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Depression screening for pregnant, postpartum women may reduce symptoms

Direct and indirect evidence suggests depression screening for pregnant and postpartum women may reduce depressive symptoms, and could decrease the prevalence of depression in this population, according to a study published in JAMA.

“Major depressive disorder (MDD) is the leading cause of disease-related disability in women around the world,” Elizabeth O’Connor, PhD, of the Kaiser Permanente Research Affiliates Evidence-based Practice Center, at the Center for Health Research in Portland, Oregon, and colleagues wrote. “In a study of U.S. women assessed in 2005, 9.1% of pregnant women and 10.2% of postpartum women met criteria for a major depressive episode.”

To review the potential benefits and harms of depression screening and treatment, and the accuracy of selected screening instruments, for pregnant and postpartum women, the researchers independently reviewed English-language articles and trials, extracting data from fair- and good-quality studies. Their sources included Medline, PubMed, PsycINFO and the Cochrane Collaboration Registry of Controlled Trials through Jan. 20, 2015. They also reviewed references and government websites.

The researchers identified 6,536 titles and abstracts, and reviewed 478 full-text articles. Ultimately, 64 fair- and good-quality trials involving pregnant or postpartum women who were 18 years and older and living in “very high-developed” countries, as defined by WHO, were included in the study. Random-effects meta-analysis was used to estimate the benefit of cognitive behavioral therapy (CBT) in pregnant and postpartum women.

Six trials, involving 11,869 women, showed 18% to 59% relative reductions with screening programs, or 2.1% to 9.1% absolute reductions, in the risk of depression at 3- to 5-month follow-up after participation in programs that included depression screening, with or without additional treatment, compared with usual care. Based on 23 studies involving 5,398 women, a cutoff of 13 on the English-language Edinburgh Postnatal Depression Scale showed sensitivity ranging from 0.67 (95% CI, 0.18-0.96) to 1 (95% CI, 0.67-1), and specificity of at least 0.87.

Aggregate results for the benefit of CBT for patients with screen-detected depression demonstrated an increase in the likelihood of remission compared with usual care, with absolute increases ranging from 6.2% to 34.6%. According to the researchers, observational evidence showed that second-generation antidepressant use during pregnancy may be associated with small increases in risk for potentially serious harms.

“The direct evidence suggested that screening pregnant and postpartum women for depression may reduce depressive symptoms in women with depression and reduce the prevalence of depression in a given population, particularly in the presence of additional treatment supports (eg, treatment protocols, care management and availability of specially trained depression care clinicians),” O’Connor and colleagues wrote. “The indirect evidence showed that screening instruments can identify pregnant and postpartum women who need further evaluation and may need treatment. The only identified harm of treatment was the use of antidepressants during pregnancy, although the absolute risk of harm appeared to be small and CBT appeared to be an effective alternative treatment approach.” – by Jason Laday