The first review of evidence by the U.S. Preventive Services Task Force (USPSTF) on ways to prevent perinatal depression has led the researchers to recommend counseling for pregnant and postpartum women at increased risk for the disorder.
The USPSTF final recommendation statement was published this month in JAMA, the journal of the American Medical Association.
“Effective counseling interventions can help prevent perinatal depression before it develops,” said Task Force member Karina Davidson, Ph.D., M.A.Sc. “We can help prevent one of the most common and serious complications of having a baby.”
Perinatal depression is depression that develops during pregnancy or after childbirth. It affects as many as 1 in 7 pregnant women and can result in negative short- and long-term consequences for both the mother and her baby, such as moms having difficulty bonding with their baby and babies getting fewer preventive health services.
The Task Force reviewed evidence on interventions to prevent perinatal depression and found that counseling is effective in pregnant and postpartum women who are at increased risk.
Two types of counseling interventions were specifically cited:
- Cognitive-behavioral therapy, which addresses negative thoughts and increases positive activities;
- Interpersonal therapy, which focuses on an individual’s relationships with other people to improve communication and address problems that contribute to depression.
The researchers did not find enough evidence to recommend any treatment approaches other than counseling, such as pharmacological treatments including sertraline, nortriptyline, or omega-3 fatty acids.
The recommendation was based on a systematic evidence review by a team led by Elizabeth O’Connor, Ph.D., behavioral health psychologist and associate director of the Kaiser Permanente Evidence-Based Practice Center in Portland, Oregon. The review, which included 50 studies accounting for over 22,000 individuals, found a 39 percent lower risk for the onset of perinatal depression tied to counseling.
The USPSTF noted that the recommendation is for persons at increased risk for perinatal depression, not those who have already been diagnosed with the condition.
Currently, there is no accurate screening tool available to assess risk of perinatal depression, but there are some factors that clinicians can use to determine risk. Women with a history of depression, symptoms of depression, and certain socioeconomic risk factors, like being a young or single parent, may be at increased risk and benefit from intervention.
“Clinicians should use patient history and risk factors to identify pregnant or postpartum individuals who are most likely to benefit from counseling,” said Task Force member Aaron B. Caughey, M.D., M.P.P., M.P.H., Ph.D. “Patients who are pregnant and concerned about depression should talk to their doctor.”
The Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine that works to improve the health of all Americans and regularly reports to the U.S. Congress. The USPSTF makes evidence-based recommendations about clinical preventive services such as screenings, counseling services and preventive medications.