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Full Title: Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes
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Objectives: The researchers systematically review the evidence on:
- The prevalence and incidence of perinatal depression.
- The accuracy of different screening instruments.
- The effectiveness of interventions for women screened as high risk for perinatal depression.
Data Sources: MEDLINE®, CINAHL, PsycINFO, Sociofile, and the Cochrane Library (1980 through March 2004); bibliographic hand searches; and experts.
Review Methods: Included were English-language studies that assessed women for major depression alone, or for major or minor depression. Studies of the prevalence and incidence of depression and the accuracy of screening tools had to include diagnostic confirmation. Studies involving interventions required a comparison group. The researchers conducted a meta-analysis of the prevalence and incidence estimates. as well as meta-analyses of the sensitivity and specificity of different screening instruments. Only qualitative synthesis was done for studies of screening outcomes.
Results: The researchers identified 30 studies of prevalence. For major depression alone, point prevalence estimates ranged from 3.1 percent to 4.9 percent at different times during pregnancy (8.5 percent to 11.0 percent for major or minor depression) and 1.0 percent to 5.9 percent at different times during the first postpartum year (6.5 percent to 12.9 percent for major or minor depression). However, these prevalence estimates were not significantly different from those of nonchildbearing women of similar age. Data on incidence were more limited, with only 10 studies of screening accuracy identified. One small study reported on accuracy of screening during pregnancy.
Although screening for postpartum depression appears feasible, the data precluded identifying an optimal screener or threshold for screening. The screening instruments studied are generally good at identifying major depression alone, but they performed more poorly for the combined major/minor depression category.
None of the studies directly tested whether screening improved outcomes. However, of 15 studies that used some sort of screening to identify women at risk of depression and subsequently provided intervention, 4 small studies of various psychosocial interventions during pregnancy did not demonstrate consistently superior outcomes for the experimental group. Similarly, six of nine studies of various psychosocial interventions reported significant improvement in postpartum depression for the experimental group. Two studies with pharmacologic interventions provided conflicting results.
Conclusions: Although limited, the available research suggests that depression is one of the most common perinatal complications and that screening is feasible and fairly accurate. Studies with larger sample sizes with a greater racial and ethnic mix are needed. Researchers also need to determine whether screening itself leads to better access to proven treatment and improved outcome relative to usual care.
Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes
Evidence-based Practice Center: Research Triangle Institute/University of North Carolina at Chapel Hill (RTI/UNC-CH)
Topic Nominator: Safe Motherhood Group
Current as of February 2005