Background
Methods
Search strategy
Inclusion criteria
Selection of studies
Quality assessment
Collection of data and analysis
Authors/Year | Setting | Study type | Sample and recruitment | Outcome Variable | Outcome Measured | Psychometric properties of the LLV-EPDS |
---|---|---|---|---|---|---|
1. Nepal et al., (1999) [24] | Specialised hospital for women and university teaching hospital, located in the Kathmandu (capital), Nepal. | Cross-sectional | • 132/149 postnatal women • Recruited from the maternity wards of respective hospitals (≥2 day’s post-delivery) and followed up after 4 weeks. | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp); Positive predictive value (PPV); Negative predictive value (NPV) | Nepalese version • Cut-off point: 12/13 • Se: 68.4 • Sp: 93.8 • PPV: 65 • NPV: 94.6 |
2. Regmi et al., (2002) [40] | University teaching hospital, located in the Kathmandu (capital), Nepal. | Cross-sectional | • 100 postnatal women (2–3 months) • Recruited from the post-natal/child immunization clinic. It recruited 40 non-child bearing women as controls (mainly nurses & their friends). | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp); Positive predictive value (PPV); Negative predictive value (NPV) | Nepalese version • Cut-off point: 12/13 • Se: 100 • Sp: 92.6 • PPV: 41.6 • NPV: 100 |
3. Patel et al., (2002) [28] | Hospital in the Northern town of Goa (Western State), India. | Prospective | • 270/297 pregnant women (≥30 week) • Recruited from the antenatal clinics, and then followed 6–8 weeks after delivery. | Psychometric properties PCMDs prevalence | - Cut-off point; Sensitivity (Se); Specificity (Sp) - PCMDs prevalence | Konkani version: • Cut-off point: 11/12 • Se: 92 • Sp: 85 |
4. Uwakwe (2003) [30] | University teaching hospital, located in the Eastern State, Nigeria. | Cross-sectional | • 225/292 postnatal women • Recruited from the maternity ward (≥7 day’s post-delivery) & then followed in the first postnatal clinic visit. | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp); Positive predictive value (PPV); Negative predictive value (NPV) | Igbo version (Eastern) • Cut-off point: 8/9 • Se: 75 • Sp: 97 • PPV: 75 • NPV: 97 |
5. Fisher et al., (2004) [23] | Maternal and Child and Family Planning Centre, located in the Ho Chi Minh city, Viet Nam. | Cross-sectional | • Cross-sectional, 506 postnatal women (6–8 weeks) • Recruited from the infant health clinics or those came for medical review | PCMDs prevalence | PCMDs prevalence | Reason included for this Review Earlier Vietnamese version-EPDS (developed by Small et al., (1999) [43] for women living in Australia) was revised before assessment of prevalence |
6. Rahman et al., (2005) [39] | Rural sub-district of Rawalpindi, Pakistan. | Cross-sectional | • 541/570 postnatal women (10 to12 weeks) • Recruited from community. | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp); Positive predictive value (PPV) | Urdu version • Cut-off point: 9/10a
• Se: 81.5 • Sp: 73.5 • PPV: 52.6 |
7. Adewuya et al., (2006) [31] | 5 Health centres, located in a semi-urban town of the Western Nigeria. | Cross-sectional | 182 pregnant women (≥32 weeks) • Recruited from antenatal clinics. | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp); Positive predictive value (PPV); Negative predictive value (NPV) | Yoruba version (Western) • Cut-off point: 9/10 • Se: 86.7 • Sp: 91.5 • PPV: 68.4 • NPV: 97 |
8. Pollock et al., (2006) [32] | Central Psychiatric Hospital, Mental Health and Necrology Centre, and 3 Primary Health Care Centres (PHCCs), located in the Ulaanbaatar (capital), Mongolia. | Cross-sectional | • 94/100 women (in reproductive age) - Recruited from psychiatric units (55) - Rest from PHCCs immunization clinics | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp); Positive predictive value (PPV); Negative predictive value (NPV) | Mongolian version • Cut-off point: 12/13 • Se: 80.9 • Sp: 61.7 • PPV: 67.9 • NPV: 76.3 |
