Given the well-documented impact of perinatal depression and anxiety on women and their families, national and international medical organizations have long supported the screening of all pregnant and postpartum women for mood and anxiety disorders. Many studies have documented the feasibility and acceptability of such screening programs; nevertheless, despite a big increase within the variety of programs incorporating screening as a part of routine care, it is evident that many ladies with mood and anxiety disorders don’t receive treatment. As well as,  we must consider the ethical implications of a situation where screening programs are launched, but without the supply of treatment.

A mixed-methods systematic review and meta-analysis from Waqas and colleagues got down to answer probably the most necessary questions we must consider as we advocate for universal screening. For girls throughout the perinatal period, do screening programs for perinatal depression and anxiety improve maternal mental health and infant outcomes in comparison with no screening?

Does Screening Improve Treatment and Outcomes?

To assist answer this query, researchers conducted a mixed-methods systematic review and meta-analysis, specifically examining whether screening programs for depression and anxiety in perinatal women improve maternal mental health and infant outcomes.

The researchers analyzed a complete of 19 studies for qualitative synthesis and 9 studies for quantitative synthesis. Out of those 19 studies, randomized controlled trial findings were reported in 9 studies, cost-effectiveness in 2 studies, and acceptability of screening programs in 10 studies. All studies were conducted in high-income countries including the USA (n?=?2), the UK (n?=?2), and one each in Hong Kong, Netherlands, Australia, Sweden, and Norway. 

Screening protocols varied across the studies and included nurses, nurses specializing in public health, midwives, health visitors, psychology students, and physicians. Six of the studies reported screening within the postpartum period and three within the antenatal period.

By way of treatment offered, non-directive counseling, psychoeducation and pharmacological therapy were probably the most regularly cited strategies utilized in these trials. In some studies, treatment (counseling, psychoeducation) was offered inside the context of the screening program; in other studies, women with depression were referred to their primary health care providers, outside mental health professionals, or specialized group treatment.

Did Screening Program Improve Treatment?

Given the heterogeneity of the screening programs examined, it’s difficult to conduct a meaningful meta-analysis. Nonetheless, this text provides a very good review of obtainable screening programs. The meta-analysis conducted here shows that identifying women with perinatal depression and anxiety could potentially result in direct health advantages for the ladies.  

For instance, Avalos and colleagues (2016) of their prospective evaluation of a screening program from the pre-implementation phase (n?=?122) to totally implemented stage (n?=?41,124), reported a corresponding increase within the diagnosis of latest cases. Most significantly, the proportion of ladies receiving treatment increased from 5.9 to 81.9%. 

However, other studies (Smith et al, 2009) reported that only a small proportion of their study sample remained in energetic treatment, citing the programs into primary healthcare settings.

Do Screening Programs Improve Maternal and Infant Outcomes?

Using a series of meta-analyses, the authors observed a discount in perinatal depression and anxiety amongst perinatal women undergoing screening programs. For the consequence of depressive disorder, meta-analysis indicated a positive impact in favor of the intervention group (OR = 0.55). 

Infant outcomes were reported in just three of the nine studies. A small improvement in child socio-emotional development was reported in a single study. One other study reported improvements in parent-child interactions. No improvements were observed when it comes to physical development of the infants or subsequent variety of hospitalizations. 

What Can We Do to Improve the Effectiveness of Screening?

While lots of the screening programs happen mostly within the context of obstetric visits, the authors note that screening could possibly be helpful when conducted at subsequent medical visits for the mother and child or locally by allied medical examiners. Screening in these settings would help to enhance the detection, diagnosis and referral of ladies to appropriate treatments.

The authors advocate for a more thoughtful integration of screening into primary care and/or maternal and child health services. This has many benefits, including more holistic health care, increased accessibility of mental health services, opportunities for reducing the stigma of mental health problems and lower costs.

Nevertheless, this suggestion carries necessary ethical implications. All the studies included on this evaluation emphasize that the screening should only be carried out when there are adequate resources for screening, diagnosis, treatment and follow-up.

STEPS for PPD: Screening and Treatment Enhancement for Postpartum Depression

The Center for Women’s Mental Health at MGH recently launched a research study, funded by the Marriott Foundation, which goals to evaluate screening to treatment pathways in individuals with postpartum depression across the Mass General Brigham (MGB) hospital system: Screening and Treatment Enhancement Program For Postpartum Depression within the MGB System or STEPS for PPD. In collaboration with multiple obstetric clinics across MGB, the STEPS project will assess clinical and treatment outcomes of postpartum screening and explore barriers and facilitators to screening and treating PPD. 

STEPS builds on previous research to analyze systems of PPD screening, referral, and treatment. Ultimately, we hope that findings from the project will make sure that patients are universally screened for postpartum depression and, in the event that they do screen positive, are referred to receive adequate care and treatment of symptoms. The knowledge gained from this study will illuminate aspects related to utilization of treatment services for postpartum depression and may inform how best to extend access and uptake of services for future patients.

Ruta Nonacs, MD PhD

References

Waqas A, Koukab A, Meraj H, Dua T, Chowdhary N, Fatima B, Rahman A.  Screening programs for common maternal mental health disorders amongst perinatal women: report of the systematic review of evidence.  BMC Psychiatry. 2022 Jan 24;22(1):54. D