Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada; School of Nursing, McGill University, Montréal, Québec, Canada.
Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
J Psychosom Res. 2014 Jun;76(6):433-46. doi: 10.1016/j.jpsychores.2014.01.006. Epub 2014 Jan 28.
Clinical practice guidelines disagree on whether health care professionals should screen women for depression during pregnancy or postpartum. The objective of this systematic review was to determine whether depression screening improves depression outcomes among women during pregnancy or the postpartum period.
Searches included the CINAHL, EMBASE, ISI, MEDLINE, and PsycINFO databases through April 1, 2013; manual journal searches; reference list reviews; citation tracking of included articles; and trial registry reviews. RCTs in any language that compared depression outcomes between women during pregnancy or postpartum randomized to undergo depression screening versus women not screened were eligible.
There were 9,242 unique titles/abstracts and 15 full-text articles reviewed. Only 1 RCT of screening postpartum was included, but none during pregnancy. The eligible postpartum study evaluated screening in mothers in Hong Kong with 2-month-old babies (N=462) and reported a standardized mean difference for symptoms of depression at 6 months postpartum of 0.34 (95% confidence interval=0.15 to 0.52, P<0.001). Standardized mean difference per 44 additional women treated in the intervention trial arm compared to the non-screening arm was approximately 1.8. Risk of bias was high, however, because the status of outcome measures was changed post-hoc and because the reported effect size per woman treated was 6-7 times the effect sizes reported in comparable depression care interventions.
There is currently no evidence from any well-designed and conducted RCT that screening for depression would benefit women in pregnancy or postpartum. Existing guidelines that recommend depression screening during pregnancy or postpartum should be re-considered.
临床实践指南在医疗保健专业人员是否应在孕期或产后期间对女性进行抑郁症筛查的问题上存在分歧。本系统评价的目的是确定抑郁症筛查是否能改善孕期或产后女性的抑郁症结局。
检索包括 CINAHL、EMBASE、ISI、MEDLINE 和 PsycINFO 数据库，检索日期截至 2013 年 4 月 1 日；手工检索杂志；参考文献回顾；纳入文献的引文追踪；以及试验注册处的审查。纳入的 RCT 必须是任何语言的研究，比较了在孕期或产后期间随机分配进行抑郁症筛查的女性与未进行筛查的女性之间的抑郁症结局。
共检索到 9242 个标题/摘要和 15 篇全文文章。仅纳入了一项关于产后筛查的 RCT，但没有关于孕期的。符合条件的产后研究评估了香港有 2 个月大婴儿的母亲（N=462）的筛查情况，并报告了产后 6 个月时抑郁症状的标准化均数差值为 0.34（95%置信区间=0.15 至 0.52，P<0.001）。与非筛查组相比，干预组中每增加 44 名接受治疗的女性的标准化均数差值约为 1.8。然而，风险偏倚较高，因为事后改变了结局测量的状态，而且报告的每例治疗女性的效果大小是可比的抑郁症治疗干预报告的 6-7 倍。
目前没有任何精心设计和实施的 RCT 证据表明，对抑郁症进行筛查会使孕期或产后女性受益。建议重新考虑目前建议在孕期或产后期间进行抑郁症筛查的现有指南。
