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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
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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“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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“turbance, administered during pregnancy with adequate postpartum follow-ups (O’Connor et al. 2016), will help sort out the effects of antidepressant use, which will aid in the contin-”
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“There is also considerable controversy over the optimal timing for screening and how often assessments need to be performed throughout the first postpartum year [77,78].”
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“A systematic review on by O’Connor et al. [30] reported that screening for depression throughout pregnancy can reduce symptom severity and, when integrated with follow-up interventions, lower the prevalence of clinical depression.”
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“The reported prevalence of PND in the present study is in accordance with other studies.(4,28,35) When the cutoff score on the EPDS was set on 11, another 13 women (almost 10% of the total number of participants) entered the risk zone of PND.”
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“For example, EPDS with a cut-off value of 12 or 13 is the most frequently utilized screening tool [16, 54].”
InfluentialPostpartum Depression and Its Determinants: A Cross-Sectional Study
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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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