The DOI matches its Crossref record; 94 of the 94 references it cites were found in a registry or an index.
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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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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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“…or individual format [189], and also is recommended as the first-line approach for perinatal women with a new mild to moderate depression episode [190], it is not widely available, particularly to people in rural areas, because of excessive costs or unprepared socio-cultural context for…”
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Hamidia, A., Kheirkhah, F., Chehrazi, M., Basirat, Z., Ghadimi, R., Barat, S., Cuijpers, P. J., O’Connor, E., Mirtabar, S. M., & Faramarzi, M. (2022) · Health Science Reports · doi:10.1002/hsr2.518 · Cited by 24
“Indeed, a systematic review confirmed that screening programs in perinatal women reduced the likelihood of depression at 3 to 5 months' follow-up.(9) Women with high-risk pregnancies, associated with obstetric complications, seem to be at particularly increased risk for developing mental disorders.”
BackgroundResultSelf-citationFear and anxiety related to COVID-19 pandemic may predispose to perinatal depression in Italy
Orsolini, L., Pompili, S., Mauro, A., Salvi, V., & Volpe, U. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.977681 · Cited by 24
State Public Insurance Coverage Policies and Postpartum Care Among Immigrants
Steenland, M. W., FABI, R. E., Bellerose, M., Desir, A., White, M. S., & Wherry, L. (2023) · JAMA · doi:10.1001/jama.2023.10249 · Cited by 24
Ammerman, R. T., Mallow, P. J., Rizzo, J. A., Putnam, F. W., & Ginkel, J. B. V. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.10.041 · Cited by 26
“Recently, there have been calls to identify, screen, and treat mothers in the context of other programs that provide services to lowincome mothers as a way to overcome these barriers (O’Connor et al., 2016).”
BackgroundPinheiro, R. T., Trettim, J. P., de Matos, M. B., Pinheiro, K. A. T., da Silva, R. A., Martins, C. D. S. R., da Cunha, G. K., Coelho, F. T., Motta, J. V. D. S., Coelho, F. M. D. C., et al. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.04.031 · Cited by 23
Johnson, A., Stevenson, E. L., Moeller, L., & McMillian-Bohler, J. M. (2021) · Journal of Midwifery & Women s Health · doi:10.1111/jmwh.13215 · Cited by 23
Cultivating mental health education in obstetrics and gynecology: a call to action
Hutner, L. A., Yeaton‐Massey, A., Toscano, M. A., Coulehan, J., Hage, B., Gopalan, P. R., Doyle, M., Olgun, M., Frew, J. R., Nagle-Yang, S. M., et al. (2021) · American Journal of Obstetrics & Gynecology MFM · doi:10.1016/j.ajogmf.2021.100459 · Cited by 23
Brehaut, E., Neupane, D., Levis, B., Wu, Y., Sun, Y. B., Ioannidis, J. P. A., Markham, S., Cuijpers, P. J., Patten, S. B., Benedetti, A., et al. (2022) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1956 · Cited by 27
“…those with more severe symptoms may be more likely to engage in and benefit from treatment than those with only mild and possibly transient symptoms (Cuijpers, 2018; Fournier et al., 2010; Furukawa et al., 2018; Gibbons et al., 2012; Khan et al., 2005; Kirsch et al., 2008; Rabinowitz et al., 2016).”
BackgroundDelavari, M., Mirghafourvand, M., & Mohammad‐Alizadeh‐Charandabi, S. (2017) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2017.1344961 · Cited by 23
Using the EPDS to Identify Anxiety in Mothers of Infants on the Neonatal Intensive Care Unit
Stasik-O’Brien, S. M., McCabe‐Beane, J. E., & Segre, L. S. (2017) · Clinical Nursing Research · doi:10.1177/1054773817740532 · Cited by 22
“…these findings suggest that the recent US Preventive Services Task Force (USPTSF) recommendation to screen for depression once in pregnancy and once in the postpartum period (E. O’Connor et al., 2016) will miss some emotionally distressed women, whose symptoms manifest primarily as anxiety.”
