番茄社区

Healthcare providers should refer pregnant and postpartum women at increased risk for depression to counseling services, according to the U.S. Preventive Service Task Force (USPSTF).

In the posted to the USPSTF website, the group found "convincing evidence" (Level B) that referring these women to counseling services, including cognitive behavioral therapy and interpersonal therapy, will have a "moderate net benefit" in helping prevent perinatal depression among women who are at increased risk.

The recommendation applies to pregnant women and women who have given birth less than 1 year ago, without a current depression diagnosis but considered at risk because of factors such unplanned/unwanted pregnancy or as a history of physical or sexual abuse.

"For the first time, the Task Force is recommending counseling to prevent perinatal depression in high-risk women," explained USPSTF member Aaron Caughey, MD, PhD, of the Oregon Health & Science University in Portland, in a statement. "Clinicians should use patient history and risk factors to identify women who are most likely to benefit."

This was echoed by fellow member Karina Davidson, PhD, of Columbia University Medical Center in New York, who added that the responsibility falls largely on primary care providers to initiate the conversation. "Perinatal depression is a serious condition that negatively affects mothers, babies, and families," she said in the statement. "Fortunately, effective counseling interventions can help prevent perinatal depression before it develops, and primary care clinicians can provide or connect women with these services."

No current guidelines address measures to prevent perinatal depression, explained the USPSTF in the draft. However, they referenced from the American College of Obstetricians and Gynecologists (ACOG) recommending women with current depression, anxiety, or a history or risk factors for of perinatal mood disorders be screened, as well as for all postpartum women to be screened for anxiety and depression.

Although there "no accurate screening tool available" for identifying at-risk women for perinatal depression -- which the USPSTF called a gap that must be addressed through future research efforts -- the statement listed clinical risk factors for clinicians to look for.

These included:

• Personal or family history of depression
• Unplanned or unwanted pregnancy
• History of physical or sexual abuse
• Stressful life events
• Gestational diabetes
• Pregnancy complications
• Low socioeconomic status
• Lack of financial or social support

With "adequate evidence" that the benefits of counseling interventions outweigh the potential harms, the USPSTF recommended either cognitive behavioral therapy or interpersonal therapy as a first-line intervention for these at-risk women.

Cognitive behavior therapy "focuses on the concept that positive changes in mood and behavior can be achieved by addressing and managing negative thoughts, beliefs, and attitudes and by increasing positive events and activities," the USPSTF explained. Common techniques with this intervention include setting goals, modifying thought patterns, patient education, and behavioral activation.

Interpersonal therapy "focuses on treating interpersonal issues that are thought to contribute to the development or maintenance of psychological disorders" through the use of exploratory questioning, decision analysis, role playing, and communication analysis. The USPSTF did not indicate which types of patients would do best with one intervention versus the other.

On average, the duration of this counseling can vary greatly -- lasting between four to 70 weeks -- depending on patient needs, although sessions are typically initiated during pregnancy.

Besides counseling interventions, the draft also touched upon a lack of definitive evidence on the benefits of other interventions including antidepressants and supplements, such as selenium and vitamin D, for the prevention of perinatal depression. However, they also mentioned a few small trials suggesting benefit from other types of interventions such as exercise, infant sleep education, in-hospital perinatal education, and peer counseling for preventing depression in this population, although additional research is still needed.

Beyond treatment for at-risk pregnant and postpartum women, the USPSTF's draft also highlighted a previous guideline among adolescents between 12-18 years of age (Level B), but found insufficient evidence to screening in children younger than 12 (I statement).

on the new draft recommendation statement will be accepted through Sept. 24.

Comment