2002 International International Biennial Scientific Meeting

DEVELOPMENT OF A NATIONAL GUIDELINE FOR POSTNATAL DEPRESSION AND PUERPERAL PSYCHOSIS

Beth Alder*, Roch Cantwell** and Joanne Topalian***

* Professor, Napier University, Edinburgh
** Glasgow University, Academic Centre, Gartnavel Hospital Glasgow
*** Programme Manager, SIGN Executive, Edinburgh

E.M.Alder@napier.ac.uk

Objective: To describe the production of a National Guideline for Postnatal Depression and Puerperal Psychosis.

Background: The Scottish Intercollegiate Guidelines Network (SIGN) was formed in 1993, with the objective of improving the quality of health through the development and dissemination of national clinical guidelines containing recommendations for effective practice based on current evidence. There are many guidelines available, but most are based on a consensus of 'expert opinion' or a non-systematic review of the scientific literature. The evidence-based guidelines developed by SIGN are derived from a systematic review of the scientific evidence, and are therefore less susceptible to bias in their conclusions and recommendations.

Method: A multidisciplinary working group developed the guideline with representation from across Scotland. They worked in subgroups and two members independently reviewed and graded each paper. The guideline recommendations were graded according to the strength of the supporting evidence. A public meeting was held to discuss the first draft, and it was revised and sent to peer review before final publication.

Results: The overall quality of the research evidence base was poor and there was one Grade A, three Grade B, nine Grade C and six Grade D recommendations. Twenty recommended good practice points were made, key criteria for clinical audit and Integrated Care Pathways were described and suggestions made for further research.

Conclusions: The guideline provides recommendations based on current evidence for best practice in the management of postnatal depression and puerperal psychosis. The guideline includes screening, diagnosis, prevention and management involving both primary and secondary care, which should lead to an integrated and effective multidisciplinary approach.