Introduction
General adult population
Prevalence
Risk factors
Consequence of depression
Current recommendations
Pregnant and postpartum population
Prevalence
Risk factors
Consequence of pregnancy and/or postpartum depression
Current practice and recommendations
Definition of a controlled trial of screening intervention
Objective
General adult population
Pregnant and postpartum population
Methods
Eligibility criteria
Inclusion criteria | Exclusion criteria | |
---|---|---|
Population | Key question 1: patients who are 18 years and older Key question 1a: patients who are 18 years and older selected for screening because they have characteristics that may suggest an elevated risk of depression* *Characteristics as defined in primary studies (e.g. trauma early in life, a family history of depression) | - If > 20% of the study population have a recent history of depression, have a current diagnosis, or are receiving treatment for depression or other mental disorders (unless results are provided separately from the population of interest) - Seeking services due to symptoms of mental disorders - Receiving assessment or care in psychiatric or mental health settings |
Intervention | Interventions that use a single question, small sets of questions, or a screening questionnaire (validated or non-validated) with a pre-defined cut-off score to identify patients who may have depression, but who have not reported their symptoms to healthcare providers or who have otherwise not been identified as possibly depressed by healthcare providers | Interventions that, in addition to screening, include depression care referral or treatment options that are not available to patients identified as depressed in the non-screening trial arm are excluded. |
Comparator | No depression screening Patients in comparator trial arms may be administered depression symptom questionnaires for the purpose of baseline or outcome assessments as long as scores are not provided to the patients or healthcare providers. | |
Outcomes | • Symptoms of depression (continuous or dichotomous) or diagnosis of MDD (using a validated diagnostic interview) • Health-related quality of life • Day-to-day functionality • Lost time at work/school • Impact on lifestyle behaviour (alcohol abuse, smoking, drugs, gambling, etc.) • Suicidality (suicide ideation, attempt or completion) • False-positive result (positive screen in the absence of depressive disorder), overdiagnosis, or overtreatment • Labelling/stigma • Harms of treatment | |
Timing | Published from May 2012 to the date the search is run | |
Study design | Randomized controlled trials (RCTs)* including cluster-controlled trials *Trials of screening in which patient eligibility is determined and then patients are enrolled prior to randomization (i.e., to screening or to no screening). Similar depression management and treatment resources are provided to patients in the screening arm of the trial who were identified as depressed as well as patients in either the screening or non-screening arms of the trial who were identified as depressed via other methods (e.g. unaided clinician diagnosis, patient report) [40] | - RCTs where patient eligibility is determined and patients are enrolled after randomization - Non-RCTs, controlled before-after, interrupted times series, cohort studies, case-control studies, cross-sectional studies, case series, case reports, and other publication types (editorials, commentaries, notes, letter, opinions) |
Setting | Primary care or other non-mental health clinic settings, including specialty clinics such as rheumatology, obstetrics, and gynaecology. | Studies conducted in mental health or psychiatric settings are excluded. |
Language | English and French |
Inclusion criteria | Exclusion criteria | |
---|---|---|
Population | Key question 1: patients during pregnancy and up to 1 year postpartum of any age Key question 1a: patients during pregnancy and up to 1 year postpartum selected for screening because they have characteristics that may suggest an elevated risk of depression* *characteristics as defined in primary studies (e.g. trauma early in life, a family history of depression) | - If > 20% of women have a recent history of depression, have a current diagnosis, or are receiving treatment for depression or other mental disorders (unless results are provided separately from the population of interest) - Women with a history of depression during pregnancy or the postpartum period - Women seeking services due to symptoms of mental disorders - Women receiving assessment or care in psychiatric or mental health settings |
Intervention | Interventions that use a single question, small sets of questions, or a screening questionnaire (validated or non-validated) with a pre-defined cut-off score to identify patients who may have depression, but who have not reported their symptoms to healthcare providers or who have otherwise not been identified as possibly depressed by healthcare providers. | Interventions that, in addition to screening, include depression care referral or treatment options that are not available to patients identified as depressed in the no screening trial arm |
Comparator | No depression screening Patients in comparator trial arms may be administered depression symptom questionnaires for the purpose of baseline or outcome assessments as long as scores are not provided to the patients or healthcare providers. | |
Outcomes | Mental health outcomes • Symptoms of depression (continuous or dichotomous) or diagnosis of MDD (using a validated diagnostic interview) • Health-related quality of life (validated tools) • Suicidality (suicide ideation, attempt, or completion) • False-positive screens (positive screens in the absence of depressive disorder), overdiagnosis, or overtreatment • Labelling/stigma • Harms of treatment Parenting outcomes • Relationship with partner and other supports • Reported/observed capacity to parent (attachment, responsiveness to infant, positive regard of infant/fetus) • Mother-child interactions including mutual touching, smiling, vocalizations, and impact on other children Infant outcomes • Infant health and development (i.e., developmental delay; failure to thrive) cognitive, emotional, motor and neural functioning and development • Infant responsiveness | |
Timing | Published from database inception to the date the search is run | |
Study design | Randomized controlled trials (RCTs)* including cluster-controlled trials *Trials of screening in which patient eligibility is determined and then patients are enrolled prior to randomization (i.e., to screening or to no screening). Similar depression management and treatment resources are provided to patients in the screening arm of the trial who were identified as depressed as well as patients in either the screening or non-screening arms of the trial who were identified as depressed via other methods (e.g. unaided clinician diagnosis, patient report) [40] | RCTs where patient eligibility is determined, and patients are enrolled after randomization Non-RCTs, controlled before-after, interrupted times series, cohort studies, case-control studies, cross-sectional studies, case series, case reports, and other publication types (editorials, commentaries, notes, letter, opinions) |
Setting | Primary care or other non-mental health clinic settings, including specialty clinics such as obstetrical, maternal-fetal medicine, and paediatric clinics | Studies conducted in mental health or psychiatric settings |
Language | English and French |
Data sources and search for studies
General adult review
Pregnant and postpartum review
Screening and data extraction
Risk of bias assessment
Data synthesis and statistical analysis
Meta-analysis
Sparse binary data and studies with zero events
Statistical heterogeneity
Subgroup analysis
Key questions | Both populations | General adult | Pregnancy and postpartum |
---|---|---|---|
1 and 1a | ▪ Socioeconomic status (e.g. income, level of education, as assessed by study authors) ▪ Race/ethnicity (will be determined post hoc, depending on populations encountered in studies) ▪ Geographical location (e.g. rural vs urban settings, country/region) ▪ Validated vs non-validated tools | ▪ Gender/sex | ▪ Timing period and frequency of screening (e.g. prenatal, immediate postpartum) |
1 only | ▪ Age groups (e.g. < 25 years of age) ▪ Immigrant status | ▪ Support status (e.g. single mother with no family support vs other) ▪ Partum status (e.g. first child vs later) | |
1a only | ▪ Risk factors for depression (to be determined post hoc, depending on the combination of risk factors as reported in studies). |