NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Interventions to Prevent Perinatal Depression: A Systematic Evidence Review for the U.S. Preventive Services Task Force
Evidence Synthesis, No. 172
Investigators: Elizabeth O’Connor, PhD, Caitlyn A. Senger, MPH, Michelle Henninger, PhD, Bradley N. Gaynes, MD, MPH, Erin Coppola, MPH, and Meghan Soulsby Weyrich, MPH.
Structured Abstract
Importance:
Depression during pregnancy and postpartum is relatively common and can have negative effects on the child as well as the mother.
Objective:
To systematically review the benefits and harms of primary care-relevant interventions to prevent perinatal depression (i.e., depression during pregnancy and postpartum depression) to inform the United States Preventive Services Task Force.
Data Sources:
MEDLINE, PubMED (for publisher-supplied records only), PsycINFO, and the Cochrane Central Register of Controlled Trials; references of relevant publications, government Web sites.
Study Selection:
English-language controlled trials of interventions to prevent perinatal depression in general populations of pregnant and postpartum individuals (up to 1 year) or in those at increased risk of perinatal depression. We included trials of behavior-based interventions, including those targeting a health system or providers, as well as those examining antidepressants and dietary supplements.
Data Extraction and Synthesis:
Two investigators independently reviewed abstracts and full-text articles, then we extracted data from studies rated as fair- and good-quality, based on predetermined criteria. Random-effects meta-analysis was used to estimate the benefits of the interventions. Strength-of-evidence ratings were made based on consistency, precision, study quality, and evidence of reporting bias, taking into account the size of the evidence base and other noted limitations.
Results:
We identified 50 trials (N=22,385) that met our inclusion criteria. Counseling interventions were the most widely studied interventions; they reduced the likelihood of the onset of perinatal depression by 39 percent (pooled risk ratio [RR]=0.61 [95% confidence interval (CI), 0.47 to 0.78], k=17, n=3094, I2=39%) and showed a 1.5-point greater reduction in depression symptom levels than control conditions (weight mean difference in change between groups (WMD)= −1.51 [95% CI −2.84 to −0.18], k=14, n=1367, I2=61%). The absolute reduction in the risk of perinatal depression was highly variable across studies (range 1.3% greater reduction in the control group to 31.8% greater reduction in the intervention group), due to both variability in population differences in outcome measures reported. Two specific counseling approaches were studied in four or more separate trials in the United States, targeting high-risk women and including a substantial proportion of Black and Latina participants: the “Mothers and Babies” course, based on cognitive-behavioral therapy, and an interpersonal therapy-based approach developed by Zlotnick and colleagues, “Reach Out, Stand Strong, Essentials for new mothers” (ROSE). Pooled effects for these interventions were even larger than the overall pooled results for counseling interventions, but with overlapping confidence intervals. Health system and physical activity interventions showed similar pooled effects to the counseling interventions, but the effects were not statistically significant. In addition, none of the three health system interventions were conducted in the United States and applicability of the interventions to the United States was limited. Some other types of behavior-based interventions showed promising results (e.g., physical activity, peer counseling); however, few showed statistically significant group differences and even fewer have been replicated. None of the behavior-based interventions reported on harms directly, but the other reported outcomes did not suggest a risk of increased harm. In two studies of prophylactic use of antidepressants initiated immediately after childbirth, sertraline showed a statistically significant benefit at 20 weeks postpartum in one very small study (n analyzed=22), but with an increased risk of side effects to the mother. There was no benefit of nortriptyline use. Two trials each found that that debriefing interventions and omega-3 fatty acids (particularly docosahexaenoic acid [DHA]) are not effective in preventing perinatal depression.
Conclusion:
Counseling interventions can be effective in preventing perinatal depression, although most evidence was limited to persons at increased risk for perinatal depression. A variety of other intervention approaches provided some evidence of effectiveness but lacked a robust evidence base and need further research.
Contents
- Acknowledgments
- Chapter 1. Introduction
- Chapter 2. Methods
- Chapter 3. Results
- Literature Search
- Summary of Results
- Key Question 1. Do Interventions to Prevent Perinatal Depression Improve Health Outcomes in Pregnant or Postpartum Women or Their Children?
- Key Question 1a. In Trials That Limit Enrollment to High-Risk Women, How Are Participants Identified as Being at High-Risk of Developing Perinatal Depression?
- Key Question 2. What Harms Are Associated With Interventions to Prevent Perinatal Depression in Pregnant or Postpartum Women?
- Chapter 4. Discussion
- Summary of Evidence
- Comparison With Other Reviews
- Harms and Acceptability of Behavior-Based Interventions
- Effect of Intervention Timing
- Identification of Persons at Increased Risk of Perinatal Depression
- Interventions for Perinatal Depression
- Limitations of the Review
- Limitations of the Evidence and Future Research Needs
- Conclusion
- References
- Appendixes
- Appendix A. Detailed Methods
- Appendix B. Antidepressant and FDA Pregnancy Categories
- Appendix C. Included Studies
- Appendix D. Excluded Studies
- Appendix E. Additional Figures
- Appendix F. Additional Evidence Tables
- Appendix G. Depression Symptom Severity Scales
- Appendix H. Accuracy of Screening Instruments to Predict Perinatal Depression
- Appendix I. Ongoing Studies
Suggested citation:
O’Connor EA, Senger CA, Henninger M, Gaynes BN, Coppola E, Soulsby Weyrich M. Interventions to Prevent Perinatal Depression: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 172. AHRQ Publication No. 18-05243-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2019.
This report is based on research conducted by the Kaiser Permanente Research Affiliates Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2015-000017-I-EPC5, Task Order No. 3). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
- NLM CatalogRelated NLM Catalog Entries
- Interventions to Prevent Perinatal Depression: Evidence Report and Systematic Review for the US Preventive Services Task Force.[JAMA. 2019]Interventions to Prevent Perinatal Depression: Evidence Report and Systematic Review for the US Preventive Services Task Force.O'Connor E, Senger CA, Henninger ML, Coppola E, Gaynes BN. JAMA. 2019 Feb 12; 321(6):588-601.
- Review Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Systematic Review for the U.S. Preventive Services Task Force[ 2017]Review Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Systematic Review for the U.S. Preventive Services Task ForcePatnode CD, Evans CV, Senger CA, Redmond N, Lin JS. 2017 Jul
- Review Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: An Updated Systematic Review for the U.S. Preventive Services Task Force[ 2018]Review Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: An Updated Systematic Review for the U.S. Preventive Services Task ForceLeBlanc EL, Patnode CD, Webber EM, Redmond N, Rushkin M, O’Connor EA. 2018 Sep
- Review Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force[ 2020]Review Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task ForcePatnode CD, Perdue LA, Rossom RC, Rushkin MC, Redmond N, Thomas RG, Lin JS. 2020 Feb
- Review Interventions to Prevent Illicit and Nonmedical Drug Use in Children, Adolescents, and Young Adults: Updated Systematic Evidence Review for the U.S. Preventive Services Task Force[ 2020]Review Interventions to Prevent Illicit and Nonmedical Drug Use in Children, Adolescents, and Young Adults: Updated Systematic Evidence Review for the U.S. Preventive Services Task ForceO’Connor E, Thomas R, Robalino S, Senger CA, Perdue LA, Patnode C. 2020 May
- Interventions to Prevent Perinatal Depression: A Systematic Evidence Review for ...Interventions to Prevent Perinatal Depression: A Systematic Evidence Review for the U.S. Preventive Services Task Force
Your browsing activity is empty.
Activity recording is turned off.
See more...