Maternal, Fetal, and Child Outcomes of Mental Health Treatments in Women: A Meta‐Analysis of Pharmacotherapy

Viswanathan, Meera; Middleton, Jennifer Cook; Stuebe, Alison M.; Berkman, Nancy D; Goulding, Alison N.; McLaurin‐Jiang, Skyler; Dotson, Andrea; Coker‐Schwimmer, Manny; Baker, Claire; Voisin, C; Bann, Carla

doi:10.1176/appi.prcp.20210001

Cited by 10 publications

(9 citation statements)

References 107 publications

(93 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thirty-nine existing systematic reviews (reported in 41 publications) of treatment for depression were included; 30 addressed psychological treatment (eTable 11 in the Supplement), and 10 addressed pharmacologic treatment (eTable 12 in the Supplement). Psychological treatment improved depression symptom severity (eFigure 2 in the Supplement). This was the case both in broad analyses that included a wide range of populations and specific interventions and in analyses of some important specific populations, including older adults, perinatal populations, and primary care patients.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Depression and Suicide Risk Screening

O’Connor

Perdue

Coppola

et al. 2023

JAMA

Self Cite

View full text Add to dashboard Cite

ImportanceDepression is common and associated with substantial burden. Suicide rates have increased over the past decade, and both suicide attempts and deaths have devastating effects on individuals and families.ObjectiveTo review the benefits and harms of screening and treatment for depression and suicide risk and the accuracy of instruments to detect these conditions among primary care patients.Data SourcesMEDLINE, PsychINFO, Cochrane library through September 7, 2022; references of existing reviews; ongoing surveillance for relevant literature through November 25, 2022.Study SelectionEnglish-language studies of screening or treatment compared with control conditions, or test accuracy of screening instruments (for depression, instruments were selected a priori; for suicide risk, all were included). Existing systematic reviews were used for treatment and test accuracy for depression.Data Extraction and SynthesisOne investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Findings were synthesized qualitatively, including reporting of meta-analysis results from existing systematic reviews; meta-analyses were conducted on original research when evidence was sufficient.Main Outcomes and MeasuresDepression outcomes; suicidal ideation, attempts, and deaths; sensitivity and specificity of screening tools.ResultsFor depression, 105 studies were included: 32 original studies (N=385 607) and 73 systematic reviews (including ≈2138 studies [N ≈ 9.8 million]). Depression screening interventions, many of which included additional components beyond screening, were associated with a lower prevalence of depression or clinically important depressive symptomatology after 6 to 12 months (pooled odds ratio, 0.60 [95% CI, 0.50-0.73]; reported in 8 randomized clinical trials [n=10 244]; I2 = 0%). Several instruments demonstrated adequate test accuracy (eg, for the 9-item Patient Health Questionnaire at a cutoff of 10 or greater, the pooled sensitivity was 0.85 [95% CI, 0.79-0.89] and specificity was 0.85 [95% CI, 0.82-0.88]; reported in 47 studies [n = 11 234]). A large body of evidence supported benefits of psychological and pharmacologic treatment of depression. A pooled estimate from trials used for US Food and Drug Administration approval suggested a very small increase in the absolute risk of a suicide attempt with second-generation antidepressants (odds ratio, 1.53 [95% CI, 1.09-2.15]; n = 40 857; 0.7% of antidepressant users had a suicide attempt vs 0.3% of placebo users; median follow-up, 8 weeks). Twenty-seven studies (n = 24 826) addressed suicide risk. One randomized clinical trial (n=443) of a suicide risk screening intervention found no difference in suicidal ideation after 2 weeks between primary care patients who were and were not screened for suicide risk. Three studies of suicide risk test accuracy were included; none included replication of any instrument. The included suicide prevention studies generally did not demonstrate an improvement over usual care, which typically included specialty mental health treatment.Conclusions and RelevanceEvidence supported depression screening in primary care settings, including during pregnancy and postpartum. There are numerous important gaps in the evidence for suicide risk screening in primary care settings.

show abstract

Section: Resultsmentioning

confidence: 99%

“…For pharmacologic treatment, 1 cohort study and 22 existing systematic reviews (eTable 16 in the Supplement) were included. There was clear evidence that persons receiving antidepressants were at a higher risk of dropout because of adverse events (eFigure 6 in the Supplement).…”

Section: Resultsmentioning

confidence: 99%

Depression and Suicide Risk Screening

O’Connor

Perdue

Coppola

et al. 2023

JAMA

Self Cite

View full text Add to dashboard Cite

show abstract

“…None of the RCTs or existing systematic reviews of psychological treatment reported on adverse events, but there was no pattern of effects indicating an elevated risk of harm. For the harms of pharmacologic treatment, 3 RCTs (eTable 9 in the Supplement) and 8 existing systematic reviews addressing medications other than antidepressants (eTable 11 in the Supplement) were included . Harms of antidepressants are addressed in a separate publication .…”

