Is it clinically and cost effective to screen for postnatal depression: a systematic review of controlled clinical trials and economic evidence
Article first published online: 11 MAY 2009
© 2009 The Authors Journal compilation © RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 116, Issue 8, pages 1019–1027, July 2009
How to Cite
Hewitt, C. and Gilbody, S. (2009), Is it clinically and cost effective to screen for postnatal depression: a systematic review of controlled clinical trials and economic evidence. BJOG: An International Journal of Obstetrics & Gynaecology, 116: 1019–1027. doi: 10.1111/j.1471-0528.2009.02148.x
- Issue published online: 10 JUN 2009
- Article first published online: 11 MAY 2009
- Accepted 4 February 2009. Published Online 11 May 2009.
- postnatal depression;
Background Postnatal depression (PND) is a common mental health problem, which is associated with adverse consequences beyond the individual with depression. It is not known whether using formal methods to identify PND are clinically and cost effective in improving maternal and infant outcomes.
Objectives To evaluate the clinical and cost effectiveness of antenatal and postnatal identification of depressive symptoms.
Search strategy Twenty electronic databases were searched to retrieve English and non-English language articles published until February 2007.
Selection criteria Randomised controlled trials or controlled trials comparing the use of formal methods to identify PND, with or without enhancement of care, or feedback of scores with not using formal methods to identify PND or usual care.
Data collection and analysis Two reviewers independently assessed studies for inclusion and extracted data. Results from the trials were combined to calculate odds ratios and 95% confidence intervals for dichotomous outcomes.
Main results Five studies were identified that compared formal use of a method to identify PND, with or without enhancement of care, or feedback of scores with not using a formal method or usual care. All of the studies used the Edinburgh Postnatal Depression Scale (EPDS) to identify women with PND. The results of the studies indicated beneficial effects of using the EPDS in reducing EPDS scores (OR = 0.61; 95% CI 0.48–0.76).
Author’s conclusions Despite some apparent beneficial effects of using formal methods to identify PND, it is difficult to disentangle the effects of the screening component alone from interventions linked to a positive screen as some of the studies included enhancements of care and/or an intervention.