However, the scenarios considered demonstrated that this conclusion was primarily driven by the costs of false positives assumed in the base-case model. CONCLUSIONS: In light of the results of our evidence synthesis and decision modelling we revisited the examination of PND screening against five of the NSC criteria. We found that the accepted criteria for a PND screening programme were not currently met. The evidence suggested that there is a simple, safe, precise and validated screening test, in principle a suitable cut-off level could be defined and that the test is acceptable to the population. Evidence surrounding clinical and cost-effectiveness of methods to identify PND is lacking. Further research should aim to identify the optimal identification strategy, in terms of key psychometric properties for postnatal populations. In particular, research comparing the performance of the Whooley and help questions, the EPDS and a generic depression measure would be informative. It would also be informative to identify the natural history of PND over time and to identify the clinical effectiveness of the most valid and acceptable method to identify postnatal depression. Further research within a randomised controlled trial would provide robust estimates of the clinical effectiveness.
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The 10-item EPDS is the most commonly used depression screening tool in perinatal care.
“The 10 item EPDS is the most commonly used depression screening tool in perinatal care; cut-off values of 10 or higher and 13 or higher are most often used to identify women who might have depression.11 12 13 14 15”
The existing meta-analysis did not pool results for pregnant women because there were too few studies, and no subgroup analyses were conducted among postpartum women because primary studies did not report the necessary data.
“The results were not pooled for pregnant women because there were too few studies, and no subgroup analyses were conducted among postpartum women because primary studies did not report the necessary data.”
An existing meta-analysis found that combined sensitivity and specificity to detect major depression in postpartum women was greater for an EPDS cut-off value of 12 or higher than for cut-off values of 10 or higher or 13 or higher.
“An existing meta-analysis that has examined EPDS screening accuracy searched databases through February 2007 and found that combined sensitivity and specificity to detect major depression in postpartum women was greater for a cut-off value of 12 or higher (sensitivity 0.86, specificity 0.87, 15 studies) than for a cut-off value of 10 or higher (sensitivity 0.92, specificity 0.77, 14 studies) or 13”
EPDS cut-off values of 10 or higher and 13 or higher are most often used to identify women who might have depression.
“The 10 item EPDS is the most commonly used depression screening tool in perinatal care; cut-off values of 10 or higher and 13 or higher are most often used to identify women who might have depression.11 12 13 14 15”
The previous EPDS meta-analysis did not pool results for pregnant women because too few studies were found, and no subgroup analyses were conducted among postpartum women because primary studies did not report the necessary data.
“The previous meta-analysis did not pool results for pregnant women because too few studies were found, and no subgroup analyses were conducted among postpartum women because primary studies did not report the necessary data”
The previous EPDS meta-analysis, being a conventional meta-analysis of published results only, was not able to incorporate results for all key cut-off values from all included studies because they were not consistently published.
“A previous meta-analysis of the EPDS, which was a conventional meta-analysis and only included published results, was not able to incorporate results for all key cut-off values from all included studies because they were not consistently published.”
Differences in results between the current IPDMA and the previous meta-analysis might have occurred because the current IPDMA consisted of 58 primary studies, including 36 with a semi-structured reference standard, versus 21 primary studies with various types of reference standards in the previous meta-analysis.
“Differences in results between the current IPDMA and the previous meta-analysis might have occurred because the current IPDMA consisted of 58 primary studies, including 36 with a semi-structured reference standard, versus 21 primary studies with various types of reference standards in the previous meta-analysis.”
Based on studies with a semi-structured reference standard, across cut-off values of 10-13, sensitivity estimates in the present IPDMA were 6-13% lower than those in the previous meta-analysis, whereas specificity estimates were 4-7% higher.
“Based on studies with a semi-structured reference standard, across cut-off values of 10-13, sensitivity estimates in the present IPDMA were 6-13% lower than those in the previous meta-analysis, whereas specificity estimates were 4-7% higher.”
The cut-off value of 11 or higher that maximised combined sensitivity and specificity in the present study is lower than both the most commonly used cut-off value of 13 or higher and the cut-off value of 12 or higher that maximised combined sensitivity and specificity in a previous EPDS accuracy meta-analysis.
