USPSTF: Counseling interventions likely to prevent perinatal depression

1. In this systematic review and meta-analysis, counseling interventions were found to help prevent the development of perinatal depression, primarily in women who were identified as being high risk.

2. There was not adequate evidence to assess the benefits and harms of non-counseling interventions.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Perinatal depression is a common condition that is often treated with pharmacological and counseling therapeutic strategies. Despite guidance on treatment of perinatal depression, there has yet to be guidelines on how to prevent its development. In this systematic review and meta-analysis, counseling interventions were found to significantly prevent perinatal depression, primarily in women who were identified as being at high risk. In contrast, non-counseling interventions, including prophylactic antidepressant administration, did not have enough evidence to adequately assess the benefits and harms of these interventions for prevention. The USPSTF recommended that clinicians provide or prefer counseling for pregnant or post-partum women at high risk for perinatal depression.

Despite moderate evidence to suggest that counseling is beneficial for perinatal depression prevention for those at highest risk, it is unclear if this intervention would be appropriate for all pregnant or post-partum women. In addition, there was a significant small studies effect for the analysis assessing counseling, and so the effect size of the intervention may be overestimated.

Click to read the study published today in JAMA

Relevant Reading: Psychosocial and psychological interventions for preventing postpartum depression

In-Depth [systematic review and meta-analysis]: 49 randomized controlled trials (RCTs) and one non-randomized controlled intervention study (n = 22,385 patients) were included. Studies were excluded if the patients were currently experiencing depression symptoms, had patients with psychotic or developmental disorders, studies limited to a select patient population (such as only HIV+ women), or were conducted in classrooms, correctional facilities, worksites, or emergency departments. The studied interventions were counseling, psychoeducation, other supportive

Interventions, care delivery models targeting improved mental health outcomes, prophylactic antidepressant use, physical activity, complementary and alternative therapies, and hormonal therapy. 20 RCTs (n = 4107) suggested that counseling reduces the development of perinatal depression (Risk Ratio 0.61; CI95 0.47 to 0.78), and effects were largest for cognitive behavioral therapy and interpersonal therapy based interventions. 3 RCTs and 1 non-randomized controlled intervention study suggested health system interventions not implementable in the US also reduced perinatal depression risk (RR 0.60; CI95 0.43 to 0.83). Physical activity interventions consistently reported point estimates to support this intervention, but only one study found statistical significance. Birth experience debriefing and omega-3 fatty acids did not show a benefit. Two trials of prophylactic antidepressants had conflicting findings: one study with nortriptyline showed no benefit (23% vs 24%; p = 0.99) and one study with sertraline showed a benefit (difference in recurrence rates 43%; p = 0.04). No harms were associated with counseling or health system interventions, and there was no difference in adverse events for the antidepressant studies.

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