9. Gausia et al., (2007) [19] | Social and Behavioural Sciences Unit (SBSU) and Hospital, located in the Dhaka (capital), Bangladesh. | Cross-sectional | • 10 female employee from SBSU • 11 mothers (baby ≤ 1 year) attending immunization clinic • 4 women whose infants were admitted to the hospital | Cultural and operational equivalence of Bangla version EPDS | Correlation between Bangla and original English version Correlation between self-report and interview administration | • Bangla and original English version (0.981; p < 0.01) • Self-report and interview ((0.752; p = 0.01) |
10. Gausia et al., (2007) [25] | Hospital, located in the Dhaka (capital), Bangladesh. | Cross-sectional | • 100 /126 postnatal women (6–8 weeks) • Recruited from child immunization clinic. | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp); Positive predictive value (PPV); Negative predictive value (NPV) | Bangla version • Cut-off point: 9/10 • Se: 88.9 • Sp: 86.8 • PPV: 40 • NPV: 98.6 |
11. Rowel et al., (2008) [37] | Field polyclinics in Kolonnawa, Western part of the Colombo (capital), Sri Lanka. | Cross-sectional | • 465 perinatal women recruited: - 265 pregnant (≥34 weeks) attending antenatal clinics. - 204 postpartum women (≥6 weeks) attending family planning or child wellbeing clinics. | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp) | Sinhalese version • Cut-off point: 8/9 Pregnant • Se: 90.7 • Sp: 86.8 Postnatal • Se: 89.9 • Sp: 78.9 |
12. Hanlon et al., (2008) [33] | Butajra (rural region) located 130 km South of the Addis Abba (capital), Ethiopia. | Cross-sectional | • 101 postnatal women (median 5 Months) • Recruited from the community. | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp) | Amharic version 1. Cut-off point: 5/6 • Sp: 76.5 • Se: 36.1 |
13. Weobong et al., (2009) [38] | Brong-Ahafo region (South part), Ghana. | Cross-sectional | • 160 pregnant women (5–11 week) • Identified from the database of 1/6 districts where vitamin A trial initiated. | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp); Positive predictive value (PPV); Negative predictive value (NPV) | Twi version • Cut-off point: 10/11 • Se: 78 • Sp: 73 • PPV: 22 • NPV: 97 |
14. Tesfaye et al., (2010) [35] | 2 Primary Health Care Centres, located in peri-urban area of the Addis Ababa (capital), Nigeria. | Cross-sectional | • 100/102 postnatal women (6 to 14 weeks) • Recruited from child immunization and postnatal clinics. | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp); Positive predictive value (PPV); Negative predictive value (NPV) | Amharic version • Cut-off point: 6/7 • Se: 78.9 • Sp: 75.3 • PPV: 42.9 • NPV: 93.8 |
15. Chibanda et al., (2010) [36] | 2 Primary Health Care Centres located in peri-urban area of the Harare (capital), Zimbabwe. | Cross-sectional | • 210/223 postnatal women (6–7 weeks) • Identified by computer generated randomization of clinic review cards, • Recruited from the 2 primary health care centres | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp); Positive predictive value (PPV); Negative predictive value (NPV) | Shona version • Cut-off point: 10/11a
• Se: 88 • Sp: 87 • PPV: 74 NPV: 94 |
16. Fernandes et al. (2010) [29] | Missionary hospital located in rural part of Karnataka State (South), India. | Cross-sectional | • 194/196 pregnant (32 – 38 weeks) women • Recruited from the antenatal clinic. | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp); Positive predictive value (PPV); Negative predictive value (NPV) | Kannada version • Cut-off point: 12/13 • Se: 100 • Sp: 84.9 • PPV: 52 • NPV: 99 |
17. Tran et al., (2011) [27] | Randomly selected Commune Health Centres (CMCs) from the Hanoi (capital) and Ha Nam province, Vietnam. | Cross-sectional | • 364/392 perinatal women - 199 were ≥ 28 weeks pregnant - Rest were 4–6 weeks postpartum) • Mostly were recruited from the CMCs and in Ha Nam province, also house visit for some. | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp); Positive predictive value (PPV); Negative predictive value (NPV) | Vietnamese version • Cut-off point: 3/4a
• Se: 69.9 • Sp: 72.9 • PPV: 69.7 • NPV: 72 |