“The cut-off value of 11 or higher that maximised combined sensitivity and specificity in the present study is lower than both the most commonly used cut-off value of 13 or higher13 and the cut-off value of 12 or higher that maximised combined sensitivity and specificity in a previous EPDS accuracy meta-analysis.13”
A previous meta-analysis of the screening accuracy of the EPDS, conducted more than 13 years ago, found that a cut-off value of 12 or higher maximised combined sensitivity and specificity in postpartum women (21 studies).
“A previous meta-analysis of the screening accuracy of the EPDS, which was conducted more than 13 years ago, found that a cut-off value of 12 or higher maximised combined sensitivity and specificity in postpartum women (21 studies)”
The study analysed data from more than twice the number of studies compared with the previous conventional meta-analysis and included results for all cut-off values from all studies.
“Strengths include analysis of data from more than twice the number of studies compared with the previous conventional meta-analysis,13 and including results for all cut-off values from all studies.”
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Kroenke, K., Spitzer, R. L., Williams, J. B. W., & Löwe, B. (2010) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2010.03.006 · Cited by 4,057 · see citing works
Mosca, L., Benjamin, E. J., Berra, K., Bezanson, J. L., Dolor, R. J., Lloyd-Jones, D. M., Newby, L. K., Piña, I. L., Roger, V. L., Shaw, L. J., et al. (2011) · Circulation · doi:10.1161/cir.0b013e31820faaf8 · Cited by 2,143 · 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 · 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
Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update
Mosca, L. J., Benjamin, E. J., Berra, K. A., Bezanson, J. L., Dolor, R. J., Lloyd‐Jones, D. M., Newby, L. K., Piña, I. L., Roger, V. L., Shaw, L. J., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.02.005 · Cited by 783 · see citing works
Validation of the Edinburgh Depression Scale during pregnancy
Bergink, V., Kooistra, L., Lambregtse-van den Berg, M. P., Wijnen, H., Bunevicius, R., van Baar, A., & Pop, V. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.07.008 · Cited by 601 · see citing works
“Generalizability may not be an issue, however, since the EDS has been validated in over 30 languages [31].”
BackgroundInfluentialPearson, R. M., Evans, J., Kounali, D., Lewis, G., Heron, J., Ramchandani, P. G., O’Connor, T. G., & Stein, A. (2013) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.2163 · Cited by 589 · see citing works
van Ginneken, N., Tharyan, P., Lewin, S., Rao, G. N., Meera, S., Pian, J., Chandrashekar, S., & Patel, V. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009149.pub2 · Cited by 575 · see citing works
O’Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016) · JAMA · doi:10.1001/jama.2015.18948 · Cited by 563 · see citing works
Lifetime costs of perinatal anxiety and depression
Bauer, A., Knapp, M., & Parsonage, M. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.12.005 · Cited by 382 · see citing works
Classification of Heart Failure in the Atherosclerosis Risk in Communities (ARIC) Study
Rosamond, W. D., Chang, P. P., Baggett, C. D., Johnson, A. M., Bertoni, A. G., Shahar, E., Deswal, A. M., HEISS, G. M., & Chambless, L. E. (2012) · Circulation Heart Failure · doi:10.1161/circheartfailure.111.963199 · Cited by 350 · see citing works
Postpartum psychiatric disorders
Meltzer-Brody, S., Howard, L. M., Bergink, V., Vigod, S., Jones, I., Munk-Olsen, T., Honikman, S., & Milgrom, J. (2018) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2018.22 · Cited by 357 · see citing works
Economic evaluation alongside randomised controlled trials: design, conduct, analysis, and reporting
Petrou, S., & Gray, A. (2011) · British medical journal · doi:10.1136/bmj.d1548 · Cited by 313 · see citing works
Thygesen, K. A., Mair, J. M., Mueller, C. E., Huber, K., Weber, M. A., Plebani, M., Hasin, Y., Biasucci, L. M., Giannitsis, E., Lindahl, B., et al. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehq509 · Cited by 274 · see citing works
Milgrom, J., Danaher, B. G., Gemmill, A. W., Holt, C., Holt, C. J., Seeley, J. R., Tyler, M. S., Ross, J., & Ericksen, J. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.4993 · Cited by 221 · see citing works
“The performance and psychometric properties of both generic and perinatal-specific depression measures used in the context of perinatal populations have been recently reviewed and were the subject of a full health technology report in 2009 [42,43].”
