Interventions to Prevent Perinatal Depression: US Preventive Services Task Force Recommendation Statement | Depressive Disorders | JAMA | JAMA Network
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Gavin  NI, Gaynes  BN, Lohr  KN, Meltzer-Brody  S, Gartlehner  G, Swinson  T.  Perinatal depression: a systematic review of prevalence and incidence.  Obstet Gynecol. 2005;106(5, pt 1):1071-1083. doi:10.1097/01.AOG.0000183597.31630.dbPubMedGoogle ScholarCrossref
O’Connor  E, Senger  CA, Henninger  M, Gaynes  BN, Coppola  E, Soulsby  MW.  Interventions to Prevent Perinatal Depression: A Systematic Evidence Review for the US Preventive Services Task Force: Evidence Synthesis No 172. Rockville, MD: Agency for Healthcare Research and Quality; 2019. AHRQ publication 18-05243-EF-1.
Hofmann  SG, Asnaani  A, Vonk  IJ, Sawyer  AT, Fang  A.  The efficacy of cognitive behavioral therapy: a review of meta-analyses.  Cognit Ther Res. 2012;36(5):427-440. doi:10.1007/s10608-012-9476-1PubMedGoogle ScholarCrossref
Phipps  MG, Raker  CA, Ware  CF, Zlotnick  C.  Randomized controlled trial to prevent postpartum depression in adolescent mothers.  Am J Obstet Gynecol. 2013;208(3):192.e1-192.e6. doi:10.1016/j.ajog.2012.12.036PubMedGoogle ScholarCrossref
Zlotnick  C, Tzilos  G, Miller  I, Seifer  R, Stout  R.  Randomized controlled trial to prevent postpartum depression in mothers on public assistance.  J Affect Disord. 2016;189:263-268. doi:10.1016/j.jad.2015.09.059PubMedGoogle ScholarCrossref
O’Connor  E, Senger  CA, Henninger  M, Gaynes  BN, Coppola  E, Soulsby  MW.  Interventions to prevent perinatal depression: a systematic review and evidence report for the US Preventive Services Task Force  [published February 12, 2019].  JAMA. doi:10.1001/jama.2018.20865Google Scholar
Tandon  SD, Leis  JA, Mendelson  T, Perry  DF, Kemp  K.  Six-month outcomes from a randomized controlled trial to prevent perinatal depression in low-income home visiting clients.  Matern Child Health J. 2014;18(4):873-881. doi:10.1007/s10995-013-1313-yPubMedGoogle ScholarCrossref
Tandon  SD, Perry  DF, Mendelson  T, Kemp  K, Leis  JA.  Preventing perinatal depression in low-income home visiting clients.  J Consult Clin Psychol. 2011;79(5):707-712. doi:10.1037/a0024895PubMedGoogle ScholarCrossref
Muñoz  RF, Le  HN, Ippen  CG,  et al.  Prevention of postpartum depression in low-income women: development of the Mamás y Bebés/Mothers and Babies course.  Cogn Behav Pract. 2007;14(1):70-83. doi:10.1016/j.cbpra.2006.04.021Google ScholarCrossref
Le  HN, Perry  DF, Stuart  EA.  Randomized controlled trial of a preventive intervention for perinatal depression in high-risk Latinas.  J Consult Clin Psychol. 2011;79(2):135-141. doi:10.1037/a0022492PubMedGoogle ScholarCrossref
Zlotnick  C, Johnson  SL, Miller  IW, Pearlstein  T, Howard  M.  Postpartum depression in women receiving public assistance: pilot study of an interpersonal-therapy-oriented group intervention.  Am J Psychiatry. 2001;158(4):638-640. doi:10.1176/appi.ajp.158.4.638PubMedGoogle ScholarCrossref
Zlotnick  C, Miller  IW, Pearlstein  T, Howard  M, Sweeney  P.  A preventive intervention for pregnant women on public assistance at risk for postpartum depression.  Am J Psychiatry. 2006;163(8):1443-1445. doi:10.1176/ajp.2006.163.8.1443PubMedGoogle ScholarCrossref
Zlotnick  C, Capezza  NM, Parker  D.  An interpersonally based intervention for low-income pregnant women with intimate partner violence: a pilot study.  Arch Womens Ment Health. 2011;14(1):55-65. doi:10.1007/s00737-010-0195-xPubMedGoogle ScholarCrossref
Substance Abuse and Mental Health Administration (SAMHSA). SAMHSA-HRSA Center for Integrated Health Solutions. SAMHSA website. Accessed December 31, 2018.
Substance Abuse and Mental Health Administration (SAMHSA). Behavioral Health Treatment Services Locator. SAMHSA website. Accessed December 31, 2018.
The Mothers & Babies Program website. Accessed December 31, 2018.
Siu  AL, Bibbins-Domingo  K, Grossman  DC,  et al; US Preventive Services Task Force (USPSTF).  Screening for depression in adults: US Preventive Services Task Force recommendation statement.  JAMA. 2016;315(4):380-387. doi:10.1001/jama.2015.18392PubMedGoogle ScholarCrossref
Siu  AL; U.S. Preventive Services Task Force.  Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement.  Ann Intern Med. 2016;164(5):360-366. doi:10.7326/M15-2957PubMedGoogle ScholarCrossref
Committee on Obstetric Practice.  The American College of Obstetricians and Gynecologists Committee Opinion No. 630: screening for perinatal depression.  Obstet Gynecol. 2015;125(5):1268-1271. doi:10.1097/01.AOG.0000465192.34779.dcPubMedGoogle ScholarCrossref
