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Validated tools to identify common mental disorders in the perinatal period: A systematic review of systematic
M Sambrook Smith1, L Cairns2, L S W Pullen3
1National Perinatal Epidemiology Unit (NPEU), National Department of Public Health (NDPH), University of Oxford, Oxford, UK.
Insights
Screening tools like the EPDS, PHQ, and BDI can detect perinatal mental health issues, but their accuracy depends on the context. Careful consideration of population and setting is crucial for valid use in clinical practice.
Area of Science:
- Perinatal mental health
- Psychometrics
- Systematic reviews
Background:
- Uncertainty exists regarding the validity of screening tools for common mental disorders (CMDs) during perinatal periods.
- This umbrella review synthesizes psychometric properties of tools for identifying perinatal CMDs.
Purpose of the Study:
- To provide an up-to-date summary of the psychometric properties of screening tools for perinatal CMDs.
- To evaluate the validity and reliability of commonly used screening instruments in perinatal populations.
Main Methods:
- Systematic umbrella review of 31 reviews identified through extensive database searches (Ovid MEDLINE, PsychINFO, EMBASE, etc.).
- Extracted and summarized pooled sensitivity and specificity estimates using forest plots.
- Assessed the quality of included reviews using the Measurement Tool to Assess Systematic Reviews (AMSTAR-2).
Main Results:
- 76 screening tools were identified; Edinburgh Postnatal Depression Scale (EPDS), Beck's Depression Inventory (BDI), and Patient Health Questionnaire (PHQ) were most frequently validated.
- Decreasing sensitivity and increasing specificity were observed with higher cut-off scores.
- Tool validity varied by ethnicity, socio-economic background, and age, with lower specificity noted in low-quality reviews.
Conclusions:
- EPDS, PHQ, and BDI show utility across diverse settings, but application context is key to validity.
- Utilizing screening tools in clinical practice is complex, requiring careful consideration of population, context, and health system.
- Further research may be needed to refine screening tool application in varied perinatal settings.
Background:
Uncertainty remains regarding the validity of screening tools to detect common mental disorders (CMDs) during perinatal periods. This umbrella review aims to provide an up-to-date summary of psychometric properties of tools for the identification of perinatal CMDs.
Methods:
Reviews were identified via Ovid MEDLINE, PsychINFO, EMBASE, Global Health and Cochrane Database of Systematic Reviews electronic databases with no date or language restriction. Pooled sensitivity and specificity estimates and ranges were extracted and summarised using forest plots. Quality assessment was conducted using Measurement Tool to Assess Systematic Reviews (AMSTAR-2).
Results:
Of 7,891 papers identified, 31 reviews met inclusion criteria. 76 screening tools were identified; most frequently validated were Edinburgh Postnatal Depression Scale (EPDS) (n = 28 reviews), Beck's Depression Inventory (BDI) (n = 13 reviews) and Patient Health Questionnaire (PHQ) (n = 12 reviews). Forest plots demonstrated a pattern of decreasing sensitivity and increasing specificity with increasing cut-off scores. Sub-group analysis of data extracted from low quality reviews demonstrated wider 95% CIs and overall lower specificity. Validity also varied according to ethnicity, socio-economic background and age.
Limitations:
Despite a low Covered Corrected Area (CCA) score the primary studies included within reviews overlapped; therefore we were unable perform meta-analysis.
Conclusions:
The evidence suggests that the EPDS, PHQ and BDI are useful across a range of diverse settings but the context of tool application is a key factor determining validity. This review highlights that utilizing screening tools in clinical practice is complex and requires careful consideration of the population, context, and health system it will be used in.
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