Radoš Sandra Nakić, Ganho-Ávila Ana, Rodriguez-Muñoz Maria F, Bina Rena, Kittel-Schneider Sarah, Lambregtse-van den Berg Mijke P, Lega Ilaria, Lupattelli Angela, Sheaf Greg, Skalkidou Alkistis, Uka Ana, Uusitalo Susanne, Bosteels-Vanden Abeele Laurence, Moura-Ramos Mariana
Department of Psychology, Catholic University of Croatia, Zagreb, Croatia.
Centre for Research in Neuropsychology and Cognitive Behavioural Interventions, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
Br J Psychiatry. 2025 Jun 26:1-12. doi: 10.1192/bjp.2025.43.
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.
This study aimed to collect up-to-date evidence on the effectiveness of interventions and provide recommendations for prevention, screening and treating PPD.
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.
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.
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.
围产期抑郁症（PPD）是围产期一种常见的心理健康障碍。然而，最近一项关于PPD临床指南的系统评价显示，各项建议存在显著不一致。
本研究旨在收集有关干预措施有效性的最新证据，并为PPD的预防、筛查和治疗提供建议。
对PPD预防、筛查和治疗干预措施的有效性进行了一系列汇总分析。在2010年至2023年期间检索了五个数据库。指南依据GRADE框架和AGREE II清单建议制定。纳入了公众利益相关者的评审。
最终分析纳入了145项系统评价并用于形成指南。制定了44项建议，包括预防、筛查和治疗方面的建议。强烈建议对无症状女性和有风险的女性采用心理和社会心理干预措施预防PPD。强烈建议在孕期和产后开展抑郁症筛查项目。对于轻度至重度抑郁症的PPD治疗，强烈推荐认知行为疗法。强烈建议使用抗抑郁药物治疗孕期重度抑郁症。强烈建议对孕期难治性和危及生命的重度抑郁症采用电休克疗法。还为医疗保健专业人员、利益相关者和研究人员提供了在不同情况下管理PPD的其他建议。
应在仔细考虑临床严重程度、既往病史、对母亲和胎儿/婴儿的风险效益以及女性的价值观和偏好后实施治疗建议。应推动在特定国家背景下实施循证临床实践指南。
