Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden.
Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
Acta Obstet Gynecol Scand. 2024 Mar;103(3):423-436. doi: 10.1111/aogs.14734. Epub 2023 Nov 28.
Depression and anxiety are significant contributors to maternal perinatal morbidity and a range of negative child outcomes. This systematic review and meta-analysis aimed to review and assess the diagnostic test accuracy of selected screening tools (Edinburgh Postnatal Depression Scale [EPDS], EPDS-3A, Patient Health Questionnaire [PHQ-9]-, PHQ-2, Matthey Generic Mood Question [MGMQ], Generalized Anxiety Disorder scale [GAD-7], GAD-2, and the Whooley questions) used to identify women with antenatal depression or anxiety in Western countries.
On January 16, 2023, we searched 10 databases (CINAHL, Cochrane Library, CRD Database, Embase, Epistemonikos, International HTA Database, KSR Evidence, Ovid MEDLINE, PROSPERO and PsycINFO); the references of included studies were also screened. We included studies of any design that compared case-identification with a relevant screening tool to the outcome of a diagnostic interview based on the Diagnostic and Statistical Manual of Mental Disorders, fourth or fifth edition (DSM-IV or DSM-5), or the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Diagnoses of interest were major depressive disorder and anxiety disorders. Two authors independently screened abstracts and full-texts for relevance and evaluated the risk of bias using QUADAS-2. Data extraction was performed by one person and checked by another team member for accuracy. For synthesis, a bivariate model was used. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).
PROSPERO CRD42021236333.
We screened 8276 records for eligibility and included 16 original articles reporting on diagnostic test accuracy: 12 for the EPDS, one article each for the GAD-2, MGMQ, PHQ-9, PHQ-2, and Whooley questions, and no articles for the EPDS-3A or GAD-7. Most of the studies had moderate to high risk of bias. Ten of the EPDS articles provided data for synthesis at cutoffs ≥10 to ≥14 for diagnosing major depressive disorder. Cutoff ≥10 gave the optimal combined sensitivity (0.84, 95% confidence interval [CI]: 0.75-0.90) and specificity (0.87, 95% CI: 0.79-0.92).
Findings from the meta-analysis suggest that the EPDS alone is not perfectly suitable for detection of major depressive disorder during pregnancy. Few studies have evaluated the other instruments, therefore, their usefulness for identification of women with depression and anxiety during pregnancy remains very uncertain. At present, case-identification with any tool may best serve as a complement to a broader dialogue between healthcare professionals and their patients.
抑郁和焦虑是导致孕产妇围产期发病率升高和一系列负面儿童结局的重要因素。本系统评价和荟萃分析旨在综述和评估选定筛查工具（爱丁堡产后抑郁量表[EPDS]、EPDS-3A、患者健康问卷[PHQ-9]、PHQ-2、Matthey 通用情绪问卷[MGMQ]、广泛性焦虑症量表[GAD-7]、GAD-2 和 Whooley 问题）在识别西方国家产前抑郁或焦虑女性方面的诊断准确性。
2023 年 1 月 16 日，我们检索了 10 个数据库（CINAHL、Cochrane 图书馆、CRD 数据库、Embase、Epistemonikos、国际卫生技术评估数据库、KSR 证据、Ovid MEDLINE、PROSPERO 和 PsycINFO）；还对纳入研究的参考文献进行了筛选。我们纳入了任何设计的研究，这些研究将基于《精神障碍诊断与统计手册》第四或第五版（DSM-IV 或 DSM-5）或《国际疾病分类和相关健康问题第十版》（ICD-10）的相关筛查工具与诊断访谈结果进行病例识别的比较。感兴趣的诊断包括重度抑郁症和焦虑症。两名作者独立筛选摘要和全文的相关性，并使用 QUADAS-2 评估偏倚风险。由一名人员进行数据提取，另一名团队成员检查准确性。对于综合分析，使用双变量模型。使用推荐评估、制定与评价（GRADE）评估证据的确定性。
PROSPERO CRD42021236333。
我们筛选了 8276 份符合条件的记录，并纳入了 16 篇原始文章，报告了诊断准确性：12 篇关于 EPDS 的文章，一篇关于 GAD-2、MGMQ、PHQ-9、PHQ-2 和 Whooley 问题的文章，没有关于 EPDS-3A 或 GAD-7 的文章。大多数研究存在中度至高度偏倚风险。10 篇 EPDS 文章提供了≥10 至≥14 截断值用于诊断重度抑郁症的综合数据。截断值≥10 给出了最佳的综合敏感性（0.84，95%置信区间[CI]：0.75-0.90）和特异性（0.87，95% CI：0.79-0.92）。
荟萃分析结果表明，单独使用 EPDS 并不完全适合在怀孕期间检测重度抑郁症。很少有研究评估了其他工具，因此，它们在识别怀孕期间患有抑郁和焦虑的女性方面的有效性仍然非常不确定。目前，使用任何工具进行病例识别最好作为医疗保健专业人员与其患者之间更广泛对话的补充。
