2002 International International Biennial Scientific Meeting

TO SCREEN OR NOT TO SCREEN FOR PERINATAL DEPRESSION? - THAT IS THE QUESTION..

Anne Buist*, Bryanne Barnett, Jeannette Milgrom, John Condon, Phillip Boyce, Marie-Paul Austin, Barbara Hayes, David Ellwood, and Sherryl Pope

*University of Melbourne, ARMC Repat Campus, Melbourne

a.buist@medicine.unimelb.edu.au

Objectives: To review the current evidence for screening for perinatal depression (i.e. depression occurring during pregnancy or the first postpartum year) in the light of the evidence available from research literature and make recommendations about future practice.

Methods: A MedLine data base search for the last ten years was undertaken, searching for "antenatal depression", "depression and pregnancy", "postnatal depression", "postpartum depression" and "screening", "detection" or "prediction". A review of current practice in the UK is provided by the National Screening Council Interim report available on the web, and information about current Australian practice was provided by the State Coordinators of the National Postnatal Depression Program.

Results: The literature was reviewed to examine the case for and the case against screening antenatally or postnatally for depression. Two different aspects emerge: antenatal screening as a predictor of postnatal depression, and screening either antenatally or postnatally for current depression. The argument against screening stems from the inability of studies to date to find a suitable predictive model; inadequate information with respect to properties of the commonly used screening scale, the EPDS, risks and benefits, and knowledge and availability of resources for treatment. The arguments for screening look to answering some of these questions through use of a large literature base in the treatment of depression, extensive international experience with the proposed screening tool, and an appropriate study to address the lack of knowledge in specific areas.

Conclusions: The need for early identification and treatment of current depression in the perinatal period is clear. There is a strong case against the use of screening as a predictor. The authors argue that we have enough information to implement a coordinated and evaluated screening program designed to answer the remaining questions.