BackgroundHenderson, C., Dixon, S., Bauer, A., Knapp, M., Morrell, C. J., Slade, P., Walters, S. J., & Brugha, T. (2019) · Psychological Medicine · doi:10.1017/s0033291718001940 · Cited by 21
A systematic review of screening for perinatal depression and anxiety in community-based settings
Bhat, A., Nanda, A., Murphy, L., Ball, A. L., Fortney, J., & Katon, J. (2022) · Archives of Women's Mental Health · doi:10.1007/s00737-021-01151-2 · Cited by 47
Machine learning prediction models for postpartum depression: A multicenter study in Japan
Matsuo, S., Ushida, T., Emoto, R., Moriyama, Y., Iitani, Y., Nakamura, N., Imai, K., Nakano‐Kobayashi, T., Yoshida, S., Yamashita, M., et al. (2022) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.15266 · Cited by 21
Effati-Daryani, F., Mohammad‐Alizadeh‐Charandabi, S., Zarei, S., Mohammadi, A., & Mirghafourvand, M. (2018) · International Journal of Culture and Mental Health · doi:10.1080/17542863.2018.1438484 · Cited by 21
Parry, B. L., Meliska, C. J., López, A. M. V., Sorenson, D. L., Martinez, L. F., Orff, H. J., Hauger, R. L., & Kripke, D. F. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.11.064 · Cited by 22
“Using strict criteria, our findings that after one night, two-thirds of pregnant DP responded and remitted to EWT, and two-thirds of postpartum DP responded to LWT, compare favorably with the 46% remission rate achieved with antidepressants and 48% with psychotherapy after 10–16 weeks in DP, and with the 34–35% increa…”
ResultYapp, E., Howard, L. M., Kadicheeni, M., Telesia, L., Milgrom, J., & Trevillion, K. (2019) · Midwifery · doi:10.1016/j.midw.2019.03.021 · Cited by 21
Association of Antenatal Depression with Clinical Subtypes of Preterm Birth
Venkatesh, K. K., Ferguson, K. K., Smith, N. A., Cantonwine, D. E., & McElrath, T. F. (2018) · American Journal of Perinatology · doi:10.1055/s-0038-1675646 · Cited by 24
Terrone, G., Mangialavori, S., di Scalea, G. L., Cantiano, A., Temporin, G., Ducci, G., Gori, A., Cacioppo, M., Schimmenti, A., & Caretti, V. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.05.040 · Cited by 21
Muñoz, M. D. L. F. R., Motrico, E., Míguez, M. C., Chaves, C., Suso‐Ribera, C., Duque, A., Salinas, M. G., Caparrós-González, R. A., Martín-Agudiez, N., Kovacheva, K. I., et al. (2023) · Clínica y Salud · doi:10.5093/clysa2023a15 · Cited by 33
Slavin, V., Creedy, D. K., & Gamble, J. A. (2020) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-020-02891-2 · Cited by 20
“Screening women for depression during the perinatal period may reduce depressive symptoms and prevalence [18] but there lacks international consensus regarding the best approach.”
BackgroundShenassa, E. D., Widemann, L., & Hunt, C. D. (2021) · Current Psychiatry Reports · doi:10.1007/s11920-021-01223-1 · Cited by 20
Bhandari, P. M., Levis, B., Neupane, D., Patten, S. B., Shrier, I., Thombs, B. D., Benedetti, A., Sun, Y., He, C., Rice, D. B., et al. (2021) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2021.03.031 · Cited by 22
Beck, A., Hamel, C., Thuku, M., Esmaeilisaraji, L., Bennett, A., Shaver, N., Skidmore, B., Colman, I., Grigoriadis, S., Nicholls, S. G., et al. (2022) · Systematic Reviews · doi:10.1186/s13643-022-02022-2 · Cited by 23
Experiences with use of technology and telehealth among women with perinatal depression
Parameswaran, U., Pentecost, R., Williams, M., Smid, M. C., & Latendresse, G. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-04889-4 · Cited by 19
Yang, Y., Wang, T., Wang, D., Liu, M., Lun, S., Ma, S., & Yin, J. (2024) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2024.04.011 · Cited by 19
Maternal depression treatment in HIV (M-DEPTH)
Wagner, G. J., McBain, R. K., Akena, D. H., Ngo, V. K., Nakigudde, J., Nakku, J. E. M., Chemusto, H., Beyeza‐Kashesya, J., Gwokyalya, V., Faherty, L. J., et al. (2019) · Medicine · doi:10.1097/md.0000000000016329 · Cited by 20
Neupane, D., Levis, B., Bhandari, P. M., Thombs, B. D., & Benedetti, A. (2021) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1873 · Cited by 19
“In the absence of a single standard cutoff, EPDS studies often report a range of cutoffs from 10 to 13 (Hewitt et al., 2009; O'Connor et al., 2016).”
