Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Apr 19, 2020; 10(4): 71-80
Published online Apr 19, 2020. doi: 10.5498/wjp.v10.i4.71
Diagnostic accuracy and clinical utility of non-English versions of Edinburgh Post-Natal Depression Scale for screening post-natal depression in India: A meta-analysis
Paul Swamidhas Sudhakar Russell, Swetha Madhuri Chikkala, Richa Earnest, Shonima Aynipully Viswanathan, Sushila Russell, Priya Mary Mammen
Paul Swamidhas Sudhakar Russell, Swetha Madhuri Chikkala, Richa Earnest, Shonima Aynipully Viswanathan, Sushila Russell, Priya Mary Mammen, Child and Adolescent Psychiatry Unit, Department of Psychiatry, Christian Medical College, Vellore 632 002, India
Author contributions: Russell PSS and Chikkala SW contributed equally to this work; Russell PSS and Chikkala SM conceived and designed the study; Chikkala SM and Earnest R did the literature search and collected data; Russell S and Viswanathan SA extracted the data; Viswanathan SA and Mammen PM appraised the quality of the studies; Russell PSS resolved the conflicts in data synthesis; Russell PSS did the statistical analyses; all authors contributed to the writing and approval of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors prepared the research paper after reading the PRSIMA checklist 2009.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Paul Swamidhas Sudhakar Russell, MBBS, MD, Professor, Child and Adolescent Psychiatry Unit, Department of Psychiatry, Christian Medical College, Bagayam, Vellore 632 002, India. russell@cmcvellore.ac.in
Received: December 26, 2019
Peer-review started: December 26, 2019
First decision: February 19, 2020
Revised: March 3, 2020
Accepted: March 25, 2020
Article in press: March 25, 2020
Published online: April 19, 2020
Processing time: 112 Days and 12.6 Hours
Abstract
BACKGROUND

The prevalence of post-natal depression (PND) is high in India, as it is in many other low to middle income countries. There is an urgent need to identify PND and treat the mother as early as possible. Among the many paper and pencil tests available to identify PND, the Edinburgh Postnatal Depression Scale (EPDS) is a widely used and validated measure in India. However, the summary diagnostic accuracy and clinical utility data are not available for this measure.

AIM

To establish summary data for the global diagnostic accuracy parameter as well as the clinical utility of the non-English versions of the EPDS in India.

METHODS

Two researchers independently searched the PubMed, EMBASE, MEDKNOW and IndMED databases for published papers, governmental publications, conference proceedings and grey literature from 2000-2018. Seven studies that evaluated the diagnostic accuracy of EPDS in five Indian languages against DSM/ICD were included in the final analysis. Two other investigators extracted the Participants’ details, Index measures, Comparative reference measures, and Outcomes of diagnostic accuracy data, and appraised the study quality using QUADS-2. Deek’s plots were used to evaluate publication bias. We used the area under the curve of the hierarchical summary area under the receiver operating characteristic curve, with the random effect model, to summarize the global diagnostic accuracy of EPDS. Using the 2 × 2 table, we calculated positive and negative likelihood ratios. From the likelihood ratios, the Fagan’s nomogram was built for evaluating clinical utility using the Bayesian approach. We calculated the 95% confidence interval (95%CI) whenever indicated. STATA (version 15) with MIDAS and METANDI modules were used.

RESULTS

There was no publication bias. The area under the curve for EPDS was 0.97 (95%CI: 0.95-0.98). The pre-test probability for the nomogram was 22%. For a positive likelihood ratio of 9, the positive post-test probability was 72% (95%CI: 68%, 76%) and for a negative LR of 0.08, the negative post-test probability was 2% (95%CI: 1%, 3%).

CONCLUSION

In this meta-analysis, we established the summary global diagnostic parameter and clinical utility of the non-English versions of the EPDS in India. This work demonstrates that these non-English versions are accurate in their diagnosis of PND and can help clinicians in their diagnostic reasoning.

Keywords: Clinical-utility; Diagnostic-accuracy; Edinburgh Postnatal Depression Scale; Meta-analysis; India; Validation

Core tip: Post-natal depression (PND) affects both the mother and baby. Currently, although one of the most common psychiatric disorders among women, early identification and treatment is underprovided in low and middle-income countries. Paper-and-pencil tests remain the primary mode of identifying PND, and the Edinburgh Postnatal Depression Scale is widely used and validated in many languages in India. This meta-analysis documents that the diagnostic parameters are good for Edinburgh Postnatal Depression Scale in India, and that its use can significantly help to scale up the services for PND.