USPSTF recommends counseling for women at risk for perinatal depression

In a draft recommendation statement, the U.S. Preventive Services Task Force advised that counseling interventions, such as cognitive behavioral therapy or interpersonal therapy, can prevent perinatal depression and should be provided to pregnant and postpartum women at increased risk.

“Perinatal depression is a serious condition that negatively affects mothers, babies and families,” Karina Davidson, PhD, MASc, member of the USPSTF said in a press release. “Fortunately, effective counseling interventions can help prevent perinatal depression before it develops, and primary care clinicians can provide or connect women with these services.”

The USPSTF based its recommendation on an evidence review of 50 trials that evaluated behavior-based and pharmacological-based interventions for the prevention of perinatal depression.

Overall, the task force found that counseling interventions diminished the odds of perinatal depression by 39% (pooled RR = 0.61; 95% CI, 0.47-0.78) and reduced depression symptoms more than control conditions (weight mean difference in change between groups = –1.51; 95% CI, –2.84 to –0.18). Effective counseling interventions included cognitive behavioral therapy and interpersonal therapy.

Other behavior-based interventions, such as those targeting health systems, physical activity and peer counseling showed “promising” results, but evidence was not robust.

In one study of 22 women, sertraline initiated immediately after childbirth showed significant benefit at 20 weeks postpartum but also increased side effects. Nortriptyline, debriefing interventions and omega-3 fatty acids did not effectively prevent perinatal depression.

The B-grade recommendation to initiate counseling for perinatal depression in high-risk women does not apply to those who have already been diagnosed with depression. The task force noted that while there is no current screening tool to evaluate the risk for perinatal depression, physicians should look for certain risk factors, including history of depression, symptoms of depression and socioeconomic factors, such as being young or a single parent.

“For the first time, the Task Force is recommending counseling to prevent perinatal depression in high-risk women,” Aaron B. Caughey, MD, MPP, MPH, PhD, member of USPSTF, said in the release. “Clinicians should use patient history and risk factors to identify women who are most likely to benefit.”

The USPSTF’s draft statement and evidence review has been posted for public comment on the USPSTF website: www.uspreventiveservicestaskforce.org. Input will be accepted through Sept. 24 at www.uspreventiveservicestaskforce.org/tfcomment.htm. – by Alaina Tedesco

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.