American Psychological Association.  Diagnostic and Statistical Manual for Psychiatric Disorders. 5th ed. Washington, DC: American Psychological Association; 2013.
Fitelson  E, Kim  S, Baker  AS, Leight  K.  Treatment of postpartum depression: clinical, psychological and pharmacological options.  Int J Womens Health. 2010;3:1-14.PubMedGoogle Scholar
Norhayati  MN, Hazlina  NH, Asrenee  AR, Emilin  WM.  Magnitude and risk factors for postpartum symptoms: a literature review.  J Affect Disord. 2015;175:34-52. doi:10.1016/j.jad.2014.12.041PubMedGoogle ScholarCrossref
Ko  JY, Rockhill  KM, Tong  VT, Morrow  B, Farr  SL.  Trends in postpartum depressive symptoms—27 states, 2004, 2008, and 2012.  MMWR Morb Mortal Wkly Rep. 2017;66(6):153-158. doi:10.15585/mmwr.mm6606a1PubMedGoogle ScholarCrossref
Jennings  KD, Ross  S, Popper  S, Elmore  M.  Thoughts of harming infants in depressed and nondepressed mothers.  J Affect Disord. 1999;54(1-2):21-28. doi:10.1016/S0165-0327(98)00185-2PubMedGoogle ScholarCrossref
Lovejoy  MC, Graczyk  PA, O’Hare  E, Neuman  G.  Maternal depression and parenting behavior: a meta-analytic review.  Clin Psychol Rev. 2000;20(5):561-592. doi:10.1016/S0272-7358(98)00100-7PubMedGoogle ScholarCrossref
Szegda  K, Markenson  G, Bertone-Johnson  ER, Chasan-Taber  L.  Depression during pregnancy: a risk factor for adverse neonatal outcomes?  J Matern Fetal Neonatal Med. 2014;27(9):960-967. doi:10.3109/14767058.2013.845157PubMedGoogle ScholarCrossref
Wouk  K, Stuebe  AM, Meltzer-Brody  S.  Postpartum mental health and breastfeeding practices: an analysis using the 2010-2011 Pregnancy Risk Assessment Monitoring System.  Matern Child Health J. 2017;21(3):636-647. doi:10.1007/s10995-016-2150-6PubMedGoogle ScholarCrossref
Minkovitz  CS, Strobino  D, Scharfstein  D,  et al.  Maternal depressive symptoms and children’s receipt of health care in the first 3 years of life.  Pediatrics. 2005;115(2):306-314. doi:10.1542/peds.2004-0341PubMedGoogle ScholarCrossref
Beck  CT.  The effects of postpartum depression on child development: a meta-analysis.  Arch Psychiatr Nurs. 1998;12(1):12-20. doi:10.1016/S0883-9417(98)80004-6PubMedGoogle ScholarCrossref
Santos  IS, Matijasevich  A, Barros  AJ, Barros  FC.  Antenatal and postnatal maternal mood symptoms and psychiatric disorders in pre-school children from the 2004 Pelotas Birth Cohort.  J Affect Disord. 2014;164:112-117. doi:10.1016/j.jad.2014.04.033PubMedGoogle ScholarCrossref
Wilson  LM, Reid  AJ, Midmer  DK, Biringer  A, Carroll  JC, Stewart  DE.  Antenatal psychosocial risk factors associated with adverse postpartum family outcomes.  CMAJ. 1996;154(6):785-799.PubMedGoogle Scholar
Shankman  SA, Lewinsohn  PM, Klein  DN, Small  JW, Seeley  JR, Altman  SE.  Subthreshold conditions as precursors for full syndrome disorders.  J Child Psychol Psychiatry. 2009;50(12):1485-1494. doi:10.1111/j.1469-7610.2009.02117.xPubMedGoogle ScholarCrossref
Kornfeld  BD, Bair-Merritt  MH, Frosch  E, Solomon  BS.  Postpartum depression and intimate partner violence in urban mothers: co-occurrence and child healthcare utilization.  J Pediatr. 2012;161(2):348-353. doi:10.1016/j.jpeds.2012.01.047PubMedGoogle ScholarCrossref
Wu  Q, Chen  HL, Xu  XJ.  Violence as a risk factor for postpartum depression in mothers: a meta-analysis.  Arch Womens Ment Health. 2012;15(2):107-114. doi:10.1007/s00737-011-0248-9PubMedGoogle ScholarCrossref
Beck  CT.  Predictors of postpartum depression: an update.  Nurs Res. 2001;50(5):275-285. doi:10.1097/00006199-200109000-00004PubMedGoogle ScholarCrossref
Kozhimannil  KB, Pereira  MA, Harlow  BL.  Association between diabetes and perinatal depression among low-income mothers.  JAMA. 2009;301(8):842-847. doi:10.1001/jama.2009.201PubMedGoogle ScholarCrossref
Kim  S, Soeken  TA, Cromer  SJ, Martinez  SR, Hardy  LR, Strathearn  L.  Oxytocin and postpartum depression.  Brain Res. 2014;1580:219-232. doi:10.1016/j.brainres.2013.11.009PubMedGoogle ScholarCrossref
Corwin  EJ, Kohen  R, Jarrett  M, Stafford  B.  The heritability of postpartum depression.  Biol Res Nurs. 2010;12(1):73-83. doi:10.1177/1099800410362112PubMedGoogle ScholarCrossref
Ortiz Collado  MA, Saez  M, Favrod  J, Hatem  M.  Antenatal psychosomatic programming to reduce postpartum depression risk and improve childbirth outcomes.  BMC Pregnancy Childbirth. 2014;14:22. doi:10.1186/1471-2393-14-22PubMedGoogle ScholarCrossref
