USPSTF: Refer pregnant, postpartum women at increased risk for perinatal depression to counseling
The U.S. Preventive Services Task Force recently gave a ‘B’ level recommendation to referring pregnant women and women less than 1-year postpartum at increased risk of perinatal depression for counseling-based interventions.
The recommendation, published in JAMA, is the first the USPSTF made for this condition.
There is no accurate screening tool for ascertaining who is at risk for perinatal depression, but some risk factors have been identified: intimate partner violence, stressful events, history of physical or sexual abuse and depression, unwanted or unplanned pregnancy, and complications during pregnancy, Katherine O’Connor, PhD, of the Kaiser Permanente Research Affiliates Evidence-Based Practice Center in Oregon, and colleagues wrote.
Women with low socioeconomic status, who lack of social support and who gave birth as a teenager are a greater risk for developing perinatal depression after delivery, they added.
O’Connor and colleagues reviewed 50 studies. Of the interventions studied, counseling-based interventions were associated with a lower likelihood of perinatal depression onset vs. controls (pooled RR = 0.61; 95% CI, 0.47-0.78). The absolute difference in risk for perinatal depression ranged from 31.8% greater reduction in the intervention group vs. 1.3% in the control group.
“Counseling interventions can be effective in preventing perinatal depression, although most evidence was limited to women at increased risk for perinatal depression. A variety of other intervention approaches provided some evidence of effectiveness but lacked a robust evidence base and need further research,” O’Connor and colleagues wrote.
In a related editorial, Marlene P. Freeman, MD, of the department of psychiatry at Massachusetts General Hospital, wrote that there are barriers to overcome before applying the USPSTF recommendations in clinical practice.
“Feasibility will require a commitment of resources and continued research into how to one: identify at-risk women, two: connect identified women to evidence-based treatments, and three: assess outcomes,” she wrote.
The ways to help these females will not be run-of-the-mill and will likely involve some effort to come to fruition, Freeman added.
“The delivery of effective care on a large scale will require creative solutions. The counseling interventions with the most robust efficacy ... require education and training. ... Options such as training of lay personnel or large-scale telehealth or internet- and smartphone-based platforms should be considered. Also, multidisciplinary teams should be involved in the care of women at the highest risk of severe illness and specialty consultation should be available for women who develop acute psychiatric illness and require more complex care,” she wrote. – by Janel Miller
Freeman MP. JAMA. 2019;published online ahead of print.
O'Connor E, et al. JAMA. 2019;doi:10.1001/jama.2018.20865
U.S. Preventive Services Task Force. JAMA. 2019;doi:10.1001/jama.2019.0007.
Disclosures: Please see the studies and editorial for the authors relevant financial disclosures.