18. Husain et al., (2013) [26] | An urban slum in the Karachi (capital), Pakistan. | Cross-sectional | • 601/664 postnatal women (0–36 months) • Recruited from the slum. | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp); Positive predictive value (PPV); Negative predictive value (NPV) | Urdu version • Cut-off point: 13/14a
• Se: 79 • Sp: 74 • PPV: 82 • NPV: 70 |
19. Stewart et al., (2013) [34] | District hospital, Mangochi, (Southern township), Malawi. | Cross-sectional | • 224 pregnant women (2nd trimester) • Recruited from antenatal clinic. | Psychometric properties | Cut-off point; Sensitivity (Se); Specificity (Sp); Positive predictive value (PPV); Negative predictive value (NPV) | Chichewa version • Cut-off point: 4/5a
• Se: 68.7 • Sp: 88.2 • PPV: 35.8 • NPV: 97.4 |
Results
Study | Clear study aim | Sample adequacy (justification) | Representative sample (with justification) | Explicit criteria for inclusion & exclusion | Response rate | Description of data | Appropriate statistical analyses | Ethics approval | Obtained informed consent from participants | Total score |
---|---|---|---|---|---|---|---|---|---|---|
1. Nepal et al., (2002) [24] | 1 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 4 |
2. Regmi et al., (2002) [40] | 1 | 0 | 0 | 1 | 1 | 0 | 1 | 1 | 0 | 5 |
3. Patel et al., (2002) [28] | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 0 | 1 | 6 |
4. Uwakwe (2003) [30] | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 0 | 0 | 5 |
5. Fisher et al., (2004) [23] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 8 |
6. Rahman et al., (2005) [39] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 8 |
7. Adewuya et al., (2006) [31] | 1 | 0 | 0 | 1 | 0 | 1 | 1 | 1 | 0 | 5 |
8. Pollock et al., (2006) [32] | 1 | 0 | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 6 |
9. Gausia et al., (2007) [19] | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 7 |
10. Gausia et al., (2007) [25] | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 0 | 6 |
11. Rowel et al., (2008) [37] | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 0 | 0 | 5 |
12. Hanlon et al., (2008) [33] | 1 | 0 | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 6 |
13. Weobong et al., (2009) [38] | 1 | 0 | 1 | 0 | 0 | 1 | 1 | 0 | 0 | 4 |
14. Tesfaye et al., (2010) [35] | 1 | 0 | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 6 |
15. Chibanda et al., (2010) [36] | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 7 |
16. Fernandes et al. (2010) [29] | 1 | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 0 | 4 |
17. Tran et al., (2011) [27] | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 0 | 7 |
18. Husain et al., (2013) [26] | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 0 | 6 |
19. Stewart et al., (2013) [34] | 1 | 0 | 0 | 1 | 0 | 1 | 1 | 1 | 0 | 5 |
Culturally Sensitive Translation
Country and Author | Forward translation | Back translation | Resolution of differences in translations by Committee approach | Pretesting | Amendments | Test of Equivalence | Translated version |
---|---|---|---|---|---|---|---|
1. Nepal | |||||||
Nepal et al., (1999) [24] | Yes (psychiatrist) | Yes (Another set) | NM | Yes | Not needed | NM | Nepalese |
2. India | |||||||
Patel et al., (2002) [28] | Yes | Yes | NM | NM | NM | NM | Konkani |
Fernandes et al. (2010) [29] | Yes (1 health professional) | Yes (Another set: health professional) | Yes (investigator, translators & another member of the study team) | Yes | NM | NM | Kannada |
3. Nigeria | |||||||
Uwakwe (2003) [30] | Yes (3 nurses) | Yes (Another set: 2 medical students & layperson) | Yes (investigator&translators) | Yes | Not needed | NM | Igbo (Eastern) |
Adewuya et al., (2006) [31] | Yes (Psychiatrist & linguist) | Yes (Another set: psychiatrist & linguist) | NM | NM | NM | NM | Yoruba (Western) |
4. Pakistan | |||||||
Rahman et al., (2005) [39] | Yes | Yes | \Yes | NM | NM | NM | Urdu |
5. Mongolia | |||||||
Pollock et al., (2006) [32] | Yes (2 medical translators) | Yes (Another set: 2 medical translators) | Yes (investigator, psychiatrist & doctor) | NM | Yes | NM | Mongolian |
