Advancing Excellence in Health Care Perinatal Depression: Prevalence, Screening, Accuracy and Screening Outcomes Susan F. Meikle, M.D., M.S.P.H. Senior Scientist for Reproductive Health Agency for Healthcare Research and Quality Center for Outcomes and Evidence Tel: Fax:

Advancing Excellence in Health Care Agency for Healthcare Research and Quality Mission To improve the quality, safety, efficiency, and effectiveness of health care for all Americans

Advancing Excellence in Health Care Evidence Based Practice Centers (EPC program) 13 centers selected competitively 13 centers selected competitively Carry out systematic reviews of the literature Carry out systematic reviews of the literature Provide summary statistics Provide summary statistics Provide information on gaps in research Provide information on gaps in research Used to develop practice guidelines Used to develop practice guidelines

Advancing Excellence in Health Care Safe Motherhood Interagency Working Group Composed of Department of Health and Human Service agencies Composed of Department of Health and Human Service agencies Established after World Health Day in 1998 Established after World Health Day in 1998 Focus on women’s health before, during and after pregnancy Focus on women’s health before, during and after pregnancy Funded an evidence report on perinatal depression Funded an evidence report on perinatal depression

Advancing Excellence in Health Care Key Questions and Answers from the EPC Report Key question #1: What is the incidence and prevalence of depression (major and minor) during pregnancy and during the post partum period? What is the incidence and prevalence of depression (major and minor) during pregnancy and during the post partum period? Major depression: prevalence is 3-5% during pregnancy and 2-6% in 12 months after delivery Is it increased during pregnancy and the post partum period compared to nonchildbearing periods? Is it increased during pregnancy and the post partum period compared to nonchildbearing periods? Does not appear to be different

Advancing Excellence in Health Care Key question #2: What is the accuracy of different screening tools for detecting depression during pregnancy and the post partum period? What is the accuracy of different screening tools for detecting depression during pregnancy and the post partum period? Screening is accurate but better for major depression Key question #3: Does prenatal or early postnatal screening for depressive symptoms with subsequent intervention lead to improved outcomes? Does prenatal or early postnatal screening for depressive symptoms with subsequent intervention lead to improved outcomes? Screening early does not appear to be effective but a variety of treatments do work. Key Questions and Answers from the EPC Report (con’t.)

Advancing Excellence in Health Care Conclusions: Depression occurs throughout pregnancy, not just postpartum Depression occurs throughout pregnancy, not just postpartum Accurate and feasible screening measures are available Accurate and feasible screening measures are available More information about treatment effects on perinatal outcomes is needed More information about treatment effects on perinatal outcomes is needed More research is needed on the rates of perinatal depression among racial and ethnic groups in the U.S. population More research is needed on the rates of perinatal depression among racial and ethnic groups in the U.S. population

Advancing Excellence in Health Care Implications Identified gaps in research for perinatal depression for researchers Identified gaps in research for perinatal depression for researchers Guided research funding for government agencies Guided research funding for government agencies Provides information for women, families, clinicians about the common nature of perinatal depression Provides information for women, families, clinicians about the common nature of perinatal depression

Advancing Excellence in Health Care Resources: Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Evidence-based Practice Centers Evidence-based Practice Centers Perinatal Depression: Prevalence, Screening, Accuracy and Screening Outcomes eport Perinatal Depression: Prevalence, Screening, Accuracy and Screening Outcomes eport eport eport