加拿大犹太总医院Brett D Thombs团队研究了爱丁堡产后抑郁量表（EPDS）筛查孕妇和产妇抑郁症的准确性。2020年11月11日，该研究发表在《英国医学杂志》上。

为了评估爱丁堡产后抑郁量表（EPDS）筛查孕产妇严重抑郁的准确性，研究组在Medline、PsycINFO和科学引文索引等大型数据库中检索从成立到2018年10月3日的文献，筛选出EPDS分数和确诊严重抑郁症分类的文章，使用双变量随机效应荟萃分析来评估EPDS的敏感性和特异性。

研究组共纳入符合条件的58项研究，包括15557名参与者，其中2069名患重度抑郁症。在EPDS评分截断值为11及以上时，综合敏感性和特异性达到了最大值。在半结构化访谈的研究（36个研究，9066名参与者，1330名严重抑郁症患者）中，截断值为10及以上时敏感性和特异性分别为0.85和0.84，截断值为11及以上时分别为0.81和0.88，截断值为13及以上时分别为0.66和0.95。各个参考标准和亚组（包括孕妇和产妇）的准确性相差不大。

研究结果表明，EPDS截断值为11及以上时，敏感性和特异性的组合达到最大化；截断值为13及以上时，灵敏度较低，但更具特异性。

附：英文原文

Title: Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data

Author: Brooke Levis, Zelalem Negeri, Ying Sun, Andrea Benedetti, Brett D Thombs

Issue&Volume: 2020/11/11

Abstract:

Objective To evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnant and postpartum women.

Design Individual participant data meta-analysis.

Data sources Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (from inception to 3 October 2018).

Eligibility criteria for selecting studies Eligible datasets included EPDS scores and major depression classification based on validated diagnostic interviews. Bivariate random effects meta-analysis was used to estimate EPDS sensitivity and specificity compared with semi-structured, fully structured (Mini International Neuropsychiatric Interview (MINI) excluded), and MINI diagnostic interviews separately using individual participant data. One stage meta-regression was used to examine accuracy by reference standard categories and participant characteristics.

Results Individual participant data were obtained from 58 of 83 eligible studies (70%; 15557 of 22788 eligible participants (68%), 2069 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of 11 or higher across reference standards. Among studies with a semi-structured interview (36 studies, 9066 participants, 1330 with major depression), sensitivity and specificity were 0.85 (95% confidence interval 0.79 to 0.90) and 0.84 (0.79 to 0.88) for a cut-off value of 10 or higher, 0.81 (0.75 to 0.87) and 0.88 (0.85 to 0.91) for a cut-off value of 11 or higher, and 0.66 (0.58 to 0.74) and 0.95 (0.92 to 0.96) for a cut-off value of 13 or higher, respectively. Accuracy was similar across reference standards and subgroups, including for pregnant and postpartum women.

Conclusions An EPDS cut-off value of 11 or higher maximised combined sensitivity and specificity; a cut-off value of 13 or higher was less sensitive but more specific. To identify pregnant and postpartum women with higher symptom levels, a cut-off of 13 or higher could be used. Lower cut-off values could be used if the intention is to avoid false negatives and identify most patients who meet diagnostic criteria.

DOI: 10.1136/bmj.m4022

Source: https://www.bmj.com/content/371/bmj.m4022