6. Bangladesh | |||||||
Gausia et al., (2007) [19] | Yes (1 Principal investigator) | Yes (Another set: translator & 2 native English speakers) | Yes (investigator,1 psychologist, 1 psychiatrist, 1 paediatrician, 3 physicians, 2 lay persons) | Yes (Probing) | Yes | Yes | Bengali |
7. Sri Lanka | |||||||
Rowel et al., (2008) [37] | Yes | Yes | NM | Yes | NM | NM | Sinhalese |
8. Ethiopia | |||||||
Hanlon et al., (2008) [33] | Yes (Physicians) Yes (Another set: physicians) | Yes (investigator,2 senior psychiatrists) | Yes (Probing) | Yes | NM | Amharic | |
Tesfaye et al., (2010) [35] | NM | Yes (Probing) | Yes | NM | |||
9. Ghana | |||||||
Weobong et al., (2009) [38] | Yes (Native & UK professionals) | Yes (Native & UK professionals) | Yes (study team) | (Qualitative study) | Not needed | NM | Twi |
10. Zimbabwe | |||||||
Chibanda et al., (2010) [36] | Yes (research assistant) | Yes | Yes (study team) | NM | NM | NM | Shona |
11. Vietnam | |||||||
‡Fisher et al., (2004) [23] | Yes | Yes | Yes (study team) | Yes (Probing) | Yes | NM | Vietnamesea
|
12. Malawi | |||||||
Stewart et al., (2013) [34] | Yes (1 health professional, psychiatrist (UK), 2 social science graduates) | Yes (Another set: 1 non-mental health professional) | Yes (antenatal clinic nurses) | Yes | Yes | NM | Chichewa (bVisual Prompt card |
Empirical Validation
Country and Author | Participant characteristics | Mode of administration | Sub-sample /Sample | Same day | Blinded | Administered by | Diagnostic Instrumentsc & diagnostic criteriad
| Cut-off | See (%) | Spf (%) | PPVg (%) | NPVh (%) |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Nepal | ||||||||||||
Nepal et al., (1999) [24] | 132/149 postnatal women convenientlyrecruited from the maternity wards of two hospitals (≥2 days post-delivery) located in the Kathmandu. Then followed up after 4 weeks (84.5 % were literate). | Interview | All 132 participants | NM | NM | 2 Psychiatrists | DSM-IV of major depression | 12/13 | 68.4 | 93.8 | 65 | 94.6 |
aRegmi et al., (2002) [40] | 100 postnatal women (2–3 months) conveniently recruited from the post-natal clinic of the university teaching hospital in the Kathmandu. This case-controlled study recruited40 non-child bearing women as controls (mainly nurses & their friends). | Self-reporting | 30 postpartum women (all 12 scored ≥ 13 and rest scored ≤12 were randomly selected) | NM | NM | NM | SCID DSM-IV of major depression | 100 | 92.6 | 41.6 | 100 | |
India | ||||||||||||
Patel et al., (2002) [28] | 270/297 pregnant (≥30 week) women conveniently recruited from antenatal clinics, and then followed 6–8 weeks after delivery (252), in Goa. Konkani, Marathi, Hindi and English speakers were included for this study. In this state, the female literacy rate is 67 % and 87 % of births are supervised. | Interviewers | Not clear | NM | NM | NM | CIS-R of common mental disorders | 11/12 | 92 | 85 | NM | NM |
Fernandes et al. (2010) [29] | 194/196 pregnant (32 – 38 weeks) women conveniently recruited from the antenatal clinic of the missionary hospital located in the rural area of Karnataka state. 95.5 % of these women had completed primary education. | Interviewer | All 194 | Yes | NM | 1 psychologist | MINI DSM-IV of depression (translated)
| 12/13 | 100 | 84.9 | 52 | 99 |
Nigeria | ||||||||||||
Uwakwe (2003) [30] | 225/292 postnatal women conveniently recruited from the maternity ward (≥7 days post-delivery), of a teaching hospital & postnatal clinic. | Self-reported, using English or local-version EPDS. | 94.0 % of the participants | NM | NM | Psychiatrist & psychiatric nurse | Diagnostic interview using ICD −10 for mental disorders | 8/9b
| 75 | 97 | 75 | 97 |
Adewuya et al., (2006) [31] | 182 pregnant women (≥32 weeks) conveniently recruited from the antenatal clinics of 5 health centres, located in a semi-urban town of western Nigeria (15.4 % were illiterate). | Interviewer administered for illiterate women. | 86 (all 75 scored ≥ 6 & rest 10 % randomly selected out of those scoring <6) | NM | Yes | 2 psychiatrists | MINI DSM-IV of Depression | 9/10 | 86.7 | 91.5 | 68 | 97 |