Screening for perinatal depression
Milgrom, J., & Gemmill, A. W. (2014) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2013.08.014 · Cited by 232 · see citing works
Rose, D. S., Trevillion, K., Woodall, A., Morgan, C., Feder, G. S., & Howard, L. M. (2010) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.109.072389 · Cited by 236 · see citing works
Rozé, J., Darmaun, D., Boquien, C., Flamant, C., Picaud, J., Savagner, C., Claris, O., Lapillonne, A., Mitanchez, D., Branger, B., et al. (2012) · BMJ Open · doi:10.1136/bmjopen-2012-000834 · Cited by 227 · see citing works
Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial
Bleakley, C., O'Connor, S. R., Tully, M. A., Rocke, L. G., MacAuley, D., Bradbury, I., Keegan, S., & McDonough, S. (2010) · BMJ · doi:10.1136/bmj.c1964 · Cited by 225 · see citing works
Taking healthcare interventions from trial to practice
Glasziou, P., Chalmers, I., Altman, D. G., Bastian, H., Boutron, I., Brice, A., Jamtvedt, G., Farmer, A., Ghersi, D., Groves, T., et al. (2010) · BMJ · doi:10.1136/bmj.c3852 · Cited by 209 · see citing works
Cano, S., Posner, H. B., Moline, M. L., Hurt, S. W., Swartz, J., Hsu, T., & Hobart, J. (2010) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2009.204008 · Cited by 208 · see citing works
Alderdice, F., McNeill, J., & Lynn, F. (2013) · Midwifery · doi:10.1016/j.midw.2012.05.010 · Cited by 194 · see citing works
den Berg, A. I. V. D. Z.-V., Boere‐Boonekamp, M. M., Groothuis‐Oudshoorn, C. G. M., & Reijneveld, S. A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.02.062 · Cited by 191 · see citing works
“160 and major depression) based on the pooled data of Hewitt et al (Hewitt et al., 2009).”
MethodRisk of Hip/Femur Fracture After Stroke: A Population-Based Case-Control Study
Pouwels, S., Lalmohamed, A., Leufkens, B., de Boer, A., Cooper, C., van Staa, T. V., & de Vries, F. (2009) · Stroke · doi:10.1161/strokeaha.109.554055 · Cited by 170 · see citing works
O’Mahen, H., Karl, A., Moberly, N. J., & Fedock, G. L. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.11.028 · Cited by 167 · see citing works
“In keeping with recommendations, we used of a cut-off of 12 for detecting depression (Hewitt et al., 2009).”
MethodBee, P., Bower, P., Byford, S., Churchill, R. C., Calam, R. M., Stallard, P. N., Pryjmachuk, S., Berzins, K. M., Cary, M., Wan, M. W., et al. (2014) · Health Technology Assessment · doi:10.3310/hta18080 · Cited by 165 · see citing works
Shun-Shin, M. J., Thompson, M., Heneghan, C. J., Perera, R., Harnden, A., & Mant, D. (2009) · BMJ · doi:10.1136/bmj.b3172 · Cited by 164 · see citing works
Szarewski, A., Mesher, D., Cadman, L., Austin, J., Ashdown-Barr, L., Ho, L., Terry, G., Liddle, S., Young, M., Stoler, M. H., et al. (2012) · Journal of Clinical Microbiology · doi:10.1128/jcm.00181-12 · Cited by 161 · see citing works
Ten steps towards improving prognosis research
Hemingway, H., Riley, R. D., & Altman, D. G. (2009) · BMJ · doi:10.1136/bmj.b4184 · Cited by 160 · see citing works
Changes in brain morphology in patients with obstructive sleep apnoea
Morrell, M. J., Jackson, M. L., Twigg, G. L., Ghiassi, R., McRobbie, D. W., Quest, R. A., Pardoe, H., Pell, G. S., Abbott, D. F., Rochford, P. D., et al. (2010) · Thorax · doi:10.1136/thx.2009.126730 · Cited by 156 · see citing works
Morrell, C. J., Sutcliffe, P., Booth, A., Stevens, J., Scope, A., Stevenson, M., Harvey, R., Bessey, A., Cantrell, A., Dennis, C.-L., et al. (2016) · Health Technology Assessment · doi:10.3310/hta20370 · Cited by 155 · see citing works
“l Two evaluated screening for PND.(45,56) l One focused on the impact on health visitors’ time before and after they were given training in cognitive–behavioural counselling.”
