1 113635Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.
2 Department of Epidemiology, Biostatistics and Occupational Health, 5620McGill University, Montréal, Québec, Canada.
3 Department of Psychology, 5620McGill University, Montréal, Québec, Canada.
4 Department of Psychiatry, 5620McGill University, Montréal, Québec, Canada.
5 Department of Medicine, 5620McGill University, Montréal, Québec, Canada.
6 Department of Educational and Counselling Psychology, 5620McGill University, Montréal, Québec, Canada.
7 Biomedical Ethics Unit, 5620McGill University, Montréal, Québec, Canada.
8 Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Staffordshire, United Kingdom.
9 Women's College Hospital and Research Institute, University of Toronto, Ontario, Canada.
10 Department of Mental Health, Bloomberg School of Public Health, 1466Johns Hopkins University, Baltimore, MD, USA.
11 Schulich Library of Physical Sciences, Life Sciences, and Engineering, 5620McGill University, Montréal, Québec, Canada.
12 Department of Clinical, Neuro and Developmental Psychology, EMGO Institute, 1190Vrije Universiteit Amsterdam, the Netherlands.
13 Department of Health Sciences, Hull York Medical School, 8748University of York, Heslington, York, United Kingdom.
14 Department of Medicine, Department of Epidemiology and Population Health, Department of Biomedical Data Science, Department of Statistics, 10624Stanford University, Stanford, CA, USA.
15 Library, 5618Concordia University, Montréal, Québec, Canada.
16 Departments of Community Health Sciences and Psychiatry, 2129University of Calgary, Alberta, Canada.
17 Mathison Centre for Mental Health Research & Education, 2129University of Calgary, Alberta, Canada.
18 Cuthbertson & Fischer Chair in Pediatric Mental Health, 2129University of Calgary, Alberta, Canada.
19 Department of Family Medicine, 5620McGill University, Montréal, Québec, Canada.
20 Department of Medicine, 1466Johns Hopkins University School of Medicine, Baltimore, MD, USA.
21 International Union for Health Promotion and Health Education, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada.
22 Department of Psychiatry, 3158University of Alberta, Edmonton, Alberta, Canada.
23 Alberta Health Services, Edmonton, Alberta, Canada.
24 Department of Medicine, 2129University of Calgary, Alberta, Canada.
25 215826Department of Psychological Sciences, Birkbeck, University of London, United Kingdom.
26 7712University of Connecticut School of Nursing, Mansfield, CT, USA.
27 Department of Child and Adolescent Psychiatry, 234015University Medical Center Hamburg-Eppendorf, Germany.
28 School of Psychology, 219951University of Minho, Portugal.
29 Institute of Psychiatry, Psychology & Neuroscience, 4616King's College London, United Kingdom.
30 South London and Maudsley NHS Foundation Trust, London, United Kingdom.
31 School of Psychiatry, 7800University of New South Wales, Kensington, Australia.
32 Ingham Institute, Liverpool, Australia.
33 Karitane, Carramar, Australia.
34 72227Department of Obstetrics and Gynaecology, Blekinge Hospital, Karlskrona, Sweden.
35 First Department of Psychiatry,

Objective: The Maternal Mental Health in Canada, 2018/2019, survey reported that 18% of 7,085 mothers who recently gave birth reported "feelings consistent with postpartum depression" based on scores =7 on a 5-item version of the Edinburgh Postpartum Depression Scale (EPDS-5). The EPDS-5 was designed as a screening questionnaire, not to classify disorders or estimate prevalence; the extent to which EPDS-5 results reflect depression prevalence is unknown. We investigated EPDS-5 =7 performance relative to major depression prevalence based on a validated diagnostic interview, the Structured Clinical Interview for DSM (SCID).

Methods: We searched Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and the Web of Science Core Collection through June 2016 for studies with data sets with item response data to calculate EPDS-5 scores and that used the SCID to ascertain depression status. We conducted an individual participant data meta-analysis to estimate pooled percentage of EPDS-5 =7, pooled SCID major depression prevalence, and the pooled difference in prevalence.

Results: A total of 3,958 participants from 19 primary studies were included. Pooled prevalence of SCID major depression was 9.2% (95% confidence interval [CI] 6.0% to 13.7%), pooled percentage of participants with EPDS-5 =7 was 16.2% (95% CI 10.7% to 23.8%), and pooled difference was 8.0% (95% CI 2.9% to 13.2%). In the 19 included studies, mean and median ratios of EPDS-5 to SCID prevalence were 2.1 and 1.4 times.

Conclusions: Prevalence estimated based on EPDS-5 =7 appears to be substantially higher than the prevalence of major depression. Validated diagnostic interviews should be used to establish prevalence.