Depression in pregnant women and children is a big problem. Instead of using screening tools with cut-off points to identify depression in every patient and patient, doctors should ask patients about their well-being as part of routine care, he said. and the recommendation of new guidance from the Association of Clinical Psychologists published in CMAJ (Journal of the Canadian Medical Association).
“Depression in pregnant women and children is scary, with a lot of burden on families, and it is important to identify it,” said Dr. Eddy Lang, a doctor. emergency physician and professor at the Cumming School of Medicine, University of Calgary and chair of the obstetrics and gynecology practice group.
However, there is little evidence that the world is showing sadness using standard and cut-off criteria improves long-term outcomes for these patients, suggesting further research is needed.
“We were disappointed to find insufficient evidence of benefit world show with question paper and cutoff marks; instead, it is best for primary care nurses to focus on asking patients about their well-being during the visit,” said Dr. Lang.
In creating the protocol, the task force included patients to understand their values and preferences about screening to inform recommendations. Participants felt strongly that discussing depression with them health provider during pregnancy and childbirth is important.
The guide is intended health providers in Canada, including doctors, nurses, midwives and others health professionals which deals with pregnant women and those who have given birth. It replaces the previous guidance from the task force, which was published in 2013.
The guidelines apply to pregnant women and those who have given birth in the first year after giving birth. It does not apply to pregnant or breastfeeding women who have a history of depression or who are being evaluated or treated for other mental health problems..
What does this mean for doctors?
- ask patients about their health as part of routine care,
- consider not using a standardized tool with a cut-off score to assess each patient,
- be on the lookout for depression, too
- use clinical judgment to decide on further steps.
“Given the effects of illness during pregnancy and childbirth, it is important to check people’s feelings,” said Dr. Emily McDonald, a professor at McGill University and a physician at McGill University. Medical Center. “If the doctors are not sure about how to start the conversation, they can go back to the questionnaire for discussion, which is different from the usual one that will use a cut-off point to determine the next steps.”
As screening practices vary across Canada, with many provinces and territories recommending testing using a standardized tool, updated guidance is needed.
“Jurisdictions that have used routine screening may want to reconsider this practice given the uncertainty of benefits,” said task member Dr. Brenda Wilson, a public health physician and professor at Memorial University, St. John’s, Newfoundland, and force work A chair. “What is important is clinical care for anxiety as part of daily care, as participating in activities without ensuring benefit can eliminate the rest. health issues.”
The protocol is endorsed by the Canadian College of Family Physicians.
See the full guide and related tools here.
If people are feeling hurt or depressed, they should talk to their primary care physician or access a grief service, like them.
“As the authors of the new guideline took care to emphasize, ignoring screening does not mean primary care practitioners should not ask patients about them. mental health and seeking to identify issues of depression that can be addressed. It should be done,” said Dr. Kirsten Patrick, Editor-in-Chief. CMAJ, in a related editorial. “In addition, they should remember that those who are more likely to be cases may be more difficult to find. However, to support professionals to do their job well, the health system will need to improve access to primary care, mental health and social resources. which can support better care for maternal dementia.”
Recommendations on instrument-based testing for anxiety during pregnancy and childbirth, DOI: 10.1503/cmj.220290
Kirsten Patrick, Ask, but don’t probe: identifying depression in primary care, Journal of the Canadian Medical Association (2022). DOI: 10.1503/cmj.221020
Journal of the Canadian Medical Association
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