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Guideline Advises Against Depression Screening in Pregnancy

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The Canadian Task Force on Preventive Health Care recommends that all pregnant and postpartum women not be routinely screened for depression using a standardized questionnaire, in line with their new guidelines.

The basis for his position is the lack of evidence that such screening “adds value beyond discussions of general well-being, depression, anxiety and mood, which are now part of established perinatal clinical care.

Dr. Eddie Lang

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“We should not take a one-size-fits-all approach,” lead author Eddie Lang, MD, professor and head of emergency medicine at the Cumming School of Medicine, University of Calgary, Alberta, Canada, told Medscape Medical News.

Instead, the task force emphasizes regular clinical care, including asking patients about their well-being and support systems. The Task Force classifies the recommendation as conditional and with very low certainty evidence.

The recommendation was published on 25 July in the CMAJ.

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One randomized trial

The Task Force is an independent group of clinicians and scientists that provides advice on primary and secondary prevention in primary health care. A working group of five members of the task force developed this recommendation with scientific support from the staff of the Public Health Agency of Canada.

In their study, the task force found only one study that showed benefit from routine screening for depression in this population. This study was a randomized controlled trial conducted in Hong Kong. The researchers evaluated 462 postpartum women who were randomly assigned to be screened with the Edinburgh Postpartum Depression Scale (EPDS) or no screening at 2 months postpartum.

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“We found that the effect of screening in this study was very uncertain for the important outcomes of interest,” Lang said.

“These include parent-child stress, family stress and infant hospitalizations. The effect of screening on all of these outcomes was very uncertain, mainly because it was such a small trial,” he said.

The Task Force also assessed how pregnant and postpartum women feel about screening. What these women wanted most was a good relationship with a trusted primary care provider who could initiate discussions about their mental health in a caring atmosphere.

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“While they told us that they liked the idea of ​​universal screening, they admitted to their family doctors that they would actually prefer to be asked about their well-being. [to be asked] how things were at home and [to have] discussing their mental health and well-being rather than a formal screening process. They felt that discussing depression with their healthcare provider during pregnancy and postpartum was critical,” Lang said.

Thus, the task force recommends “against instrumental screening for depression using a threshold-based questionnaire to distinguish between ‘positive’ and ‘negative results’ given to all individuals during pregnancy and in the postpartum period (up to 1 year postpartum)”.

Screening remains common

“There is a lot of uncertainty in the scientific community about whether all pregnant women and women in childbirth should be screened to systematically determine if they may be suffering from depression,” Lang said.

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In 2013, the task force recommended that prenatal or postpartum women not be screened for depression, but screening is still being done in many provinces, Lang said.

Lang emphasized that the recommendation does not apply to routine care, in which the provider asks questions about the patient’s mental health and discusses it, acting on their clinical judgment; it also does not apply to diagnostic pathways in which the clinician suspects that the person may have depression and tests the person accordingly.

“In our guidelines, we say that all clinicians should ask about the patient’s well-being, his mood, his anxiety, and these questions are an important part of the clinical assessment of pregnant women and puerperas. But we also say that the usefulness of doing this with a questionnaire and using a threshold score on the questionnaire to decide who needs further evaluation or possibly treatment is not proven by the study,” Lang said.

Growing problem

For Diane Franker, MD, CEO of the Society of Obstetricians and Gynecologists of Canada, all this is good, but the reality is that such screening is better than nothing.

Dr. Diane Franker

Quebec is the only Canadian province that conducts universal screening for all pregnant women and postpartum women, Franker told Medscape Medical News. She was not part of the task force.

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“I agree that there should be more than one approach, but the problem is that there is such a lack of resources. There are many questions that can come up when you follow a woman during her pregnancy,” she said.

Frankoeur said COVID-19 has hit women especially hard, including pregnant and postpartum women, who are the most vulnerable.

“Especially in the era of COVID, it was surprising how badly women felt. Their stress levels were so high. We need a special approach dedicated to prenatal mental health because it is a problem that is bigger than before,” she said.

Violence against women has increased significantly since the start of the COVID-19 pandemic, Franker said. “Many more women were killed by their partners. We’ve never seen anything like it before and I hope we never see it again,” she said.

“Help was more available a few years ago, but now it’s really difficult if and when you need a quick consultation with a specialist and the woman is really depressed. This could take forever. , what’s next? Who will be there to take these women and help them? And we don’t have an answer,” Franker said.

She added that pregnant women and women suffering from depression need more than pills. “We calm them down and treat their depression pharmacologically, but this is also the time to provide appropriate support and help them through their pregnancy and prepare well for the reception of their newborn, because as we now know, this first year of life is really important for the baby. And mom needs support.

Funding for the Canadian Preventive Health Care Task Force is provided by the Public Health Agency of Canada. Lang and Francoeur did not report any related financial relationship.

CMAJ. Published online July 25, 2022 Full text

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