In their recently updated guideline for depression screening during pregnancy and the postpartum period, the Canadian Task Force on Preventive Health Care concluded that evidence is uncertain as to whether screening is beneficial relative to usual care. (1) This was the key driver in their recommendation not to screen for depression during pregnancy and the postpartum period.
To identify evidence, the Task Force undertook a systematic review of randomized controlled trials (RCTs) and, to our disappointment, excluded other study designs from their evaluation. Although the RCT is considered a gold standard for comparative effectiveness research given its protection against bias, the shortcomings of RCTs, such as lack of generalizability of study findings to real-world settings, are often undervalued. (2) Evidence suggests that a well-designed observational study can yield similar results to an RCT. (3) Observational studies that use health administrative data are increasingly being used to support population-level research and health decision-making. (4)
In Alberta, screening for postpartum depression (PPD) takes place during well-child visits. Using longitudinal data from a prospective birth cohort linked...