Dimidjian  S, Goodman  SH, Felder  JN, Gallop  R, Brown  AP, Beck  A.  Staying well during pregnancy and the postpartum: a pilot randomized trial of mindfulness-based cognitive therapy for the prevention of depressive relapse/recurrence.  J Consult Clin Psychol. 2016;84(2):134-145. doi:10.1037/ccp0000068PubMedGoogle ScholarCrossref
Woolhouse  H, Mercuri  K, Judd  F, Brown  SJ.  Antenatal mindfulness intervention to reduce depression, anxiety and stress: a pilot randomised controlled trial of the MindBabyBody program in an Australian tertiary maternity hospital.  BMC Pregnancy Childbirth. 2014;14:369. doi:10.1186/s12884-014-0369-zPubMedGoogle ScholarCrossref
Milgrom  J, Schembri  C, Ericksen  J, Ross  J, Gemmill  AW.  Towards parenthood: an antenatal intervention to reduce depression, anxiety and parenting difficulties.  J Affect Disord. 2011;130(3):385-394. doi:10.1016/j.jad.2010.10.045PubMedGoogle ScholarCrossref
Leung  SS, Lee  AM, Wong  DF,  et al.  A brief group intervention using a cognitive-behavioural approach to reduce postnatal depressive symptoms.  Hong Kong Med J. 2016;22(suppl 2):S4-S8.PubMedGoogle Scholar
Gorman  L. Prevention of Postpartum Difficulties in a High Risk Sample [dissertation]. Iowa City: University of Iowa; 1997.
Feinberg  ME, Kan  ML.  Establishing family foundations: intervention effects on coparenting, parent/infant well-being, and parent-child relations.  J Fam Psychol. 2008;22(2):253-263. doi:10.1037/0893-3200.22.2.253PubMedGoogle ScholarCrossref
Brugha  TS, Morrell  CJ, Slade  P, Walters  SJ.  Universal prevention of depression in women postnatally: cluster randomized trial evidence in primary care.  Psychol Med. 2011;41(4):739-748. doi:10.1017/S0033291710001467PubMedGoogle ScholarCrossref
MacArthur  C, Winter  HR, Bick  DE,  et al.  Effects of redesigned community postnatal care on womens’ health 4 months after birth.  Lancet. 2002;359(9304):378-385. doi:10.1016/S0140-6736(02)07596-7PubMedGoogle ScholarCrossref
Fontein-Kuipers  YJ, Ausems  M, de Vries  R, Nieuwenhuijze  MJ.  The effect of Wazzup Mama?! an antenatal intervention to prevent or reduce maternal distress in pregnancy.  Arch Womens Ment Health. 2016;19(5):779-788. doi:10.1007/s00737-016-0614-8PubMedGoogle ScholarCrossref
Songøygard  KM, Stafne  SN, Evensen  KA, Salvesen  KÅ, Vik  T, Mørkved  S.  Does exercise during pregnancy prevent postnatal depression?  Acta Obstet Gynecol Scand. 2012;91(1):62-67. doi:10.1111/j.1600-0412.2011.01262.xPubMedGoogle ScholarCrossref
Perales  M, Refoyo  I, Coteron  J, Bacchi  M, Barakat  R.  Exercise during pregnancy attenuates prenatal depression.  Eval Health Prof. 2015;38(1):59-72. doi:10.1177/0163278714533566PubMedGoogle ScholarCrossref
Norman  E, Sherburn  M, Osborne  RH, Galea  MP.  An exercise and education program improves well-being of new mothers.  Phys Ther. 2010;90(3):348-355. doi:10.2522/ptj.20090139PubMedGoogle ScholarCrossref
Hiscock  H, Cook  F, Bayer  J,  et al.  Preventing early infant sleep and crying problems and postnatal depression: a randomized trial.  Pediatrics. 2014;133(2):e346-e354. doi:10.1542/peds.2013-1886PubMedGoogle ScholarCrossref
Werner  EA, Gustafsson  HC, Lee  S,  et al.  PREPP: postpartum depression prevention through the mother-infant dyad.  Arch Womens Ment Health. 2016;19(2):229-242. doi:10.1007/s00737-015-0549-5PubMedGoogle ScholarCrossref
Hiscock  H, Wake  M.  Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood.  BMJ. 2002;324(7345):1062-1065. doi:10.1136/bmj.324.7345.1062PubMedGoogle ScholarCrossref
Wisner  KL, Perel  JM, Peindl  KS, Hanusa  BH, Piontek  CM, Findling  RL.  Prevention of postpartum depression: a pilot randomized clinical trial.  Am J Psychiatry. 2004;161(7):1290-1292. doi:10.1176/appi.ajp.161.7.1290PubMedGoogle ScholarCrossref
Wisner  KL, Perel  JM, Peindl  KS, Hanusa  BH, Findling  RL, Rapport  D.  Prevention of recurrent postpartum depression.  J Clin Psychiatry. 2001;62(2):82-86. doi:10.4088/JCP.v62n0202PubMedGoogle ScholarCrossref
Llorente  AM, Jensen  CL, Voigt  RG, Fraley  JK, Berretta  MC, Heird  WC.  Effect of maternal docosahexaenoic acid supplementation on postpartum depression and information processing.  Am J Obstet Gynecol. 2003;188(5):1348-1353. doi:10.1067/mob.2003.275PubMedGoogle ScholarCrossref
Mozurkewich  EL, Clinton  CM, Chilimigras  JL,  et al.  The Mothers, Omega-3, and Mental Health Study: a double-blind, randomized controlled trial.  Am J Obstet Gynecol. 2013;208(4):313.e1-313.e9. doi:10.1016/j.ajog.2013.01.038PubMedGoogle ScholarCrossref
 ACOG Committee Opinion No. 736: optimizing postpartum care.  Obstet Gynecol. 2018;131(5):e140-e150. doi:10.1097/AOG.0000000000002633PubMedGoogle ScholarCrossref
US Preventive Services Task Force
Recommendation Statement
February 12, 2019

