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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
Open accessAbstract
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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“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
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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 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
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“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]
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“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
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“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]
In the citing paper
“The systematic review conducted to support the USPSTF guideline reported the range of accuracy estimates for EPDS cut-off values of 10 or higher (14 studies) and 13 or higher (17 studies) in 23 primary studies, but did not include a meta-analysis.14 15”
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The association of unplanned pregnancy with perinatal depression: a longitudinal cohort study
Muskens, L., Boekhorst, M. G. B. M., Kop, W. J., van den Heuvel, M. I., Pop, V. J. M., & Beerthuizen, A. (2022) · Archives of Women s Mental Health · doi:10.1007/s00737-022-01225-9 · Cited by 73
Goletzke, J., Kocalevent, R.-D., Hansen, G., Rose, M., Becher, H., Hecher, K., Arck, P., & Diemert, A. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.09.002 · Cited by 63
Appraisal of systematic reviews on interventions for postpartum depression: systematic review
Chow, R., Huang, E., Li, A., Li, S. H., Fu, S. Y., Son, J. S., & Foster, L. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-020-03496-5 · Cited by 63
Boekhorst, M. G. B. M., Muskens, L., Hulsbosch, L. P., Deun, K. V., Bergink, V., Pop, V. J. M., & van den Heuvel, M. I. (2021) · Archives of Women s Mental Health · doi:10.1007/s00737-021-01104-9 · Cited by 60
Effect of Brief Interpersonal Therapy on Depression During Pregnancy
Hankin, B. L., Demers, C. H., Hennessey, E. P., Perzow, S. E. D., Curran, M. C., Gallop, R., Hoffman, M. C., & Davis, E. P. (2023) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2023.0702 · Cited by 64
Mental Health Problems and Cancer Risk Factors Among Young Adults
Massetti, G. M., Thomas, C. C., King, J., Ragan, K. R., & Lunsford, N. B. (2017) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2017.04.023 · Cited by 57
Yang, S. Q., Zhou, Y., Yang, S. T., Mao, X., Chen, L., Bai, Z.-H., Ping, A. Q., Xu, S. Y., Li, Q. W., Gao, K., et al. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.07.007 · Cited by 58
Gariepy, A. M., Lundsberg, L. S., Miller, D., Stanwood, N. L., & Yonkers, K. A. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.06.058 · Cited by 63
“…and Gynecologists (American College of Obstetricians and Gynecologists, 2015) and from the United States Preventive Services Task Force (O’Connor et al., 2016) to screen and provide appropriate treatment for depression and anxiety at least once during the perinatal period for all…”
BackgroundResultPrenatal risk factors for internalizing and externalizing problems in childhood
Tien, J., Lewis, G. D., & Liu, J. (2019) · World Journal of Pediatrics · doi:10.1007/s12519-019-00319-2 · Cited by 59
“Recent evidence suggests that simply screening pregnant women, even without additional treatment-related support, increased rates of treatment seeking and reduced the prevalence of depression [172].”
BackgroundKingston, D. E., Austin, M., van Zanten, S. V., Harvalik, P., Giallo, R., McDonald, S. D., MacQUEEN, G. M., Vermeyden, L., Lasiuk, G. C., Sword, W. A., et al. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.6866 · Cited by 63
Reilly, N., Kingston, D., Loxton, D., Talcevska, K., & Austin, M. (2020) · Women and Birth · doi:10.1016/j.wombi.2019.03.004 · Cited by 54
Wang, G., Deng, Y., Jiang, Y., Lin, Q., Dong, S., Song, Y., Zhu, L., Zhu, Q., Sun, W., Zhang, Y., et al. (2018) · SLEEP · doi:10.1093/sleep/zsy179 · Cited by 55
“The success of primary care screening for and treatment of depression in pregnant and postpartum women could be readily translated into sleep problems and other mood disturbances [62].”
BackgroundNaja, S., Al-Kubaisi, N., Chehab, M. A. H., Al-Dahshan, A., Adli, N., & Bougmiza, I. M. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-030365 · Cited by 55
Stentzel, U., Grabe, H. J., Schmidt, S., Tomczyk, S., van den Berg, N., & Beyer, A. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04790-0 · Cited by 52
“Diagnostics and treatment are needed as early as possible [11, 20, 21].”
