Antenatal screening for postnatal depression: a systematic review.
OBJECTIVE
To describe the screening properties of the antenatal tools which have been developed to predict depression after birth and to summarize the implications of the findings for antenatal screening.


METHODS
Systematic review and secondary analysis of published papers.


RESULTS
Sixteen studies including sufficient data for the calculation of screening properties were identified. The majority developed a study-specific screening instrument. Outcome assessments used the Edinburgh Postnatal Depression Scale or standardized diagnostic psychiatric interviews, or both. In the two largest population-based studies, the proportion of women screening as positive ('at risk' of postnatal depression) was 16 and 52%, respectively, and of these only 35 and 8% actually developed depression after birth.


CONCLUSIONS
No screening instrument(s) met the criteria for routine application in the antenatal period. Factors that may have affected poor sensitivity and positive predictive values include the exclusion of key domains in predicting risk, particularly personality, a past history of abuse and postnatal events, the contribution of which may be being under-estimated in studies evaluating antenatal risk prediction tools.
Austin
M-P
MP
Mood Disorders Unit and School of Psychiatry University of New South Wales, Sydney, Australia. m.austin@unsw.edu.au
Lumley
J
J
D019052:Depression, Postpartum / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*