BackgroundMethodInfluentialSelf-citationGerhards, S. A. H., de Graaf, L. E., Jacobs, L. E., Severens, J. L., Huibers, M. J. H., Arntz, A., Riper, H., Widdershoven, G., Metsemakers, J. F. M., & Evers, S. M. A. A. (2010) · British Journal of Psychiatry · doi:10.1192/bjp.bp.109.065748 · Cited by 135 · see citing works
Zhong, Q., Gelaye, B., Rondon, M., E. Sánchez, S., J. García, P., Sánchez, E., V. Barrios, Y., E. Simon, G., C. Henderson, D., May Cripe, S., et al. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.03.028 · Cited by 140 · see citing works
“The timing of assessment may impact the prevalence rate of depression (Hewitt et al., 2009).”
BackgroundValue of information analysis: the state of application
Keisler, J. M., Collier, Z. A., Chu, E., Sinatra, N., & Linkov, I. (2013) · Environment Systems & Decisions · doi:10.1007/s10669-013-9439-4 · Cited by 137 · see citing works
Shakeel, N., Eberhard-Gran, M., Sletner, L., Slinning, K., Martinsen, E., Holme, I., & Jenum, A. (2015) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-014-0420-0 · Cited by 117 · see citing works
“This measure is now the most frequently used screening instrument in epidemiological studies related to depression in pregnancy and postpartum [35].”
MethodLevis, B., Yan, X. W., He, C., Sun, Y., Benedetti, A., & Thombs, B. D. (2019) · BMC Medicine · doi:10.1186/s12916-019-1297-6 · Cited by 137 · see citing works
Screening for postnatal depression in primary care: cost effectiveness analysis
Paulden, M., Palmer, S., Hewitt, C. E., & Gilbody, S. M. (2009) · BMJ · doi:10.1136/bmj.b5203 · Cited by 131 · see citing works
Self-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
“[27,28] , 2013 AHRQ Review [2] b Depression”
BackgroundMethodInfluentialSelf-citationThombs, 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 · see citing works
“Other meta-analyses [45-47] have examined results from multiple cutoffs but have similarly been limited to using published accuracy outcomes for each cutoff.”
MethodSelf-citationTikotzky, L. (2014) · Behavioral Sleep Medicine · doi:10.1080/15402002.2014.940111 · Cited by 121 · see citing works
“This rate is comparable to rates seen among similarly postpartum women assessed by the EPDS (Eberhard-Gran, Tambs, Opjordsmoen, Skrondal, & Eskild, 2004; Gorman et al., 2004; Heron, O’Connor, Evans, Golding, & Glover, 2004; Hewitt et al., 2009).”
ResultDevelopment of the Tilburg Pregnancy Distress Scale: the TPDS
Pop, V. J. M., Pommer, A. M., Pop‐Purceleanu, M., Wijnen, H. A. A., Bergink, V., & Pouwer, F. (2011) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-11-80 · Cited by 114 · see citing works
“As recently reviewed, the vast majority of measures used to assess psychological functioning in pregnant women to date were originally developed to detect depression and anxiety symptoms in general or during the postpartum period [9].”
InfluentialBrugha, T. S., Morrell, C. J., Slade, P., & Walters, S. J. (2011) · Psychological Medicine · doi:10.1017/s0033291710001467 · Cited by 111 · see citing works
“The EPDS is a widely used self-report measure to identify women at risk of postnatal depression (PND) with good evidence of sensitivity and specificity (Gibson et al. 2009 ; Hewitt et al. 2009) and a score ranging from 0 to 30, consisting of eight depression and two anxiety items.”
MethodThombs, 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
“36 The authors of another noted the possibility of a “disease progression bias” in one study of patients after stroke and indicated that none of the other 11 studies reviewed had limitations related to composition of patients.”
Thombs, 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
“However, these recommendations are controversial [57,58] and not supported by evidence of benefit from RCTs [59-62].”
BackgroundThe role of diet and nutritional supplementation in perinatal depression: a systematic review
Sparling, T. M., Henschke, N., Nesbitt, R., & Gabrysch, S. (2016) · Maternal and Child Nutrition · doi:10.1111/mcn.12235 · Cited by 103 · see citing works
Ma, J., Wang, S., Yu, H., Li, D., Luo, S., Zheng, S., Wan, L., & Duan, K. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.03.026 · Cited by 99 · see citing works
Ross, L. E., McQueen, K., Vigod, S. N., & Dennis, C. (2010) · Human Reproduction Update · doi:10.1093/humupd/dmq025 · Cited by 97 · see citing works
“Although this approach has been criticized, the EPDS has relatively good sensitivity and specificity, particularly when used to detect both major and minor depression (Hewitt et al., 2009).”
