opinion: national guidelines ignore urgency of perinatal depression

recently the canadian task force on preventive health care was widely rebuked over their recommendation against breast cancer screening in women under 50. the task force is an advisory body established by the public health agency of canada (phac) to create clinical guidelines for healthcare providers across the country.

in response to public backlash, the hon. minister of health, mark holland opened an external review of the task force. but this is not the first time that the task force has faced substantial criticism.

mental health experts concerned about perinatal depression in expectant and new mothers have repeatedly critiqued the 2013 and updated 2022 task force guidelines on “depression during pregnancy and the postpartum period.”  shockingly, the task force recommends against universal screening for depression during and after pregnancy using the global gold standard screening tool.

in canada, depression is a serious mental health problem affecting 23 per cent —  nearly one quarter — of expectant and new mothers. it is the  leading cause of death by suicide in new mothers , and depression during pregnancy is a powerful predictor.

the symptoms of depression such as low mood and fatigue undermine mothers’ abilities to be sensitive and responsive to their growing infants’ needs. these children are at risk for language and learning delays, behavioural and mental health problems and health problems linked to asthma and allergies .

typically, mothers’ depression also precedes fathers’ depression, affecting 22 per cent of canadian men . when both parents are depressed , children are in double jeopardy.

two letters have been published in the canadian medical association journal (cmaj) from researchers and clinicians expressing dismay at the recently updated recommendations on perinatal depression.

the british columbia reproductive mental health program and perinatal services bc also disagree with the task force recommendations, as does the province of alberta’s health services . both provinces engage in screening for perinatal depression, despite the task force recommendations.

first, the guidelines are based on inappropriately limited, restricted evidence, with an over reliance on data from randomized controlled trials of screening programs. clinicians and researchers have advocated that observational and non-randomized trial data be considered – including important canadian data.

a canadian pragmatic trial using longitudinal follow-up and health records showed that women screened at high risk of depression were nearly four times more likely to be diagnosed with depression than unscreened mothers.

second, the guidelines do not adequately acknowledge the complexity of historical inequities in healthcare for women and failed to address stakeholder input. past-president of the canadian psychiatric association advised that the guidelines need to be informed by expert judgement by clinicians including physicians.

third, the guidelines do not acknowledge the impact of stigma that undermines women’s likelihood of sharing their symptoms. clinicians are convinced that women are unlikely to be forthcoming about their symptoms. research suggests women would be willing, or even relieved to be screened , especially if there was a universal program.