SPECIAL ARTICLE
Should Postpartum Depression Be Targeted to Improve Child Mental Health?

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ABSTRACT

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.

Section snippets

THE CRITERIA

The criteria outlined in Table 1 would not be required to evaluate a given target if an associated intervention had already been demonstrated to result in substantially improved child mental health outcomes through replicated, low-cost, large-scale effectiveness prevention trials. However, few, if any, targeted prevention programs can claim such a status in the field of child mental health, or for that matter, in most other fields. Nevertheless, prevention initiatives aimed at improving child

DISCUSSION

We have presented seven criteria that should be considered when evaluating a given target for a prevention intervention designed to improve child mental health outcomes. Although these criteria are not exhaustive of all potential issues that should be considered, they cover key aspects that may influence the success of a targeted prevention program. Such criteria may help guide prioritization among different proposed prevention targets.

We find mixed support for endorsing PD as a target for

Limitations

This mixed review in no way suggests that efforts should not be made to provide treatment for women with PD. PD represents a major psychiatric disorder with associated morbidity for the inflicted woman, and hence treatment should be offered. Whether or not her offspring have poor outcomes from such a disorder should not be a deciding factor in justifying treatment of this disorder.

However, most articles on PD discuss risk to young offspring. An implicit or explicit message is that intervening

Service Implications

Although we used PD as an example to illustrate our proposed criteria, our belief is that these items may serve as general criteria for evaluating a variety of proposed prevention targets. Other potential targets that could be evaluated include parenting practices, poverty, and early aggressive behavior. Multiple risk factor combinations could potentially be considered as well.

The list of criteria that we have presented are provisional, and we suspect that further work may add to, subtract

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    Dr. McLennan is supported through a Clinical Fellowship from the Alberta Heritage Foundation for Medical Research.

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    Copyright © 2002 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.