MethodSharp, D., Chew-Graham, C. A., Tylee, A. T., Lewis, G., Howard, L. M., Anderson, I. M., Abel, K. M., Turner, K. M., Hollinghurst, S., Tallon, D., et al. (2010) · Health Technology Assessment · doi:10.3310/hta14430 · Cited by 97 · see citing works
Brealey, S., Hewitt, C. E., Green, J. M., Morrell, J., & Gilbody, S. M. (2010) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2010.513045 · Cited by 97 · see citing works
“Against this background, a programme of research was undertaken that systematically reviewed the validity (in terms of key psychometric properties), acceptability, clinical effectiveness and cost effectiveness of identification methods for PND (Hewitt et al., 2009).”
MethodSelf-citationPrevalence and predictors of postpartum depression in Riyadh, Saudi Arabia: A cross sectional study
Nasr, R. S. A., Altharwi, K., Derbah, M. S., Gharibo, S. O., Fallatah, S. A., Alotaibi, S. G., Almutairi, K. A., & Asdaq, S. M. B. (2020) · PLoS ONE · doi:10.1371/journal.pone.0228666 · Cited by 94 · see citing works
Carter, T., Bastounis, A., Guo, B., & Jane Morrell, C. (2019) · Archives of Women's Mental Health · doi:10.1007/s00737-018-0869-3 · Cited by 92 · see citing works
Improving perinatal depression care: the Massachusetts Child Psychiatry Access Project for Moms
Byatt, N., Biebel, K., Moore Simas, T. A., Sarvet, B., Ravech, M., Allison, J., & Straus, J. (2016) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2016.03.002 · Cited by 91 · see citing works
“treatment rates or patient outcomes [11-15].”
Hachem, C. E., Rohayem, J., Khalil, R. B., Richa, S., Kesrouani, A. K., Gemayel, R., Aouad, N., Hatab, N., Zaccak, E., Yaghi, N., et al. (2014) · BMC Psychiatry · doi:10.1186/s12888-014-0242-7 · Cited by 89 · see citing works
“In the absence of treatment, PPD can lead to chronic depression, disturbances in the interaction between the mother and her newborn and suicide as well as infanticide in rare cases [3].”
BackgroundNeuraminidase inhibitors--the story behind the Cochrane review
Doshi, P. (2009) · BMJ · doi:10.1136/bmj.b5164 · Cited by 86 · see citing works
Flynn, H. A., Sexton, M. B., Ratliff, S. M., Porter, K. E., & Zivin, K. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2010.10.022 · Cited by 85 · see citing works
“The 10-item EPDS is currently among themost commonly used and studied perinatal depression screening tools worldwide (Boyd et al., 2005; Hewitt et al., 2009).”
InfluentialA systematic review on the acceptability of perinatal depression screening
El‐Den, S., O’Reilly, C. L., & Chen, T. F. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.06.015 · Cited by 81 · see citing works
“Two prior publications (Brealey et al., 2010; Hewitt et al., 2009) on the acceptability of screening for perinatal depression have been identified.”
BackgroundFirst-time mothers’ confidence mood and stress in the first months postpartum. A cohort study
Kristensen, I. H., Simonsen, M., Trillingsgaard, T., Pontoppidan, M., & Kronborg, H. (2018) · Sexual & Reproductive Healthcare · doi:10.1016/j.srhc.2018.06.003 · Cited by 80 · see citing works
Factor structure of the Edinburgh Postnatal Depression Scale in a population-based sample.
Coates, R., Ayers, S., & de Visser, R. O. (2016) · Psychological Assessment · doi:10.1037/pas0000397 · Cited by 80 · see citing works
“Interventions can ease symptoms and improve wellbeing of mothers (Dennis & Hodnett, 2007); however, effective treatment is hampered by low levels of identification of perinatal mental illness with 50% of women with depression and anxiety not identified (Hewitt et al., 2009).”
