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Cited by 563Maternal Mental Health During Pregnancy and PostpartumAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

Primary Care Screening for and Treatment of Depression in Pregnant and Postpartum Women: Evidence Report and Systematic Review for the US Preventive Services Task Force

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O’Connor, Elizabeth, Rossom, Rebecca C., Henninger, Michelle, Groom, Holly C., Burda, Brittany U.·2016·JAMA
DOI 10.1001/jama.2015.18948
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Abstract

IMPORTANCE: Depression is a source of substantial burden for individuals and their families, including women during the pregnant and postpartum period. OBJECTIVE: To systematically review the benefits and harms of depression screening and treatment, and accuracy of selected screening instruments, for pregnant and postpartum women. Evidence for depression screening in adults in general is available in the full report. DATA SOURCES: MEDLINE, PubMed, PsycINFO, and the Cochrane Collaboration Registry of Controlled Trials through January 20, 2015; references; and government websites. STUDY SELECTION: English-language trials of benefits and harms of depression screening, depression treatment in pregnant and postpartum women with screen-detected depression, and diagnostic accuracy studies of depression screening instruments in pregnant and postpartum women. DATA EXTRACTION AND SYNTHESIS: Two investigators independently reviewed abstracts and full-text articles and extracted data from fair- and good-quality studies. Random-effects meta-analysis was used to estimate the benefit of cognitive behavioral therapy (CBT) in pregnant and postpartum women. MAIN OUTCOMES AND MEASURES: Depression remission, prevalence, symptoms, and related measures of depression recovery or response; sensitivity and specificity of selected screening measures to detect depression; and serious adverse effects of antidepressant treatment. RESULTS: Among pregnant and postpartum women 18 years and older, 6 trials (n = 11,869) showed 18% to 59% relative reductions with screening programs, or 2.1% to 9.1% absolute reductions, in the risk of depression at follow-up (3-5 months) after participation in programs involving depression screening, with or without additional treatment components, compared with usual care. Based on 23 studies (n = 5398), a cutoff of 13 on the English-language Edinburgh Postnatal Depression Scale demonstrated sensitivity ranging from 0.67 (95% CI, 0.18-0.96) to 1.00 (95% CI, 0.67-1.00) and specificity consistently 0.87 or higher. Data were sparse for Patient Health Questionnaire instruments. Pooled results for the benefit of CBT for pregnant and postpartum women with screen-detected depression showed an increase in the likelihood of remission (pooled relative risk, 1.34 [95% CI, 1.19-1.50]; No. of studies [K] = 10, I2 = 7.9%) compared with usual care, with absolute increases ranging from 6.2% to 34.6%. Observational evidence showed that second-generation antidepressant use during pregnancy may be associated with small increases in the risks of potentially serious harms. CONCLUSIONS AND RELEVANCE: Direct and indirect 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. Evidence for pregnant women was sparser but was consistent with the evidence for postpartum women regarding the benefits of screening, the benefits of treatment, and screening instrument accuracy.

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Crossref · 10.1001/jama.2015.18948

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  • CBT and IPT are recommended for the treatment of antenatal and postnatal depression.

    “cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT) are recommended for the treatment of antenatal and postnatal depression (Matrics Cymru, 2017;NICE, 2014;O'Connor et al., 2016).”

    From Acceptance and Commitment Therapy for perinatal mood and anxiety disorders: A feasibility and proof of concept study. (2020) · cites this paper as O'Connor et al., 2016

    Key Question 4 (page not available) reports that CBT or related interventions increased short-term remission, with similar effects in pregnant and postpartum women. It does not report evidence for interpersonal psychotherapy (IPT) or recommend both therapies; the CBT finding supports only part of the attributed claim. (LLM, conf=0.87)

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  • The evidence base for psychological therapies in the perinatal context has largely focused on the prevention and treatment of mild-to-moderate depression, particularly postnatal depression.

    “The evidence base for psychological therapies in the perinatal context has largely focused on the prevention and treatment of mild-to-moderate depressionparticularly postnatal depression (Dennis, & Hodnett, 2007;O'Connor et al., 2016).”

