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February 12, 2019

Counseling Interventions to Prevent Perinatal Depression

JAMA. 2019;321(6):620. doi:10.1001/jama.2019.0253

The US Preventive Services Task Force (USPSTF) has recently published recommendations on providing counseling interventions to prevent perinatal depression.

What Is Perinatal Depression?

Perinatal depression refers to depression in women during pregnancy or after giving birth (known as postpartum depression). It is a problem that is both common and treatable and, in some women, preventable. Symptoms of perinatal depression include feeling sad, hopeless, drained of energy, angry, or disconnected from your baby and other loved ones. In more severe cases, it can lead to thinking about harming yourself or your baby. It is normal to sometimes feel sad, worried, or stressed about becoming or being a new parent, but perinatal and postpartum depression refers to symptoms that are more constant and overwhelming, like a darkness that does not lift.

Some women have a higher chance of developing perinatal depression than others. Risk factors include a personal or family history of depression, a history of physical or sexual abuse, having an unplanned or unwanted pregnancy, intimate partner violence, current stressful life events, lack of social or financial support, and younger (adolescent) maternal age.

How Can Perinatal Depression Be Prevented?

Studies have shown that counseling interventions, including cognitive behavioral therapy and interpersonal therapy, can help prevent perinatal depression. Cognitive behavioral therapy teaches mothers how to manage negative thoughts and create positive actions. Interpersonal therapy focuses on addressing interpersonal issues that contribute to underlying depression or anxiety. Counseling sessions can be done in individual or group settings by psychologists, midwives, nurses, and other mental health care professionals.

What Is the Population Under Consideration for Providing Counseling Interventions to Prevent Perinatal Depression?

This recommendation applies to pregnant women and women who have given birth within the last year who do not have a current diagnosis of depression but who are considered to be at increased risk of developing perinatal depression.

What Are the Potential Benefits and Harms of Providing Counseling Interventions to Prevent Perinatal Depression?

The USPSTF found convincing evidence that counseling interventions are effective in preventing perinatal depression. Although there is no standard risk assessment tool available, based on the population of women included in these studies, women with a history of depression, current depressive symptoms, or certain socioeconomic risk factors could be considered at higher risk and may benefit from counseling interventions. Potential harms of counseling interventions are believed to be small and mainly involve side effects from medications that are sometimes used along with counseling to prevent perinatal depression.

How Strong Is the Recommendation to Provide Counseling Interventions to Prevent Perinatal Depression?

The USPSTF concludes with moderate certainty that counseling interventions to prevent perinatal depression have a moderate net benefit for pregnant or postpartum women at increased risk.

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Article Information

Source: US Preventive Services Task Force. Interventions to prevent perinatal depression: US Preventive Services Task Force recommendation statement [published February 12, 2019]. JAMA. doi:10.1001/jama.2019.0007