1 Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.
2 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.
3 School of Primary, Centre for Prognosis Research, Community and Social Care, Keele University, Keele, Staffordshire, UK.
4 Department of Psychiatry, McGill University, Montréal, Québec, Canada.
5 Department of Psychology, McGill University, Montréal, Québec, Canada.
6 Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
7 Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada.
8 Department of Medicine, Stanford University, Stanford, California, USA.
9 Department of Health Research and Policy, Stanford University, Stanford, California, USA.
10 Department of Biomedical Data Science, Stanford University, Stanford, California, USA.
11 Department of Statistics, Stanford University, Stanford, California, USA.
12 Department of Clinical, Neuro and Developmental Psychology, EMGO Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
13 Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK.
14 Library, Concordia University, Montréal, Québec, Canada.
15 Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta, Canada.
16 Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada.
17 Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, Alberta, Canada.
18 Department of Family Medicine, McGill University, Montréal, Québec, Canada.
19 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
20 International Union for Health Promotion and Health Education, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada.
21 Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
22 Alberta Health Services, Edmonton, Alberta, Canada.
23 Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
24 Women's College Hospital and Research Institute, University of Toronto, Toronto, Ontario, Canada.
25 Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
26 Department of Psychological Sciences, Birkbeck, University of London, London, UK.
27 Department of Psychiatry, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India.
28 University of Connecticut School of Nursing, Mansfield, Connecticut, USA.
29 Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
30 Discipline of Psychiatry, Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
31 Department of Psychiatry, Westmead Hospital, Sydney, New South Wales, Australia.
32 Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.
33 Departments of Psychiatry, Pediatrics, Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA.
34 Faculty of Psycho

Objectives: Estimates of depression prevalence in pregnancy and postpartum are based on the Edinburgh Postnatal Depression Scale (EPDS) more than on any other method. We aimed to determine if any EPDS cutoff can accurately and consistently estimate depression prevalence in individual studies.

Methods: We analyzed datasets that compared EPDS scores to Structured Clinical Interview for DSM (SCID) major depression status. Random-effects meta-analysis was used to compare prevalence with EPDS cutoffs versus the SCID.

Results: Seven thousand three hundred and fifteen participants (1017 SCID major depression) from 29 primary studies were included. For EPDS cutoffs used to estimate prevalence in recent studies (=9 to =14), pooled prevalence estimates ranged from 27.8% (95% CI: 22.0%-34.5%) for EPDS = 9 to 9.0% (95% CI: 6.8%-11.9%) for EPDS = 14; pooled SCID major depression prevalence was 9.0% (95% CI: 6.5%-12.3%). EPDS =14 provided pooled prevalence closest to SCID-based prevalence but differed from SCID prevalence in individual studies by a mean absolute difference of 5.1% (95% prediction interval: -13.7%, 12.3%).

Conclusion: EPDS =14 approximated SCID-based prevalence overall, but considerable heterogeneity in individual studies is a barrier to using it for prevalence estimation.