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Should postpartum depression be targeted to improve child mental health?
John D McLennan1, David R Offord
1Canadian Centre for Studies of Children at Risk and the Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario.
Objective:
To evaluate whether postpartum depression (PD) is an appropriate target to prevent poor child outcomes.
Method:
Criteria are proposed for evaluating the appropriateness of targeting PD. The target factor should (1) be a causal factor for the negative outcome, (2) have high attributable risk for the negative outcome, (3) be alterable, and (4) be easily and accurately identified through screening. The associated intervention should (5) have characteristics to facilitate dissemination, (6) have low risk for adverse impact, and (7) be acceptable to key stakeholders.
Results:
PD is given a mixed endorsement as an appropriate target for a prevention intervention. Positive characteristics include that PD is moderately prevalent, it is linked with poor child outcomes, it requires inexpensive screening for detection, it is alterable through treatment interventions that may be realistically disseminated, and its treatment is likely to have popular and political support. However, efforts to detect syndromal depression may be costly, strength of the link between PD and poor child outcomes is undetermined, and risks associated with the intervention have not been investigated.
Conclusions:
Further study is required to assess the appropriateness of PD as a prevention target for improving child outcomes. These provisional criteria may be useful for evaluating other proposed prevention targets.