Pakistan | ||||||||||||
Rahman et al., (2005) [39] | 541/570 postnatal women (10 to12 weeks) recruited from a rural community of the Rawalpindi sub-district. About 75 % were illiterate. | Interviewers | All 541 | Yes | Yes | 2 Mental health professionals | SCAN for ICD-10 for depressive disorders (translated & adapted)
| 9/10b
| 81.5 | 73.1 | 52.6 | NM |
Husain et al., (2013) [26] | 601/664 postnatal women (0–36 months) recruited from an urban slum in the capital Karachi. | All 601 | Yes | Yes | NM | CIS-R, ICD −10b for depression | 13/14b
| 79 | 74 | 82 | 70 | |
Mongolia | ||||||||||||
Pollock et al., (2006) [32] | 94/100 women (in reproductive age) conveniently recruited from two specialised psychiatric units (55) & rest from the 3 community based immu1nization clinics in the capital Ulaanbaatar (adult literacy rate near 100 %) | Not clear | All 94 | Yes | NM | 1 bstetrician-an/gynaecologist, 1 psychologist | CIS-R, ICD-10 for depressive disorders (translated & adapted)
| 12/13b
| 80.9 | 61.7 | 67.9 | 76.3 |
Bangladesh | ||||||||||||
Gausia et al., (2007) [25] | 100/126 postnatal women \(6–8 weeks) conveniently recruited from a child immunization clinic in Dhaka, 11 % were illiterate. | 1 interviewer | All 100 | Yes | Yes | 1 psychiatrist | SCID DSM-IV of depression | 9/10 | 88.9 | 86.8 | 40 | 98.6 |
Sri Lanka | Pregnant | |||||||||||
Rowel et al., (2008) [37] | 465 perinatal women conveniently recruited for this study: of them 265 were pregnant (≥34 weeks) and attending antenatal clinics. The other 204 were postpartum women (≥6 weeks) attending a family planning or child wellbeing clinic (all could read & write). | Not clear | All 465 | NM | NM | 1 psychiatrist | Diagnostic interview using ICD-10 for mental disorders | 8/9 | 90.7 | 86.8 | NM | NM |
Postnatal | ||||||||||||
89.9 | 78.9 | NM | NM | |||||||||
Ethiopia | ||||||||||||
Hanlon et al., (2008) [33] | 101 postnatal women (median 5 Months) recruited from the Butajra sub-district (rural community) | 20 Interviewers | 52 participants | NM | NM | Psychiatrists | CPRS DSM-IV of common mental disorders | 5/6 | 76.5 | 36.1 | NM | NM |
Tesfaye et al., (2010) [35] | 100/102 postnatal women (6 to 14 weeks) conveniently recruited from child immunization and/or postnatal clinics in 2 primary health care centres, located in the peri-urban area of the capital Addis Ababa. 21 % were illiterate. | Interviewers | All 100 | Yes | Yes | 2 psychiatrists | 6/7 | 78.9 | 75.3 | 42.9 | 93.8 | |
Ghana | ||||||||||||
Weobong et al., (2009) [38] | 160 pregnant women (5–11 week) identified from the database of 1/6 districts where vitamin A trial was implemented. | Interviewers | About half | Yes | Yes | 1 psychologist | SCAN for common mental disorders | 10/11 | 78 | 73 | 22 | 97 |
Zimbabwe | ||||||||||||
Chibanda et al., (2010) [36] | 210/223 postnatal women (6–7 weeks) conveniently recruited from the 2 primary health care centres, located in a peri-urban area of the capital Harare (74 % completed secondary education). | 6 interviewers | All 210 | Yes | Yes | 2 psychiatrists | DSM-IV of major depression | 10/11b
| 88 | 87 | 74 | 94 |
Vietnam | ||||||||||||
Tran et al., (2011) [27] | 364/392 perinatal women (199 were ≥ 28 weeks pregnant & rest were 4–6 weeks postpartum) from randomly selected commune health centres in the capital Hanoi. Rural women were recruitedfrom the Ha Nam province. | Interviewers | All 364 | Yes | Yes | 1 psychiatrist | SCID DSM-IV of depression, generalised anxiety, panic disorders | 3/4b
| 69.7 | 72.9 | 69.7 | 72 |
Malawi | ||||||||||||
Stewart et al., (2013) [34] | 224 pregnant women (2nd trimester) conveniently recruited from a rural district hospital. Only Chichewa speakers were recruited for this study. | 2 interviewers | 92 (all scored ≥9; every other for those scored 6–9 & every fourth scored ≤5) | NM | Yes | 1 (NM) | SCID DSM-IV of depressive disorders | 4/5b
| 68.7 | 88.2 | 35.8 | 97.4 |