Table 3Inclusion and exclusion criteria

Study CharacteristicInclusion CriteriaExclusion Criteria
Populations
  • Pregnant women and women up to 12 months postpartum
  • Subgroups of potential interest include:
    • Race/ethnicity
    • Income
    • Parity
    • Cultural norms
    • History of mood disorders
    • Perinatal outcomes
    • History of intimate partner violence
  • Fathers or domestic partners
  • Women currently undergoing treatment for depression
  • Studies where the primary objective is to detect depression during pregnancy rather than to identify risk factors for postpartum depression (studies that assessed women prenatally for risk of postpartum depression were not excluded)
  • Studies exclusively addressing bipolar disorder, a primary psychotic disorder, or maternity blues; or studies that include these populations and do not report results for subjects not fitting these subgroups separately
Interventions
  • Screening using a validated screening instrument for depression, including, but not necessarily limited to:
    • Bromley Postnatal Depression Scale (BPDS)
    • Edinburgh Postnatal Depression Scale (EPDS)
    • Postpartum Depression Screening Scale (PDSS)
    • Leverton Questionnaire (LQ)
    • Center for Epidemiologic Studies Depression Scale (CES-D)
    • Hospital Anxiety and Depression Scale (HADS)
    • Patient Health Questionnaire-9 (PHQ-9)
    • Beck Depression Inventory (BDI-1A, BDI-II)
    • Zung Self-Rating Depression Scale (Zung SDS)
    • Hamilton Rating Scale for Depression (HRSD)
    • Postpartum Depression Predictors Inventory-Revised (PDPI-R)
    • General Health Questionnaire (GHQ-D)
    • Montgomery Asberg Depression Rating Scale (MADRS)
    • Generalized Contentment Scale
    • Patient Health Questionnaire-2 (PHQ-2)
    • Primary Care Evaluation of Mental Disorders
    • Patient Health Questionnaire (PRIME-MD PHQ)
  • Validation studies, or screening conducted using a nonvalidated instrument
Comparators
  • No formal protocol for screening, screening with another validated instrument, or screening with the same instrument under different conditions (e.g., different settings or different timing)
  • Comparison to screening with a nonvalidated instrument
Outcomes
  • Performance characteristics (KQs 13):
    • Sensitivity
    • Specificity
    • Predictive values
  • Intermediate outcomes
    • KQs 13:
      • Diagnosis of depression based on the DSM-IV-TR criteria using a validated instrument
    • KQs 4 and 5:
      • Receipt of appropriate diagnostic and treatment services for symptoms of depression
      • Scores on validated measures of maternal well-being and parenting
      • Breastfeeding (e.g., proportion initiating breastfeeding or duration of breastfeeding)
      • Receipt of appropriate diagnostic and treatment services for symptoms of depression
  • Final outcomes (KQ 4):
    • Scores on validated diagnostic instruments for depression
    • Health-related quality of life, based on validated measures
    • Maternal suicidal/infanticidal behaviors
    • Scores on validated instruments of infant health and development
    • Maternal health system resource utilization, including number of visits and estimates of total and attributable costs
    • Infant health system resource utilization, including number of visits and estimates of total and attributable costs
    • Paternal outcomes, including scores on validated mental health instruments, health-related quality of life, and health system resource utilization (measured as described above for maternal outcomes)
  • Adverse effects (KQ 5):
    • Scores on validated measures of stigmatization
    • Health-related quality of life, based on validated measures
    • Maternal health system resource utilization, including number of visits and estimates of total and attributable costs
    • Infant health system resource utilization, including number of visits and estimates of total and attributable costs
    • Paternal outcomes, including scores on validated mental health instruments, health-related quality of life, and health system resource utilization (measured as described above for maternal outcomes)
  • Outcomes measured predelivery
  • Only outcome of interest reported is depression; outcome was measured with the screening instrument only and not confirmed with a reference standard
  • Only outcome of interest reported is sensitivity/specificity, and insufficient data provided to construct a 2-by-2 table
  • Article provides information only about the association between postpartum depression and other outcomes without linking screening to those outcomes
Timing
  • Intervention
    • Prenatal period
    • Immediate postpartum period (up to 6 weeks after delivery)
    • Up to 12 months after delivery
  • Followup
    • Begins at delivery; timing of followup not limited
  • Outcomes measured predelivery
Setting
  • Any clinical provider setting, home
  • Study locations include at least one high-income economy as defined by the World Bank.73 We restrict the study to economically developed countries—countries that have greater cultural and health care system similarities to the United States—to improve applicability of the study results to U.S. populations.
None
Study design
  • Original data
  • RCTs, prospective and retrospective observational studies with comparator; for test characteristics, cross-sectional studies acceptable if includes patients with diagnostic uncertainty and direct comparison of test results with an appropriate reference standard
  • RCTs: All sample sizes
  • Observational studies: sample size ≥100 subjects
  • Editorials, nonsystematic reviews, letters, case series, case reports
Publications
  • English-language only
  • Peer-reviewed articles
  • Relevant systematic review, meta-analysis, or methods article (to be used for background only)a
  • Published on or after January 1, 2004
  • Non-English-language articlesb

BDI-IA = Beck Depression Inventory-IA; BDI-II = Beck Depression Inventory-II; BPDS = Bromley Postnatal Depression Scale; CES-D = Center for Epidemiologic Studies Depression Scale; DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision; EPDS = Edinburgh Postnatal Depression Scale; GHQ-D = General Health Questionnaire; HADS = Hospital Anxiety and Depression Scale; HRSD = Hamilton Rating Scale for Depression; KQ = Key Question; LQ = Leverton Questionnaire; MADRS = Montgomery Asberg Depression Rating Scale; PDPI-R = Postpartum Depression Predictors Inventory-Revised; PDSS = Postpartum Depression Screening Scale; PHQ-2 = Patient Health Questionnaire-2; PHQ-9 = Patient Health Questionnaire-9; PRIME-MD PHQ = Primary Care Evaluation of Mental Disorders Patient Health Questionnaire; RCT = randomized controlled trial; Zung SDS = Zung Self-Rating Depression Scale

a

Systematic reviews and meta-analyses were excluded from direct abstraction; those representing key sources were hand-searched as potential sources of additional citations to consider in the review. Articles providing methods information only (i.e., not reporting data) were not considered among the formal set of included articles, but were used to supplement the abstractions of the studies they referenced.

b

Given the high volume of literature available in English-language publications and concerns about the applicability of non-English publication studies to settings in the United States, non-English articles were excluded.

From: Methods

Cover of Efficacy and Safety of Screening for Postpartum Depression
Efficacy and Safety of Screening for Postpartum Depression [Internet].
Comparative Effectiveness Reviews, No. 106.
Myers ER, Aubuchon-Endsley N, Bastian LA, et al.

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