    From Acceptance and Commitment Therapy for perinatal mood and anxiety disorders: A feasibility and proof of concept study. (2020) · cites this paper as O'Connor et al., 2016

    Key Question 4 reports that 15 of 18 intervention trials recruited postpartum women and that CBT or related therapies were the most common behavioral interventions. The Discussion says treatment studies generally excluded women with the greatest disease severity. However, the review included only treatment results from a trial that also studied prevention, so it does not establish the claim about a prevention evidence base or specifically characterize the studied depression as mild-to-moderate. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Barriers to care include stigma, risks of using antidepressant medications during pregnancy, lack of time, childcare issues, limited resources, high stress, lack of transportation, and inadequate support.

    “Stigma, risks of using antidepressant medications during pregnancy, lack of time, childcare issues, as well as limited resources, particularly in rural regions, high amounts of stress, lack of transportation and inadequate support were identified as impeding barriers to care [6, 21, 25].”

    From Mental health-related telemedicine interventions for pregnant women and new mothers: a systematic literature review (2023) · cites this paper as [21]

    Key Question 5b reports associations between antidepressant use during pregnancy and some serious maternal and infant harms. The cited paper does not identify those risks as barriers to care, or substantiate the listed barriers involving stigma, time, childcare, rural resources, stress, transportation, or support. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Psychological interventions are particularly pertinent in the perinatal context given the potential risks to foetal and infant development associated with psychotropic medication exposure.

    “and particularly pertinent in the perinatal context given the potential risks to foetal and infant development associated with psychotropic medication exposure (Howard et al., 2014;O'Connor, Rossom, Henninger, Groom, & Burda, 2016;Waters, Hay, Simmonds, & vanGoozen, 2014).”

    From Acceptance and Commitment Therapy for perinatal mood and anxiety disorders: A feasibility and proof of concept study. (2020) · cites this paper as O'Connor, Rossom, Henninger, Groom, & Burda, 2016

  • Evidence suggests that screening for postpartum depression can reduce depressive symptoms in women with depression and decrease the prevalence of depression in the population, especially when combined with treatment.

    “Evidence suggests that screening for PPD can reduce depressive symptoms in women with depression and decrease the prevalence of depression in the population, especially when combined with treatment [12].”

    From Challenges in diagnosing and treating postpartum depression in the primary care Setting- a qualitative study (2025) · cites this paper as [12]

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Research works printed but not linked: 4

  1. O'Connor E, Rossom RC, Henninger M, et al. Screening for Depression in Adults: An Updated Systematic Evidence Review for the US Preventive Services Task Force: Evidence Synthesis No. 128 [AHRQ Publication No. 14-05208-EF-1]. Rockville, MD: Agency for Healthcare Research and Quality; 2016.
  2. Chen H, Bautista D, Ch'ng YC, Li W, Chan E, Rush AJ. Screening for postnatal depression in Chinese-speaking women using the Hong Kong translated version of the Edinburgh Postnatal Depression Scale. Asia Pac Psychiatry. 2013;5(2): E64-E72.
  3. Hayes RM, Wu P, Shelton RC, et al. Maternal antidepressant use and adverse outcomes: a cohort study of 228,876 pregnancies [published correction appears in Am J Obstet Gynecol. 2013;208(4):326].
  4. Am J Obstet Gynecol. 2012;207(1):49.e1-49.e9.

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Authors
O’Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U.
Affiliations
Kaiser Permanente (US)
Corresponding author
O’Connor, Elizabeth
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2016-01-26
Volume
315
Issue
4
Pages
388
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2015.18948
OpenAlex
W2264673320
Cited by
563
References
94
Citations by year
2026: 42 · 2025: 47 · 2024: 43 · 2023: 58 · 2022: 55 · 2021: 75 · 2020: 65 · 2019: 60 · 2018: 52 · 2017: 47 · 2016: 19
FWCI
8.77
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
Agency for Healthcare Research and Quality
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
depression screening, postpartum depression, pregnancy, primary care, cognitive behavioral therapy, antidepressants, Edinburgh Postnatal Depression Scale, Patient Health Questionnaire, depression remission, maternal mental health
MeSH terms
Adult, Antidepressive Agents, Depression, Female, Humans, Mass Screening, Pregnancy, Pregnancy Complications, Surveys and Questionnaires, Remission Induction, Sensitivity and Specificity, United States, Cognitive Behavioral Therapy, Antidepressive Agents, Second-Generation, Depression, Postpartum, Advisory Committees

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