In its newest suggestions, the Canadian Process Drive on Preventive Well being Care recommends in opposition to screening all people for melancholy throughout being pregnant and the postpartum interval utilizing standardized questionnaires. This determination relies on the truth that the proof recognized by the duty power is unclear as as to whether screening confers profit above typical scientific care. This suggestion assumes that typical care throughout being pregnant and the postpartum interval contains inquiry and a focus to psychological well being and well-being of sufferers.
To be clear, the duty power continues to advocate screening for perinatal melancholy; nevertheless, they’re saying that screening utilizing a standardized questionnaire doesn’t seem to supply any profit over typical care.
The duty power discovered just one research demonstrating a good thing about routine melancholy screening in perinatal sufferers. This research was a randomized managed trial carried out in Hong Kong by which 462 postpartum girls had been randomly assigned to obtain screening utilizing the Edinburgh Postnatal Melancholy Scale (EPDS) or no screening at two months postpartum. The ladies within the screening group had been much less seemingly than the no screening group to have an elevated EPDS rating at six months postpartum (danger ratio: 0.59).
In an interview with Medscape, the lead creator Dr. Eddy Lang additionally famous that this suggestion displays womens’ preferences. He famous, “Though they advised us they favored the thought of common screening, they admitted to their household medical doctors that they really most well-liked to be requested about their well-being, [to be asked] how issues had been going at house, and [to have] a dialogue about their psychological well being and well-being, moderately than a proper screening course of. They felt a dialogue about melancholy with a major healthcare supplier in the course of the being pregnant and postpartum interval is essential.”
Whereas the Canadian Process Drive on Preventive Well being Care is appropriate — we should not have a transparent sign to point that questionnaire-based screening improves outcomes — recommending in opposition to standardized screening appears short-sighted. We have now ample proof to point that typical obstetric care doesn’t reliably establish girls with perinatal melancholy and that standardized questionnaires outperform clinicians when it comes to figuring out girls with melancholy throughout being pregnant and the postpartum interval. After all, most sufferers wish to have a extra private dialog about their psychological well being with their supplier. The questionnaire is in no way an alternative to this dialogue; utilizing questionnaires helps clinicians to supply extra individualized, focused care. A standardized questionnaire is a comparatively cheap and simple technique of flagging girls who want a extra thorough psychological analysis and, primarily based on that analysis, would possibly profit from further assist or intervention.
I believe that the explanation we don’t see higher outcomes with screening for perinatal melancholy doesn’t replicate an issue with screening however is extra indicative of what occurs when girls display constructive for melancholy. Regardless of growing consciousness of and luxury with treating perinatal melancholy over the previous couple of many years, there proceed to be many limitations to acquiring care. We proceed to listen to about girls who haven’t been in a position to entry care in a well timed trend and those that haven’t been capable of finding treaters with experience within the therapy of perinatal temper and nervousness problems.
Perinatal melancholy is the commonest complication of being pregnant and childbirth. Even when our psychological well being care system shouldn’t be but in a position to absolutely tackle the wants of this inhabitants, we have to proceed to make maternal psychological well being a precedence. This contains common screening, the identification of girls at excessive danger for perinatal temper and nervousness problems, preventative interventions, and constructing a community of acceptable therapy referrals. We can not afford to reverse instructions with suggestions that suggest that screening utilizing standardized devices is ineffective.
Ruta Nonacs, MD PhD
Lang E, Colquhoun H, LeBlanc JC, et al. Recommendation on instrument-based screening for depression during pregnancy and the postpartum period. CMAJ July 25, 2022 194 (28) E981-E989.
Guideline Advises Against Depression Screening in Pregnancy (Medscape)