A history of mental health problems may predict maternal distress in women postpartum
Seimyr, L., Welles‐Nyström, B., & Nissen, E. (2012) · Midwifery · doi:10.1016/j.midw.2011.11.013 · Cited by 78 · see citing works
“The diagnosis of postpartum depression is described in relation to time that has passed after childbirth (Condon, 2010; Hewitt et al., 2009).”
BackgroundDimidjian, S., & Goodman, S. H. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.11.008 · Cited by 75 · see citing works
“measure of depressive symptoms among postnatal women (Hewitt et al., 2009) and has good psychometric properties and clear guidelines regarding clinical cutoffs among pregnant and postnatal women (Matthey, Henshaw, Elliot, & Barrnet, 2006).”
BackgroundFord, E. M., Shakespeare, J., Elias, F., & Ayers, S. (2016) · Family Practice · doi:10.1093/fampra/cmw101 · Cited by 72 · see citing works
“Well-validated screening tools exist for perinatal depression, which have been used in primary care populations (15,43,44), but a majority of GPs are not using these particular tools routinely (36,45).”
Prevention of Overweight/Obesity as a Strategy to Optimize Cardiovascular Health
Cornier, M., Marshall, J. A., Hill, J. O., Maahs, D. M., & Eckel, R. H. (2011) · Circulation · doi:10.1161/circulationaha.110.968461 · Cited by 74 · see citing works
Van Lieshout, R. J., Layton, H., Savoy, C. D., Brown, J. S. L., Ferro, M. A., Streiner, D. L., Bieling, P. J., Feller, A., & Hanna, S. (2021) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2021.2488 · Cited by 73 · see citing works
Long-term outcomes of participants in a perinatal depression early detection program
Reay, R. E., Matthey, S., Ellwood, D. A., & Scott, M. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.07.035 · Cited by 73 · see citing works
Engineer, N., Darwin, L., Deole, N., Kandala, N., Smith, S. C., & Grammatopoulos, D. K. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2013.05.003 · Cited by 73 · see citing works
“This reported performance characteristics at this cut-off point is: sensitivity of 0.81 and specificity of 0.86 for detection of both major and minor depression and a sensitivity of 0.917 and specificity of 0.77 for major depression only (Hewitt et al., 2009).”
BackgroundInfluentialKelder, J. C., Cowie, M., McDonagh, T. A., Hardman, S. M. C., Grobbee, D. E., Cost, B., & Hoes, A. W. (2011) · Heart · doi:10.1136/hrt.2010.220426 · Cited by 73 · see citing works
Maternal and infant predictors of attendance at Neonatal Follow‐Up programmes
Ballantyne, M., Stevens, B., Guttmann, A., Willan, A. R., & Rosenbaum, P. (2013) · Child Care Health and Development · doi:10.1111/cch.12015 · Cited by 71 · see citing works
Gale, C., Santhakumaran, S., Nagarajan, S., Statnikov, Y., Modi, N., & on behalf of the Neonatal Data Analysis Unit and the Medicines for Neonates Investigator Group (2012) · BMJ · doi:10.1136/bmj.e2105 · Cited by 69 · see citing works
Darwin, Z. J., Domoney, J., Iles, J. E., Bristow, F., Siew, J., & Sethna, V. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.585479 · Cited by 69 · see citing works
Ingram, J., Taylor, H., Churchill, C., Pike, A., & Greenwood, R. (2011) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/archdischild-2011-300601 · Cited by 68 · see citing works
Postnatal women's experiences of management of depressive symptoms: a qualitative study
Slade, P., Morrell, C. J., Rigby-Brown, A., Ricci, K., Spittlehouse, J. K., & Brugha, T. S. (2010) · British Journal of General Practice · doi:10.3399/bjgp10x532611 · Cited by 67 · see citing works
Pope, C. J., Mazmanian, D. S., Bédard, M., & Sharma, V. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.04.014 · Cited by 66 · see citing works
Evans, K., Spiby, H., & Morrell, J. (2019) · Archives of Women's Mental Health · doi:10.1007/s00737-018-0936-9 · Cited by 51 · see citing works
Self-citationLyubenova, 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 10‐item Edinburgh Postnatal Depression Scale (EPDS) (Cox, Holden, & Sagovsky, 1987) is the most commonly used depression screening tool for women in pregnancy or postpartum (Hewitt et al., 2009; Howard et al., 2014).”
