Individual participant data meta-analysis to compare EPDS accuracy to detect major depression with and without the self-harm item
Authors: Qiu Xia , Wu Yin , Sun Ying , Levis Brooke , Tian Jizhou , Boruff Jill T. , Cuijpers Pim , Ioannidis John P. A. , Markham Sarah , Ziegelstein Roy C. , Vigod Simone N. , Benedetti Andrea , Thombs Brett D. ,   the DEPRESsion Screening Data (DEPRESSD) EPDS Group, He Chen , Krishnan Ankur , Bhandari Parash Mani , Neupane Dipika , Negeri Zelalem , Imran Mahrukh , Rice Danielle B. , Azar Marleine , Chiovitti Matthew J. , Gilbody Simon , Kloda Lorie A. , Patten Scott B. , Mitchell Nicholas D. , Alvarado Rubén , Barnes Jacqueline , Beck Cheryl Tatano , Bindt Carola , Correa Humberto , Couto Tiago Castro e , Chorwe-Sungani Genesis , Eapen Valsamma , Favez Nicolas , Felice Ethel , Fellmeth Gracia , Fernandes Michelle , Field Sally , Figueiredo Barbara , Fisher Jane R. W. , Green Eric P. , Honikman Simone , Howard Louise M. , Kettunen Pirjo A. , Kohlhoff Jane , Kozinszky Zoltán , Leonardou Angeliki A. , Maes Michael , Martínez Pablo , Radoš Sandra Nakić , Nishi Daisuke , Pawlby Susan J. , Rochat Tamsen J. , Rowe Heather J. , Sharp Deborah J. , Skalkidou Alkistis , Smith-Nielsen Johanne , Stein Alan , Su Kuan-Pin , Sundström-Poromaa Inger , Tadinac Meri , Tandon S. Darius , Tendais Iva , Töreki Annamária , Tran Thach D. , Trevillion Kylee , Turner Katherine , Væver Mette S. , van Heyningen Thandi , Vega-Dienstmaier Johann M. , Wynter Karen , Yonkers Kimberly A. 
Published: March 2023

Item 10 of the Edinburgh Postnatal Depression Scale (EPDS) is intended to assess thoughts of intentional self-harm but may also elicit concerns about accidental self-harm. It does not specifically address suicide ideation but, nonetheless, is sometimes used as an indicator of suicidality. The 9-item version of the EPDS (EPDS-9), which omits item 10, is sometimes used in research due to concern about positive endorsements of item 10 and necessary follow-up. We assessed the equivalence of total score correlations and screening accuracy to detect major depression using the EPDS-9 versus full EPDS among pregnant and postpartum women. We searched Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science from database inception to October 3, 2018 for studies that administered the EPDS and conducted diagnostic classification for major depression based on a validated semi-structured or fully structured interview among women aged 18 or older during pregnancy or within 12 months of giving birth. We conducted an individual participant data meta-analysis. We calculated Pearson correlations with 95% prediction interval (PI) between EPDS-9 and full EPDS total scores using a random effects model. Bivariate random-effects models were fitted to assess screening accuracy. Equivalence tests were done by comparing the confidence intervals (CIs) around the pooled sensitivity and specificity differences to the equivalence margin of δ = 0.05. Individual participant data were obtained from 41 eligible studies (10,906 participants, 1407 major depression cases). The correlation between EPDS-9 and full EPDS scores was 0.998 (95% PI 0.991, 0.999). For sensitivity, the EPDS-9 and full EPDS were equivalent for cut-offs 7–12 (difference range − 0.02, 0.01) and the equivalence was indeterminate for cut-offs 13–15 (all differences − 0.04). For specificity, the EPDS-9 and full EPDS were equivalent for all cut-offs (difference range 0.00, 0.01). The EPDS-9 performs similarly to the full EPDS and can be used when there are concerns about the implications of administering EPDS item 10.

Trial registration: The original IPDMA was registered in PROSPERO (CRD42015024785).