Interventions to Prevent Perinatal Depression: US Preventive Services Task Force Recommendation Statement

US Preventive Services Task Force
JAMA. 2019;321(6):580-587. doi:10.1001/jama.2019.0007

Importance  Perinatal depression, which is the occurrence of a depressive disorder during pregnancy or following childbirth, affects as many as 1 in 7 women and is one of the most common complications of pregnancy and the postpartum period. It is well established that perinatal depression can result in adverse short- and long-term effects on both the woman and child.

Objective  To issue a new US Preventive Services Task Force (USPSTF) recommendation on interventions to prevent perinatal depression.

Evidence Review  The USPSTF reviewed the evidence on the benefits and harms of preventive interventions for perinatal depression in pregnant or postpartum women or their children. The USPSTF reviewed contextual information on the accuracy of tools used to identify women at increased risk of perinatal depression and the most effective timing for preventive interventions. Interventions reviewed included counseling, health system interventions, physical activity, education, supportive interventions, and other behavioral interventions, such as infant sleep training and expressive writing. Pharmacological approaches included the use of nortriptyline, sertraline, and omega-3 fatty acids.

Findings  The USPSTF found convincing evidence that counseling interventions, such as cognitive behavioral therapy and interpersonal therapy, are effective in preventing perinatal depression. Women with a history of depression, current depressive symptoms, or certain socioeconomic risk factors (eg, low income or young or single parenthood) would benefit from counseling interventions and could be considered at increased risk. The USPSTF found adequate evidence to bound the potential harms of counseling interventions as no greater than small, based on the nature of the intervention and the low likelihood of serious harms. The USPSTF found inadequate evidence to assess the benefits and harms of other noncounseling interventions. The USPSTF concludes with moderate certainty that providing or referring pregnant or postpartum women at increased risk to counseling interventions has a moderate net benefit in preventing perinatal depression.

Conclusions and Recommendation  The USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. (B recommendation)