On Tuesday the U.S. Preventive Services Task Force released new recommendations on screening for depression in adults, notably calling for depression screening in women both during and after pregnancy.
The recommendations, published in the Journal of the American Medical Association, suggest: “All adults older than 18 years should be routinely screened for depression. This includes pregnant women and new mothers as well as elderly adults.”
“Depression is among the leading causes of disability in persons 15 years and older,” the task force statement said. “It affects individuals, families, businesses, and society and is common in patients seeking care in the primary care setting. Depression is also common in postpartum and pregnant women and affects not only the woman but her child as well. …The [task force] found convincing evidence that screening improves the accurate identification of adult patients with depression in primary care settings, including pregnant and postpartum women.”
The government-appointed panel found that the harms from such screening are “small to none,” though it did cite potential harm related to drugs frequently prescribed for depression:
The USPSTF found that second-generation antidepressants (mostly selective serotonin reuptake inhibitors [SSRIs]) are associated with some harms, such as an increase in suicidal behaviors in adults aged 18 to 29 years and an increased risk of upper gastrointestinal bleeding in adults older than 70 years, with risk increasing with age; however, the magnitude of these risks is, on average, small. The USPSTF found evidence of potential serious fetal harms from pharmacologic treatment of depression in pregnant women, but the likelihood of these serious harms is low. Therefore, the USPSTF concludes that the overall magnitude of harms is small to moderate.
Nancy Byatt, medical director at the Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms) and an assistant professor of psychiatry and obstetrics and gynecology at UMass Medical School, said the new recommendations “are an incredibly important step to have depression care become a routine part of obstetrical care.”
She added: “Depression in pregnancy is twice as common as diabetes in pregnancy and obstetric providers always screen for diabetes and they have a clear treatment plan. The goal [here] is that women are screened for depression [during pregnancy and postpartum] and they are assessed and treated and this becomes a routine part of care just like diabetes.”
Dr. Ruta Nonacs, who’s in the psychiatry department at Massachusetts General Hospital and editor-in-chief at the MGH Center for Women’s Mental Health, sent her thoughts via email:
In that the USPSTF recommendation recognizes pregnant and postpartum women as a group at high risk for depression, this represents a step in the right direction in terms of ensuring that psychiatric illness in this vulnerable population is identified and appropriately treated. However, there remain significant obstacles to overcome. Research and clinical experience indicate that while pregnant and postpartum women with mood and anxiety disorders can be identified through screening, many women identified in this manner do not seek or are not able to find treatment.
While screening is important, we must also make sure we tend to the construction of a system that provides appropriate follow-up and treatment. Because stigma continues to be significant with regard to mental health issues in mothers and mothers-to-be and because there are concerns regarding the use of medication in pregnant and nursing women, we must make sure that after screening, we help women to access appropriate resources and treaters who have expertise in the treatment of women during pregnancy and the postpartum period.