USPSTF: Screen Pregnant, Postpartum Women for Depression Risk

Troy Brown, RN

August 30, 2018

New draft guidance from the US Preventive Services Task Force (USPSTF) recommends screening all pregnant and postpartum women for perinatal depression risk. Women found to be at risk should be referred for counseling.

The level B recommendation, published online August 28, refers to women who are pregnant or within the first year after childbirth and does not apply to women who have a current diagnosis of depression.

Risk factors for perinatal depression include a history of depression in themselves or a family member, history of physical or sexual abuse, experiencing an unplanned or unwanted pregnancy, current stressors, pregestational or gestational diabetes, and pregnancy complications such as premature contractions or hyperemesis. Social factors associated with an increased risk include low socioeconomic status, inadequate social or financial support, and adolescent parenthood.

"There are limited data on the best way to identify women at increased risk of perinatal depression. A pragmatic approach, based on the populations included in the systematic evidence review, would be to provide counseling interventions to women with one or more of the following: a history of depression, current depressive symptoms (that do not reach a diagnostic threshold), or certain socioeconomic risk factors (e.g., low income or young or single parenthood)," the authors write.

An accompanying evidence review found "convincing evidence" that counseling interventions are effective at preventing perinatal depression in women at increased risk and found that the potential harms associated with these interventions are small.

The evidence review considered studies of women with mental health symptoms or disorders but excluded studies that focused on women with a depression diagnosis or severe depressive symptoms, women currently undergoing treatment for a depressive disorder, and studies of women with psychosis or developmental disorders.

Studies included in the evidence review looked at a variety of interventions with different settings, formats, intensity, and intervention staff. Counseling primarily consisted of in-person visits and occurred in individual and group settings.

Counseling interventions for prevention of perinatal depression studied in the evidence review primarily included cognitive behavioral therapy and interpersonal therapy. Cognitive therapy uses interventions such as patient education, goal setting, techniques to identify and change maladaptive thought patterns, and behavioral activation. Interpersonal therapy is used to treat interpersonal issues that are believed to play a part in the development or continuation of psychological disorders and includes the use of open-ended and clarifying questions, role-playing, and analysis of decisions and communication.

Perinatal depression affects as many as one in seven women in the United States, varying by age, race, and ethnicity, and other sociodemographic factors. Perinatal depression rates are higher among women aged 19 years or younger, women of American Indian or Alaska Native ethnicity, those with fewer than 12 years of education, unmarried women, and those with at least six stressful life events in the previous 12 months.

Acts of harming themselves or others are rare in women with perinatal depression; however, women with the disorder experience more thoughts of harming their infants than women without the disorder. In addition, perinatal depression negatively affects a woman's ability to parent her child, and children of affected women may experience problems with emotional and cognitive development.

Symptoms of perinatal depression include decreased interest and energy, depressed mood, alterations in sleep or eating patterns, difficulty thinking or concentrating, feeling worthless, and repeated suicidal ideation. Depressed mood or loss of interest must occur and be present for at least 2 weeks. Perinatal depression is more severe than postpartum "baby blues" — "a commonly experienced transient mood disturbance consisting of crying, irritability, fatigue, and anxiety that usually resolves within 10 days of delivery," the authors explain in the guideline.

The guideline is the first from the USPSTF to address perinatal depression; the draft recommendation statement and evidence review are available for public comment on the USPSTF website through September 24, 2018.

The guideline and evidence review authors have reported no relevant financial relationships.

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