MethodSelf-citationEdvardsson, K., Garvare, R., Ivarsson, A., Eurenius, E., Mogren, I., & Nyström, M. E. (2011) · BMC Health Services Research · doi:10.1186/1472-6963-11-61 · Cited by 62 · see citing works
Real-Time PCR Assay Provides Reliable Assessment of Intrapartum Carriage of Group B Streptococcus
Alfa, M. J., Sepehri, S., Gagne, P. D., Helawa, M., Sandhu, G., & Harding, G. K. M. (2010) · Journal of Clinical Microbiology · doi:10.1128/jcm.00594-10 · Cited by 62 · see citing works
Zheng, X., Morrell, J., & Watts, K. (2018) · Midwifery · doi:10.1016/j.midw.2018.04.005 · Cited by 64 · see citing works
Self-citationStreetly, A., Latinovic, R., & Henthorn, J. S. (2010) · Journal of Clinical Pathology · doi:10.1136/jcp.2010.077560 · Cited by 61 · see citing works
Cost-effectiveness of interventions for perinatal anxiety and/or depression: a systematic review
Camacho, E. M., & Shields, G. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-022022 · Cited by 61 · see citing works
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., et al. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-009742 · Cited by 57 · 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-citationWilliamson, I., Benge, S., Barton, S., Petrou, S., Letley, L., Fasey, N., Haggard, M., & Little, P. (2009) · BMJ · doi:10.1136/bmj.b4984 · Cited by 57 · see citing works
Does postnatal depression screening work? Throwing out the bathwater, keeping the baby
Milgrom, J., Mendelsohn, J., & Gemmill, A. W. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.09.031 · Cited by 59 · see citing works
Zehbe, I., Moeller, H., Severini, A., Weaver, B., Escott, N. G., Bell, C., Crawford, S., Bannon, D., & Paavola, N. (2011) · BMJ Open · doi:10.1136/bmjopen-2010-000030 · Cited by 59 · see citing works
What is the most effective way to maintain weight loss in adults?
Simpson, S. A., Shaw, C., & McNamara, R. L. (2011) · BMJ · doi:10.1136/bmj.d8042 · Cited by 59 · see citing works
Novel strategies in newborn screening for cystic fibrosis: a prospective controlled study
Langen, A. M. M. V.-V., Loeber, J. G., Elvers, B., Triepels, R. H., Gille, J. J. P., van der Ploeg, C. P. B., Reijntjens, S., Dompeling, E., & Dankert-Roelse, J. E. (2012) · Thorax · doi:10.1136/thoraxjnl-2011-200730 · Cited by 59 · see citing works
Symptoms of depression in parents after discharge from NICU associated with family‐centred care
Axelin, A., Feeley, N., Campbell-Yeo, M. L., Tandberg, B. S., Szczapa, T., Wielenga, J. M., Weis, J., Bošnjak, A. P., Jónsdóttir, R. B., George, K., et al. (2021) · Journal of Advanced Nursing · doi:10.1111/jan.15128 · Cited by 59 · see citing works
“A review of measures to identify postpartum depression concluded the EPDS has good diagnostic performance (Hewitt et al., 2009 ).”
BackgroundScreening for Postpartum Depression in Well-Baby Care Settings: A Systematic Review
van der Zee-van den Berg, A. I., Boere-Boonekamp, M. M., IJzerman, M. J., Haasnoot-Smallegange, R. M. E., & Reijneveld, S. A. (2017) · Maternal and Child Health Journal · doi:10.1007/s10995-016-2088-8 · Cited by 57 · see citing works
Powell, R., Pattison, H. M., Bhoyar, A., Furmston, A., Middleton, L., DANIELS, J. P., & Ewer, A. K. (2012) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/fetalneonatal-2011-301225 · Cited by 57 · see citing works
Reilly, N. M., Kingston, D. E., Loxton, D. J., Talcevska, K., & Austin, M. (2019) · Women and Birth · doi:10.1016/j.wombi.2019.03.004 · Cited by 56 · see citing works
Nutrients and perinatal depression: a systematic review
Sparling, T. M., Nesbitt, R., Henschke, N., & Gabrysch, S. (2017) · Journal of Nutritional Science · doi:10.1017/jns.2017.58 · Cited by 53 · see citing works
“Various screening tools have been developed that show good reliability, sensitivity and specificity depending on the cut-off point, and have been adapted to many different languages and cultural contexts((57,58)).”
