Stakeholders and their perspectives on perinatal depression screening: a systematic review

Background: Untreated perinatal depression significantly affects the health outcomes of both mothers and infants and increases the economic burden on families and society. Early depression screening to identify at-risk women is essential, and involving key stakeholders ensures the successful integration of best practices within healthcare settings. Objectives: This study aims are: 1) to identify stakeholders from guidelines and studies that influence the implementation of perinatal depression screening; and 2) to provide a thematic summary of stakeholders' perspectives on the opportunities and challenges for scaling perinatal depression screening. Methods: A total of 10 databases were comprehensively searched from their inception until July 28 in 2024, encompassing both Chinese and English literature. Websites of academic organizations were also explored to obtain guidelines pertaining to perinatal depression screening. This study followed the PRISMA guidelines for systematic reviews. Stakeholders' perspectives were analyzed using second-order thematic qualitative analysis. Results: A total of 3268 original articles and 104 guidelines were retrieved. Titles, abstracts, and full texts were screened, resulting in the inclusion of 57 original studies and 9 guidelines for data analysis. The most commonly mentioned stakeholders in perinatal depression screening were health care workers (n = 48) and perinatal women (n = 32), followed by healthcare leaders/managers (n = 16) and policymakers (n = 15). A total 23 articles reported stakeholders' perspectives, from which 291 quotes were extracted. Thematic synthesis identified 12 initial codes, which were summarized into three themes: perinatal depression screening practices, challenges in implementing screening, facilitating factors and opportunities for screening services. Conclusions: This study identified 17 types of stakeholders, with health care workers and perinatal women being the primary groups. Additionally, key challenges in perinatal depression screening were identified, highlighting the need for future research to focus cost, quality, and reimbursement structures to ensure the sustainable and scalable implementation of screening initiatives.