Final Research Plan
Perinatal Depression: Preventive Interventions
June 01, 2023
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
- Do interventions to prevent perinatal depression improve health outcomes in pregnant or postpartum individuals or their children?
- In trials that limit enrollment to individuals at increased risk, how are participants identified as being at increased risk of developing perinatal depression?
- What harms are associated with interventions to prevent perinatal depression in pregnant or postpartum individuals?
Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.
- Are there reliable and valid prognostic tools for identifying individuals who are at increased risk of developing perinatal depression?
- When is the most effective time to provide interventions to prevent perinatal depression?
To the extent possible, we plan to describe the population, risk assessment, and intervention characteristics of the included studies. Data on population characteristics will help us to explore the degree to which the findings are representative of different populations of persons at risk for perinatal depression. These groups include, but are not limited to, categorizations by various social determinants of health, such as education, socioeconomic status, age, gender, and racial, ethnic, and cultural identity. We will endeavor to determine if depression prevention interventions developed and customized for specific populations are effective in those populations.
The Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions.
|Aim/ Objective||Studies with a primary aim to prevent perinatal depression||Studies restricted to screening for and treatment of depression during pregnancy or in the postpartum period|
|Population||Pregnant and postpartum (≤1 year) individuals; study may target individuals with mental health symptoms or disorders (see exceptions under exclusion criteria)||
|Interventions||Interventions to reduce the risk of perinatal depression initiated during pregnancy or the first year postpartum, including:
Maternal health outcomes:
|KQ 1: Maternal behavioral intermediate outcomes (e.g., physical activity levels or dietary intake)|
|Timing of Outcome Assessment||KQ 1: ≥6 weeks after baseline assessment or intervention initiation
KQ 2: ≥6 weeks after baseline assessment or intervention initiation
For prophylactic psychotropic pharmacotherapy interventions only: any time after the intervention is initiated
|KQ 1: <6 weeks after baseline assessment or intervention initiation|
|Study Designs||KQ 1: RCTs
KQ 2: RCTs; for medications determined to be efficacious in KQ1 evidence: RCTs, existing systematic reviews
|All other study designs (e.g., case report or case series)|
|Countries||Countries categorized as “Very High” on the 2021 Human Development Index, as defined by the United Nations Development Programme||Countries not categorized as “Very High” on the Human Development Index|
|Languages||English||Languages other than English|
|Quality||Fair or good, according to design-specific criteria||Poor, according to design-specific criteria|
Abbreviations: AIDS = acquired immunodeficiency syndrome; ED = emergency department; HIV = human immunodeficiency virus; KQ = key question; RCT = randomized, controlled trial.
The draft Research Plan was posted for public comment on the U.S. Preventive Services Task Force (USPSTF) website from February 23, 2023, to March, 22, 2023. In response to public comment, the Research Plan was revised to clarify the list of included and excluded maternal health outcomes for Key Question 1 (benefits) and the included study designs and minimum followup time requirement for Key Question 2 (harms). Other minor clarifying revisions were made to the Research Plan text.