An influential national task force has for the first time recommended depression screening for pregnant and postpartum women as part of its screening guidelines for all adults. The guidelines, published Tuesday in JAMA, say screening should be accompanied with effective treatment or referral to someone who can provide care.
The U.S. Preventive Services Task Force's recommendation comes amid growing awareness that depression can be a significant burden on mothers, their newborn children and their families. Between 8 and 19 percent of women have reported frequent postpartum depressive symptoms, according to the Centers for Disease Control and Prevention.
But "awareness is different from recommending that there be routine screening," says Dr. Karina Davidson, a Task Force member and professor of behavioral medicine at Columbia University Medical Center.
"One of the hopes the task force has is that this report will instigate routine screening of pregnant and postpartum women so we can find the women in need of depression treatment and make sure they receive the care they need," says Davidson.
The Task Force suggests using several common screening tests, adding that people who test positive should undergo additional testing. But it says it is unable to recommend how often patients should be screened.
"We are frustrated that there isn't sufficient evidence to make recommendations about the ideal screening interval, and we are calling for more research in that area," Davidson says. "It is tempting to offer personal opinion or clinical opinion as to what is the best interval, but we really don't have the kind of studies we'd like to see having been conducted, on which to make an evidence-based recommendation."
For now, the Task Force recommends that doctors screen all patients who haven't been screened before, with additional screening for some patients based on their risk factors, other health conditions and life events.
In an editorial in JAMA Psychiatry published Tuesday, University of Pittsburgh Drs. Charles Reynolds III and Ellen Frank argue that more frequent screening – possibly every six to 12 months – is appropriate for some higher-risk patients.
Some patients, they write, don't have depression symptoms that meet the criteria for a depression diagnosis. These people benefit from preventing their symptoms from becoming more severe or chronic, say Reynolds and Frank, who add that "a particularly vulnerable group in this regard is young mothers and, by virtue of the association between untreated depression and poor outcomes in offspring, their children."
Reynolds and Frank go on to suggest that "special mention should be made of this group and of the possibility of screening mothers in the offices of their family practice or pediatric health care professionals since mothers are more likely to seek health care on a regular basis for their children than for themselves."
Risk factors for depression during pregnancy and postpartum include poor self-esteem, childcare stress, prenatal anxiety, difficult infant temperament, lower socioeconomic status and unintended pregnancy, among others, according to the Task Force.
The Task Force recommends that doctors work with adults patients with depression to determine the best treatment plan, which could include antidepressants, psychotherapy or both. Meanwhile, for pregnant women with depression, it says it has sufficient evidence to recommend cognitive behavioral therapy. The guidelines encourage doctors to consider recommending counseling to pregnant or breastfeeding women with depression, as some medications could harm the fetus or newborn child.
The Task Force, an independent panel of clinicians and scientists commissioned by the federal Agency for Healthcare Research and Quality, makes evidence-based recommendations about preventive services and issues an annual report to Congress that identifies critical evidence gaps in research related to clinical preventive services.
Its recommendations also help determine which screenings, services and preventive medications are covered by insurance under the Affordable Care Act. By assigning its screening recommendation a "B" grade, the Task Force ensures that all adults aged 18 and over, including pregnant and postpartum women, can be screened for depression with no cost sharing.