Depression screening and patient outcomes in pregnancy or postpartum: a systematic review.
OBJECTIVE
Clinical practice guidelines disagree on whether health care professionals should screen women for depression during pregnancy or postpartum. The objective of this systematic review was to determine whether depression screening improves depression outcomes among women during pregnancy or the postpartum period.


METHODS
Searches included the CINAHL, EMBASE, ISI, MEDLINE, and PsycINFO databases through April 1, 2013; manual journal searches; reference list reviews; citation tracking of included articles; and trial registry reviews. RCTs in any language that compared depression outcomes between women during pregnancy or postpartum randomized to undergo depression screening versus women not screened were eligible.


RESULTS
There were 9,242 unique titles/abstracts and 15 full-text articles reviewed. Only 1 RCT of screening postpartum was included, but none during pregnancy. The eligible postpartum study evaluated screening in mothers in Hong Kong with 2-month-old babies (N=462) and reported a standardized mean difference for symptoms of depression at 6 months postpartum of 0.34 (95% confidence interval=0.15 to 0.52, P<0.001). Standardized mean difference per 44 additional women treated in the intervention trial arm compared to the non-screening arm was approximately 1.8. Risk of bias was high, however, because the status of outcome measures was changed post-hoc and because the reported effect size per woman treated was 6-7 times the effect sizes reported in comparable depression care interventions.


CONCLUSIONS
There is currently no evidence from any well-designed and conducted RCT that screening for depression would benefit women in pregnancy or postpartum. Existing guidelines that recommend depression screening during pregnancy or postpartum should be re-considered.
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada; School of Nursing, McGill University, Montréal, Québec, Canada. Electronic address: brett.thombs@mcgill.ca.
Brett D
BD
Thombs
Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada. Electronic address: arthurs.erin@gmail.com.
Erin
E
Arthurs
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada. Electronic address: coronado.steph@gmail.com.
Stephanie
S
Coronado-Montoya
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. Electronic address: michelleroseman@gmail.com.
Michelle
M
Roseman
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada. Electronic address: vanessa.delisle@mail.mcgill.ca.
Vanessa C
VC
Delisle
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. Electronic address: allison.leavens@gmail.com.
Allison
A
Leavens
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada. Electronic address: brooke.levis@gmail.com.
Brooke
B
Levis
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. Electronic address: laurent.azoulay@mcgill.ca.
Laurent
L
Azoulay
Harold E. Harrison Medical Library, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA. Electronic address: cherismith@comcast.net.
Cheri
C
Smith
McGill University Health Centre, Royal Victoria Hospital, Montréal, Québec, Canada. Electronic address: luisa.ciofani@sympatico.ca.
Luisa
L
Ciofani
Health Psychology Section, Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands. Electronic address: jcoynester@gmail.com.
James C
JC
Coyne
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Oncology, McGill University, Montréal, Québec, Canada. Electronic address: nancy.feeley@mcgill.ca.
Nancy
N
Feeley
Psychological Medicine and Health Services Research, Hull York Medical School and Department of Health Sciences, University of York, York, UK. Electronic address: simon.gilbody@york.ac.uk.
Simon
S
Gilbody
Public Health Department, Laval Regional Health Board, Laval, Québec, Canada. Electronic address: joyschi@yahoo.ca.
Joy
J
Schinazi
Women's Health Program, University Health Network, Toronto, Ontario, Canada; Departments of Psychiatry, Obstetrics and Gynaecology, Family and Community Medicine, Medicine, Surgery and Anesthesia, University of Toronto, Ontario, Canada. Electronic address: donna.stewart@uhn.ca.
Donna E
DE
Stewart
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada. Electronic address: phyllis.zelkowitz@mcgill.ca.
Phyllis
P
Zelkowitz
D000328:Adult; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D019052:Depression, Postpartum / Q000175:diagnosis; D005260:Female; D006801:Humans; D008403:Mass Screening; D015588:Observer Variation; D017063:Outcome Assessment, Health Care; D018743:Perinatal Care / Q000379:methods / Q000592:standards / Q000639:trends; D017410:Practice Guidelines as Topic / Q000592:standards; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control
Depression; Perinatal; Postpartum; Pregnancy; Screening; Systematic review