A systematic review of psychosocial screening tools for identification of postpartum mental health status beyond depressive symptoms

Background

Mental health is a key driver of maternal health, particularly in the postpartum period. Psychiatric screening may improve linkage to care and outcomes. Limited evidence exists beyond screening for depression.

Objective

The goal of this systematic review was to characterize the effects of systematic psychiatric and psychosocial screening on the identification, referral for, and resolution of postpartum mental health symptoms beyond depressive symptoms.

Methods

We identified studies that screened for psychiatric or psychosocial symptoms during pregnancy or postpartum and assessed at least one result of the screening in the postpartum year (e.g., diagnosis, linkage to care, resolution of symptoms). We searched six bibliographic databases on October 25, 2022 and again on December 15, 2023. Results were screened using Covidence. Two reviewers assessed each title/abstract and full text. We conducted a quality assessment using a modified version of the EPHPP (Effective Public Health Practice Quality Assessment Tool for Quantitative Studies).

Results

Of 5758 initially eligible studies, we selected 47 which fit our criteria. The most common symptom type was anxiety (25), followed by life course trauma (7), general psychosocial screening (4), and posttraumatic stress disorder (6). Studies primarily assessed diagnostic accuracy, followed by referral to care as outcomes. We deemed most studies of low quality (80.8 %), primarily due to a lack of an unscreened control group for assessing screening effectiveness.

Conclusions

Postpartum screening is feasible and accurate for many psychiatric symptoms beyond depression. It is unclear whether it is effective in linking to care or improving postpartum outcomes.