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.

Abstract

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. 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. 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. 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%). 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.