Is it clinically and cost effective to screen for postnatal depression: a systematic review of controlled clinical trials and economic evidence

Postnatal depression (PND) is a common mental health problem, which is associated with adverse consequences beyond the individual with depression. It is not known whether using formal methods to identify PND are clinically and cost effective in improving maternal and infant outcomes. To evaluate the clinical and cost effectiveness of antenatal and postnatal identification of depressive symptoms. Twenty electronic databases were searched to retrieve English and non-English language articles published until February 2007. Randomised controlled trials or controlled trials comparing the use of formal methods to identify PND, with or without enhancement of care, or feedback of scores with not using formal methods to identify PND or usual care. Two reviewers independently assessed studies for inclusion and extracted data. Results from the trials were combined to calculate odds ratios and 95% confidence intervals for dichotomous outcomes. Five studies were identified that compared formal use of a method to identify PND, with or without enhancement of care, or feedback of scores with not using a formal method or usual care. All of the studies used the Edinburgh Postnatal Depression Scale (EPDS) to identify women with PND. The results of the studies indicated beneficial effects of using the EPDS in reducing EPDS scores (OR = 0.61; 95% CI 0.48-0.76). Despite some apparent beneficial effects of using formal methods to identify PND, it is difficult to disentangle the effects of the screening component alone from interventions linked to a positive screen as some of the studies included enhancements of care and/or an intervention.