Evidence-based clinical practice guidelines for prevention, screening and treatment of peripartum depression
Sandra Nakić Radoš, Ana Ganho-Ávila, María de la Fe Rodríguez Muñoz, Rena Bina, Sarah Kittel‐Schneider, Mijke P. Lambregtse‐van den Berg, Ilaria Lega, Angela Lupattelli, Greg Sheaf, Alkistis Skalkidou, Ana Uka, Susanne Uusitalo, Laurence Bosteels-Vanden Abeele, Mariana Moura‐Ramos
Abstract
BACKGROUND: Peripartum depression (PPD) is a prevalent mental health disorder in the peripartum period. However, a recent systematic review of clinical guidelines relating to PPD has revealed a significant inconsistency in recommendations. AIMS: This study aimed to collect up-to-date evidence on the effectiveness of interventions and provide recommendations for prevention, screening and treating PPD. METHOD: A series of umbrella reviews on the effectiveness of PPD prevention, screening and treatment interventions was conducted. A search was performed in five databases from 2010 until 2023. The guidelines were developed according to the GRADE framework and AGREE II Checklist recommendations. Public stakeholder review was included. RESULTS: One hundred and forty-five systematic reviews were included in the final analysis and used to form the guidelines. Forty-four recommendations were developed, including recommendations for prevention, screening and treatment. Psychological and psychosocial interventions are strongly recommended for preventing PPD in women with no symptoms and women at risk. Screening programmes for depression are strongly recommended during pregnancy and postpartum. Cognitive-behavioural therapy is strongly recommended for PPD treatment for mild to severe depression. Antidepressant medication is strongly recommended for treating severe depression in pregnancy. Electroconvulsive therapy is strongly recommended for therapy-resistant and life-threatening severe depression during pregnancy. Other recommendations are offered to healthcare professionals, stakeholders and researchers in managing PPD in different contexts. CONCLUSION: Treatment recommendations should be implemented after carefully considering clinical severity, previous history, risk-benefit for mother and foetus/infant and women's values and preferences. Implementation of evidence-based clinical practice guidelines within country-specific contexts should be facilitated.