To the Editor: In their meta-analysis, Dr Paulson and Ms Bazemore1 reported a synthesized point prevalence for paternal depression of 10.4% based on studies between the first trimester of pregnancy and 1-year postpartum, more than double the 12-month general population period prevalence for major depressive disorder (MDD) among men (4.8%).2 A recent population survey of more than 15 000 women, on the other hand, found that rates of MDD differed very little, if at all, between women in pregnancy (8.4%) and postpartum (9.3%) compared with nonpregnant women (8.1%).3
The apparent reason for this discrepancy is that the analysis by Paulson and Bazemore depended almost entirely on rates of men who scored above cutoff thresholds on self-report depressive symptom questionnaires, whereas the population surveys2 - 3 used diagnostic interviews for MDD. Scores above cutoffs on questionnaires are not equivalent to MDD diagnoses. A self-report measure with 80% specificity, for example, would produce a rate of 20% when there are no MDD cases. Rates from questionnaire cutoff scores may systematically underestimate or overestimate depression rates, depending on the instrument and cutoff score used. One systematic review,4 for instance, found similar depression rates across studies of patients after myocardial infarction when the same instruments and cutoffs were used but reported very different rates when different measures and cutoffs were used. In that study, the prevalence of MDD based on diagnostic interview was approximately 20% across studies, which was substantially different from rates based on a Beck Depression Inventory score of 10 or greater (31%, 6 studies), a Hospital Anxiety and Depression Scale (HADS) score of 8 or greater (16%, 4 studies), or a HADS score of 11 or greater (7%, 4 studies).
To generate a single estimate of depression prevalence, Paulson and Bazemore combined rates from 12 different assessment tools and many different cutoff thresholds, including 4 different Center for Epidemiologic Studies Depression Scale cutoff thresholds that ranged from 9 to 16 and 4 different Edinburgh Postnatal Depression Scale (EPDS) cutoffs that ranged from 6 to 12. The problem of combining such a wide range of tools and cutoffs is clearly demonstrated by a study reviewed by Paulson and Bazemore, which reported a rate of 5% for EPDS scores greater than 9 and 16% for EPDS scores greater than 6 in the same group of fathers.5 When Paulson and Bazemore considered only 3 studies that used validated diagnostic interviews for MDD, however, the rate was 4.9%, which, while still important, is similar to the general population rate for men.
Financial Disclosures: Dr Thombs reported receiving research support from the Canadian Institutes of Health Research and the Fonds de la Recherche en Santé Québec. Ms Roseman reported receiving support for her graduate studies from the Fonds de la Recherche en Santé Québec. No other disclosures were reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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