BackgroundMethodJanuary, J., & Chimbari, M. J. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019085 · Cited by 18
Sunnqvist, C., Sjöström, K., & Finnbogadóttir, H. (2019) · International Journal of Women s Health · doi:10.2147/ijwh.s185930 · Cited by 22
“There is evidence that pregnant women with major depressive disorder require medical therapy(11) and psychotherapy for mild and moderate depressive disorders.(12) According to a review by O’Connor et al,(12) the absolute risk of antidepressant during pregnancy appear to be small, and cognitive behavioral therapy may b…”
BackgroundNurse–Patient Interaction as a Treatment for Antepartum Depression: A Mixed-Methods Analysis
Evans, E. C., Deutsch, N. L., Drake, E., & Bullock, L. (2017) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390317705449 · Cited by 19
“In January 2016, the U.S. Preventive Services Task Force (USPSTF) recommended the screening of adults for depression, including pregnant and postpartum women, highlighting the fact that depression during pregnancy is a serious health care problem needing greater awareness, treatment, and research (O’Connor, Rossom, He…”
BackgroundMethodInfluentialYe, Y., Chen, L., Xu, J., Dai, Q., Luo, X., Shan, N., & Qi, H. (2021) · BioMed Research International · doi:10.1155/2021/6641510 · Cited by 20
“87 or higher when the cut-off value is 13 [21].”
BackgroundGoldstein, E., Brown, R., Lennon, R. P., & Zgierska, A. E. (2022) · Birth · doi:10.1111/birt.12664 · Cited by 18
Fatemi, A., Amiri, F. N., Faramarzi, M., Chehrazi, M., Rad, H. A., & Pahlavan, Z. (2023) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-023-05650-1 · Cited by 18
Yoshioka‐Maeda, K., & Kuroda, M. (2017) · Public Health Nursing · doi:10.1111/phn.12328 · Cited by 18
The dynamic serotonin system of the maternal brain
Lonstein, J. S. (2018) · Archives of Women s Mental Health · doi:10.1007/s00737-018-0887-1 · Cited by 22
“Because of a desperate need for increased attention to maternal affective disorders, the United States Preventive Services Task Force and the American College of Obstetricians and Gynecologists each recently recommended routine mental health screening for all pregnant and postpartum women (Committee on Obstetric Pract…”
Review of the Assessment and Management of Perinatal Mood and Anxiety Disorders
Weingarten, S. J., & Osborne, L. M. (2024) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20230023 · Cited by 17
Muthelo, L., Mbombi, M. O., Mphekgwana, P. M., Mabila, L. N., Dhau, I., Tlouyamma, J., Mashaba, R. G., Mothapo, K., Ntimana, C. B., Seakamela, K. P., et al. (2024) · BMC Women s Health · doi:10.1186/s12905-024-03040-z · Cited by 24
Fusar‐Poli, P., Estradé, A., Mathi, K., Mabia, C., Yanayirah, N., Floris, V., Figazzolo, E., Esposito, C. M., Mancini, M., Rosfort, R., et al. (2025) · World Psychiatry · doi:10.1002/wps.21264 · Cited by 25
“Because of the risk and high impact on the mother-baby dyad (postpartum psychosis is considered a psychiatric emergency 1 ), screening women for these conditions and preventive interventions are clinically recommended 14-16 .”
Cheng, J., Ren, Z., Rehman, S., Zhou, Z., Wang, X., Wang, Y., Peng, Y., Xiong, J., Qin, X., Peng, Z., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.02.004 · Cited by 19
Yang, S., Yang, S., Duan, K., Tang, Y., Ping, A., Bai, Z.-H., Gao, K., Shen, Y., Chen, M., Yu, R.-L., et al. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.09.099 · Cited by 22
Dörsam, A. F., Bye, A., Graf, J., Howard, L. M., Throm, J. K., Müller, M., Wallwiener, S., Zipfel, S., Micali, N., & Giel, K. E. (2022) · International Journal of Eating Disorders · doi:10.1002/eat.23780 · Cited by 17
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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