The DOI matches its Crossref record; 239 of the 243 references it cites were found in a registry or an index.
Methods to identify postnatal depression in primary care: an integrated evidence synthesis and value of information analysis
Open accessAbstract
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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In the citing paper
“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”
In the citing paper
“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.”
In the citing paper
“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”
In the citing paper
“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”
In the citing paper
“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”
In the citing paper
“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.”
In the citing paper
“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.”
In the citing paper
“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.”
In the citing paper
“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”
In the citing paper
“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)”
In the citing paper
“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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Effects of Mergers and Acquisitions on Financial Performance of Petroleum Companies in Kenya
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“A cut-off score of 11 or higher has been recommended (Levis et al., 2020), in place of the more commonly used cut-off of 13 or higher (Hewitt et al., 2009), as it maximises combined sensitivity (0.81) and specificity (0.88).”
InfluentialFæðingarþunglyndi. Endurmat á vinnuleiðbeiningum með EPDS kvarðanum
Guðmundsdóttir, A. K., & Bárðardóttir, H. H. (2011)
Perinatal Depressive Disorders
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Review: Maternal postadoption depression: theory refinement through qualitative content analysis
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“I note that other key authors have also used the EPDS, which is validated to screen for postnatal depression (Hewitt et al., 2009), with additional validated measures to add robustness, e.g. Senecky et al. (2009).”
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“Considering the serious consequences of postpartum depression, it is such a shame that the level of proper care and treatment is still below expectation [5].”
BackgroundLok, K. Y. W., Chow, C. L. Y., Tan, S. W., Smith, R. D., Lin, J., Kong, C. W., & Fong, D. (2020) · doi:10.21203/rs.3.rs-94450/v1
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Kulisewa, K., Dussault, J. M., Gaynes, B. N., Hosseinipour, M. C., Go, V. F., Kutengule, A., LeMasters, K. H., Meltzer-Brody, S. E., Midiani, D., Mphonda, S. M., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22604891
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Additional file 1 of A quantitative comparison of two measures of postpartum depression
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Metadata
- 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 › Medicine › Pediatrics, Perinatology and Child Health › 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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