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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.

Objective: To review the recent recommendation against routinely screening adults for depression in primary care settings by the Canadian Task Force on Preventive Health Care (CTFPHC)., Methods: We reviewed the CTFPHC recommendation and discussed it in the context of relevant evidence., Results: Depression screening, which involves using depression symptom questionnaires to attempt to identify patients who have unrecognized depression, was previously recommended by the CTFPHC in primary care settings with staff-assisted depression care programs in place to ensure accurate diagnosis, effective treatment, and follow-up, but not in the absence of such programs. The CTFPHC recently updated this guideline and recommended against routinely screening adults for depression in primary care because there have not been any randomized controlled trials (RCTs) that have shown depression screening to be beneficial and because of a concern about the potentially high number of false-positive screens that would occur. Without evidence from RCTs of better health outcomes from screening, there are numerous factors that suggest that depression screening, even with collaborative depression care, may not be beneficial for patients, including the high rate of patients already treated, uncertainty about the ability of depression screening tools to accurately identify previously unrecognized patients, and relatively small treatment effects among patients with less severe depression who would be most likely to be identified through screening. Routine screening would expose some patients to avoidable risks and would pose a significant cost burden., Conclusion: The CTFPHC recommendation to not screen for depression in primary care is consistent with available evidence. Clinicians in primary care settings should be alert to signs of depression and attend to symptoms through assessment and, as appropriate, referral or management, as recommended by the CTFPHC.