BackgroundSmith, M. S., Cairns, L., Pullen, L., Opondo, C., Fellmeth, G. L., & Alderdice, F. A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.11.011 · Cited by 54 · see citing works
Postpartum Depression: Screening, Diagnosis, and Management Programs 2000 through 2010
Yawn, B. P., Olson, A. L., Bertram, S. L., Pace, W. D., Wollan, P. C., & Dietrich, A. J. (2012) · Depression Research and Treatment · doi:10.1155/2012/363964 · Cited by 54 · see citing works
Prevalence and incidence of postnatal depression: what can systematic reviews tell us?
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Self-citationPostpartum depression screening by telephone: a good alternative for public health and research
de Figueiredo, F. P., Parada, A. P., Cardoso, V. C., Batista, R. F. L., da Sílva, A. A. M., Barbieri, M. A., Cavalli, R. D. C., Bettiol, H., & Del‐Ben, C. M. (2014) · Archives of Women s Mental Health · doi:10.1007/s00737-014-0480-1 · Cited by 54 · see citing works
“…an effective, low-cost, and broad screening procedure may impact the detection rates and treatment of suspected cases, thereby decreasing the negative consequences of postpartum depression (Gjerdingen and Yawn 2007; Kim et al. 2007; Hanusa et al. 2008; Hewitt et al. 2009; Clare and Yeh 2012).”
BackgroundMethodInfluentialLevis, 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
“We used data accrued for an IPDMA on the diagnostic accuracy of the EPDS, which is the most commonly used depression screening tool for women in pregnancy or postpartum (Hewitt et al., 2009).”
MethodSelf-citationKheirabadi, G. R., Maracy, M. R., Akbaripour, S., & Masaeli, N. (2012) · Europe PMC (PubMed Central) · Cited by 51 · see citing works
Therapeutic Acetaminophen Is Not Associated With Liver Injury in Children: A Systematic Review
Lavonas, E. J., Reynolds, K. M., & Dart, R. C. (2010) · PEDIATRICS · doi:10.1542/peds.2009-3352 · Cited by 51 · see citing works
Watson, J. M., Kang'ombe, A. R., Soares, M. O., Chuang, L., Worthy, G., Bland, M., Iglesias, C., Cullum, N. A., Torgerson, D. J., Nelson, E. A., et al. (2011) · BMJ · doi:10.1136/bmj.d1092 · Cited by 49 · see citing works
Causes of women׳s postpartum depression symptoms: Men׳s and women׳s perceptions
Habel, C., Feeley, N., Hayton, B. C., Bell, L., & Zelkowitz, P. (2015) · Midwifery · doi:10.1016/j.midw.2015.03.007 · Cited by 49 · see citing works
Yongmei, H., Hu, P., Zhang, Y., Lu, Q., Wang, D., Yin, L., Chen, Y., & Zou, X. (2014) · Brazilian Journal of Psychiatry · doi:10.1590/1516-4446-2013-1170 · Cited by 49 · see citing works
- Authors
- Hewitt, C., Gilbody, S., Brealey, S., Paulden, M., Palmer, S., Mann, R., Green, J., Morrell, J., Barkham, M., Light, K., & Richards, D.
- Affiliations
- University of York (GB)
- University of Sheffield (GB)
- Corresponding author
- Gilbody, S
- Venue
- Health Technology Assessment
- Published
- 2009-07
- Volume
- 13
- Issue
- 36
- Pages
- 1-145, 147
- ISSN
- 1366-5278 (ISSN-L)
- 2046-4924
- OpenAlex
- W2040040787
- Cited by
- 330
- References
- 243
- Citations by year
- 2026: 2 · 2025: 16 · 2024: 10 · 2023: 16 · 2022: 19 · 2021: 17 · 2020: 16 · 2019: 16 · 2018: 20 · 2017: 12 · 2016: 24 · 2015: 26 · 2014: 23 · 2013: 18 · 2012: 26
- FWCI
- 4.23
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Health Technology Assessment (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Health Technology Assessment programme (05/39/06)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- postpartum depression, Edinburgh Postnatal Depression Scale, screening, primary care, screening validity, acceptability, cost-effectiveness, value for money, decision-analytic model, maternal mental health, health visitors, clinical effectiveness, cost estimation, National Health Service
- MeSH terms
- Adult, Female, Humans, Primary Health Care, Depression, Postpartum, Evidence-Based Medicine, Diagnostic Techniques and Procedures
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