On Feb. 12, the U.S. Preventive Services Task Force (USPSTF) posted a final recommendation statement(www.uspreventiveservicestaskforce.org) and final evidence summary(www.uspreventiveservicestaskforce.org) on interventions to prevent perinatal depression.
After examining the available evidence, the USPSTF found that counseling can help prevent perinatal depression in women who are at increased risk.
Accordingly, the task force recommends clinicians provide or refer pregnant and postpartum women who are at increased risk of perinatal depression to counseling interventions, such as cognitive behavioral therapy or interpersonal therapy. This is a "B" recommendation.(www.uspreventiveservicestaskforce.org)
"Effective counseling interventions can help prevent perinatal depression before it develops," said USPSTF member Karina Davidson, Ph.D., M.A.Sc., in a news release.(www.uspreventiveservicestaskforce.org) "We can help prevent one of the most common and serious complications of having a baby."
This recommendation applies to pregnant women and women who gave birth within the past year who are at increased risk for depression. There currently is no accurate screening tool available to identify women at risk for perinatal depression. The most common risk factors used in the studies task force members reviewed included a history of depression, current depressive symptoms, and socioeconomic risk factors such as being a young or single parent.
"Clinicians should use patient history and risk factors to identify pregnant or postpartum individuals who are most likely to benefit from counseling," said USPSTF member Aaron Caughey, M.D., M.P.P., M.P.H., Ph.D., in the release.
Note, too, that this final recommendation statement does not apply to women who are already diagnosed with depression.
This final recommendation statement is consistent with the USPSTF's August 2018 draft recommendation.
Response to Public Comment
A draft version of this recommendation statement was posted for public comment on the USPSTF website from Aug. 28 to Sept. 24, 2018.
Some commenters suggested the recommendation should be expanded to include associated mood disorders (such as anxiety disorder). However, the task force affirmed that the primary focus of its recommendation and evidence review was depression, noting that several additional outcomes (including anxiety) were included in the scope of the evidence review but reporting on incidence or symptoms was limited and inconsistent.
Other commenters asked why perinatal depression screening tools such as the Edinburgh Postnatal Depression Scale were not recommended as risk-assessment tools. Additionally, commenters were looking for clarification regarding the population at risk that would benefit from counseling interventions.
"The focus of this recommendation is the prevention of depression; the USPSTF has a separate recommendation on screening for depression in all adults, including pregnant women,(www.uspreventiveservicestaskforce.org)" the final recommendation statement pointed out.
More studies are needed on the use of tools for risk assessment, including established screening tools, the task force said.(www.uspreventiveservicestaskforce.org) The task force also noted that it revised who it said would be at increased risk for depression based on the available study population.
Finally, several commenters voiced concerns that clinicians might struggle to implement these recommendations due to lack of access to mental health services.
"The USPSTF recognizes these barriers and provided some additional information about mental health resources and systems to connect patients to appropriate care in the Implementation section (under Other Considerations) and Additional Approaches to Prevention of Depression section (under Clinical Considerations(www.uspreventiveservicestaskforce.org) subhead)," the final recommendation said.
The AAFP's Commission on Health of the Public and Science plans to review the USPSTF's final recommendation statement and evidence summary and determine the Academy's stance on the recommendation.
Related AAFP News Coverage
Leader Voices Blog: At Home or Abroad, ALSO Training Improves Maternal Outcomes
More From AAFP
American Family Physician: Identification and Management of Peripartum Depression
American College of Obstetricians and Gynecologists: Committee on Obstetric Practice; Committee Opinion No. 757; Oct. 24, 2018 (Replaces Committee Opinion No. 630, May 2015): Screening for Perinatal Depression(www.acog.org)