Table 4.
Screening programmes compared to care as usual for postpartum depression?
|
Patient or population: Pregnant women and new mothers with symptoms of depression or anxiety Intervention: screening programmes Comparison: care as usual | ||||||
|
Outcome № of participants (studies) |
Relative effect (95% CI) | Anticipated absolute effects (95% CI) | Certainty | What happens | ||
| Difference | ||||||
|
Rates of depression assessed with: Psychometric scales № of participants: 9009 (10 RCTs) |
OR 0.55 (0.45 to 0.66) |
17.5% |
10.4% (8.7 to 12.3) |
7.0% fewer (8.8 fewer to 5.2 fewer) |
⨁⨁⨁◯ MODERATE a |
Screening programmes likely reduces rates of depression slightly. |
|
Severity of Anxiety symptoms assessed with: Psychometric scales № of participants: 3654 (3 RCTs) |
– | – | – |
SMD 0.18 SD lower (0.25 lower to 0.12 lower) |
⨁⨁⨁⨁ HIGH |
Screening programmes reduces severity of Anxiety symptoms slightly. |
|
Treatment seeking № of participants: 1082 (3 RCTs) |
OR 3.74 (2.14 to 6.52) |
17.4% |
44.0% (31 to 57.8) |
26.6% more (13.7 more to 40.4 more) |
⨁⨁⨁◯ MODERATE b |
Screening programmes likely results in a large increase in treatment seeking. |
|
Parental distress assessed with: Psychometric scales № of participants: 2336 (5 RCTs) |
– | – | – |
SMD 0.27 SD lower (0.39 lower to 0.15 lower) |
⨁⨁⨁◯ MODERATE c |
Screening programmes likely reduces parental distress slightly. |
|
Quality of life assessed with: Psychometric scales № of participants: 5157 (4 RCTs) |
– | – | – |
SMD 0.2 SD higher (0.14 higher to 0.27 higher) |
⨁⨁⨁⨁ HIGH |
Screening programmes increases quality of life slightly. |
|
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio; SMD: Standardised mean difference | ||||||
|
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
Explanations
a. Three out ten studies were rated as having a overall low risk of bias. Meta-regression did not reveal any significant association of scores on risk of bias scale with the pooled effect size
b. Two out of three studies had an overall higher risk of bias. Subgroup analysis could not be conducted to ascertain association between risk of bias scores and effect size
c. Egger’s regression statistic revealed significant publication bias