Section: Resultsmentioning

confidence: 99%

Anxiety Screening

O’Connor

Henninger

Perdue

et al. 2023

JAMA

Self Cite

View full text Add to dashboard Cite

ImportanceAnxiety is commonly seen in primary care and associated with substantial burden.ObjectiveTo review the benefits and harms of screening and treatment for anxiety and the accuracy of instruments to detect anxiety among primary care patients.Data SourcesMEDLINE, PsychINFO, Cochrane library through September 7, 2022; references of existing reviews; ongoing surveillance for relevant literature through November 25, 2022.Study SelectionEnglish-language original studies and systematic reviews of screening or treatment compared with control conditions and test accuracy studies of a priori–selected screening instruments were included. Two investigators independently reviewed abstracts and full-text articles for inclusion. Two investigators independently rated study quality.Data Extraction and SynthesisOne investigator abstracted data; a second checked accuracy. Meta-analysis results were included from existing systematic reviews where available; meta-analyses were conducted on original research when evidence was sufficient.Main Outcomes and MeasuresAnxiety and depression outcomes; global quality of life and functioning; sensitivity and specificity of screening tools.ResultsOf the 59 publications included, 40 were original studies (N = 275 489) and 19 were systematic reviews (including ≈483 studies [N≈81 507]). Two screening studies found no benefit for screening for anxiety. Among test accuracy studies, only the Generalized Anxiety Disorder (GAD) GAD-2 and GAD-7 screening instruments were evaluated by more than 1 study. Both screening instruments had adequate accuracy for detecting generalized anxiety disorder (eg, across 3 studies the GAD-7 at a cutoff of 10 had a pooled sensitivity of 0.79 [95% CI, 0.69 to 0.94] and specificity of 0.89 [95% CI, 0.83 to 0.94]). Evidence was limited for other instruments and other anxiety disorders. A large body of evidence supported the benefit of treatment for anxiety. For example, psychological interventions were associated with a small pooled standardized mean difference of −0.41 in anxiety symptom severity in primary care patients with anxiety (95% CI, −0.58 to −0.23]; 10 RCTs [n = 2075]; I2 = 40.2%); larger effects were found in general adult populations.Conclusions and RelevanceEvidence was insufficient to draw conclusions about the benefits or harms of anxiety screening programs. However, clear evidence exists that treatment for anxiety is beneficial, and more limited evidence indicates that some anxiety screening instruments have acceptable accuracy to detect generalized anxiety disorder.

show abstract

“…Interestingly, the risk significantly decreased if lithium-taking patients were compared only to patients with affective disorders not taking lithium (Fornaro et al 2020 ). This result highlights the importance of taking as reference adequate control groups in pregnancy studies, so to balance the benefits and risks of pharmacological intervention (Viswanathan et al 2021 ; Scrandis 2017 ). Recent meta-analytic findings confirmed previous naturalistic observations (Rosso et al 2016 ) and showed that postpartum relapse rates in BD were significantly higher among patients who were medication-free during pregnancy (66%; 95% CI = 57–75) than among those using prophylactic medication (23%; 95% CI = 14–37) (Wesseloo et al 2016 ).…”

Section: Discussionmentioning

confidence: 97%

Lithium use in childhood and adolescence, peripartum, and old age: an umbrella review

Janiri

Sampogna

Albert

et al. 2023

Int J Bipolar Disord

View full text Add to dashboard Cite

Background Lithium is one of the most consistently effective treatment for mood disorders. However, patients may show a high level of heterogeneity in treatment response across the lifespan. In particular, the benefits of lithium use may vary in special clinical conditions. The aim of this study was to test this hypothesis by conducting an umbrella review on the efficacy and safety of lithium in childhood and adolescence, peripartum and old age. Methods We applied the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria (PRISMA) to identify systematic reviews/meta-analyses on the efficacy and/or safety of lithium in mood disorders in special clinical conditions: (i) childhood and adolescence; (ii) peripartum (pregnancy, postpartum and lactation); (iii) old age. The Risk of Bias Assessment Tool for Systematic Reviews (ROBIS) tool was used to assess the risk of bias. Overlap in primary studies across systematic reviews was calculated through the Corrected Covered Area (CCA). Results We included 20 independent studies, for a total of 8209 individuals treated with lithium. Regarding paediatric age, efficacy and safety results suggested that lithium may be superior to placebo in bipolar disorders (BD) and not associated with serious adverse events. Nevertheless, primary available data are very limited. Efficacy in paediatric major depressive disorder (MDD) is not clear. During peripartum, lithium use was superior to non-lithium in preventing mood episodes and it was associated with low risk of congenital anomalies and with normal child neurodevelopment. Regarding old age, limited evidence supported lithium as an effective treatment in BD and resistant MDD; low doses should be used in this population. Systematic reviews on paediatric age showed the lowest risk of bias (80% of the studies at low risk). The CCA range of included studies was 13–47%. Conclusions This umbrella review supports the use of lithium across the lifespan, including special clinical condition. Nevertheless, more studies with increased methodological homogeneity are needed.

show abstract

Maternal, Fetal, and Child Outcomes of Mental Health Treatments in Women: A Meta‐Analysis of Pharmacotherapy

Cited by 10 publications

References 107 publications

Depression and Suicide Risk Screening

Depression and Suicide Risk Screening

Anxiety Screening

Lithium use in childhood and adolescence, peripartum, and old age: an umbrella review

Contact Info

Product

Resources

About