BackgroundRadoš, S. N., Akik, B. K., Žutić, M., Muñoz, M. D. L. F. R., Uriko, K., Motrico, E., Moreno-Peral, P., Apter, G., & den Berg, M. P. L. (2024) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2024.152456 · Cited by 74
Association of Antenatal Depression Symptoms and Antidepressant Treatment With Preterm Birth
Venkatesh, K. K., Riley, L. E., Castro, V. M., Perlis, R. H., & Kaimal, A. J. (2016) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000001397 · Cited by 55
“In general, these findings support current national efforts underway to expand universal antepartum depression screening in pregnancy as part of routine prenatal care to further the goal of optimizing both maternal and neonatal outcome.(3,22) If additional studies support the finding of decreased risk among women bein…”
ResultA qualitative inquiry on pregnant women’s preferences for mental health screening
Bayrampour, H., McNeil, D. A., Benzies, K., Salmon, C., Gelb, K. R., & Tough, S. (2017) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-017-1512-4 · Cited by 54
The dynamic course of peripartum depression across pregnancy and childbirth
Dekel, S., Ein‐Dor, T., Ruohomäki, A., Lampi, J., Voutilainen, S., Tuomainen, T., Heinonen, S. T., Kumpulainen, K., Pekkanen, J., Keski‐Nisula, L., et al. (2019) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2019.03.016 · Cited by 58
Mota, N. P., Chartier, M., Ekuma, O., Nie, Y., Hensel, J. M., MacWilliam, L., McDougall, C., Vigod, S. N., & Bolton, J. M. (2019) · The Canadian Journal of Psychiatry · doi:10.1177/0706743719838784 · Cited by 55
Silang, K. A., Sohal, P. R., Bright, K. S., Leason, J., Roos, L., Lebel, C., Giesbrecht, G. F., & Tomfohr-Madsen, L. M. (2022) · JMIR Mental Health · doi:10.2196/31116 · Cited by 50
“Screening alone, even without further treatment, has shown significant reductions in depression during the perinatal period [25].”
BackgroundReligiosity/Spirituality and Mental Health and Quality of Life of Early Pregnant Women
Panconi, C. R., Almeida, V. D. C., Ezequiel, O. D. S., Fajardo, E. F. D. M., Lucchetti, A. L. G., & Lucchetti, G. (2021) · Journal of Religion and Health · doi:10.1007/s10943-020-01124-2 · Cited by 52
Seeking an Objective Diagnosis of Depression
Bilello, J. A. (2016) · Biomarkers in Medicine · doi:10.2217/bmm-2016-0076 · Cited by 52
Waters, C. S., Annear, B., Flockhart, G., Jones, I., Simmonds, J. R., Smith, S., Traylor, C., & Williams, J. F. (2020) · British Journal of Clinical Psychology · doi:10.1111/bjc.12261 · Cited by 51
“…(NICE, 2014), 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).”
BackgroundWilley, S., Blackmore, R., Gibson‐Helm, M. E., Ali, R., Boyd, L., McBride, J., & Boyle, J. A. (2019) · Women and Birth · doi:10.1016/j.wombi.2019.10.003 · Cited by 50
Rondung, E., Massoudi, P., Nieminen, K., Wickberg, B., Peira, N., Silverstein, R. A., Moberg, K., Lundqvist, M., Grundberg, Å., & Hultcrantz, M. (2023) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.14734 · Cited by 61
“Both previously published 9,10 and later 11 systematic reviews have reported similar findings, revealing a paucity of primary studies evaluating potential positive and negative effects of structured case-identification of depression and anxiety during pregnancy.”
BackgroundDeprato, A., Ruchat, S.-M., Ali, M. U., Cai, C., Forte, M., Gierc, M. S. H., Meyer, S., Sjwed, T. N., Shirazi, S., Matenchuk, B. A., et al. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-108478 · Cited by 55
Tandon, S. D., Mackrain, M., Beeber, L. S., Topping-Tailby, N., Raska, M., & Arbour, M. (2020) · PLoS ONE · doi:10.1371/journal.pone.0230211 · Cited by 54
“Two recent evidence reports from the Task Force highlight postpartum depression; one focuses on the value of screening pregnant and postpartum women for depression to facilitate reduction in depressive symptoms [60], and the other notes a number of effective counseling interventions to prevent postpartum depression [6…”
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Perinatal weight and risk of prenatal and postpartum depressive symptoms
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Eustis, E. H., Ernst, S., Sutton, K., & Battle, C. L. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1121-1 · Cited by 45
Bem-estar e saúde mental materna
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Blackwell, C. K., Tang, X., Elliott, A., Thomes, T., Louwagie, H., Gershon, R. C., Schalet, B. D., & Cella, D. F. (2021) · Psychological Assessment · doi:10.1037/pas0001009 · Cited by 43
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Screening for Depression in Pregnancy and the Postpartum Period
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Different trajectories of depressive symptoms during pregnancy
Boekhorst, M. G. B. M., Beerthuizen, A., Endendijk, J. J., van Broekhoven, K. E. M., van Baar, A. L., Bergink, V., & Pop, V. J. M. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.01.021 · Cited by 48
Different patterns of depressive symptoms during pregnancy
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“Furthermore, the US Preventive Services Task Force has recently advocated for this screening (O’Connor et al. 2016; Siu et al. 2016).”
BackgroundBurger, H., Verbeek, T., Aris-Meijer, J. L., Beijers, C., Mol, B. W., Hollon, S. D., Ormel, J., van Pampus, M. G., & Bockting, C. L. H. (2020) · The British Journal of Psychiatry · doi:10.1192/bjp.2019.260 · Cited by 41
Metadata
- Authors
- O’Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U.
- Affiliations
- Kaiser Permanente (US)
- Corresponding author
- O’Connor, Elizabeth
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2016-01-26
- Volume
- 315
- Issue
- 4
- Pages
- 388
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- 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
- bronze
- doi.org
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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