Thank you very much, and good afternoon.

Today, we are calling for an urgent revision of the Canadian task force guideline on perinatal depression screening. This guideline undermines decades of work by experts in B.C. and across Canada to promote universal standardized screening, and places the burden of advocating for their mental health on Canadian women at an incredibly vulnerable time in their lives. We can, and should, do better.

My name is Catriona Hippman, and I'm a post-doctoral research fellow with the B.C. reproductive mental health program, the University of British Columbia and the University of Calgary. I'm a Canadian Institutes of Health Research fellow and a Michael Smith Health Research BC fellow.

Perinatal depression is an important public health issue. It affects 10% to 15% of women, with even higher rates among marginalized groups, affecting almost half of immigrant and indigenous women. In light of this, it's unsurprising that suicide is a leading cause of maternal deaths in Canada.

Early identification is key to improved outcomes. When caught early through universal standardized screening, perinatal depression can be successfully treated, and negative downstream consequences for the child and the family can be prevented. Not only can we prevent disastrous outcomes for families with early identification, but we can also save costs for the health care system. A 2021 report by the Canadian Perinatal Mental Health Collaborative demonstrated that costs of $150,000 for each mother-baby dyad affected by perinatal depression and anxiety could be reduced to $5,000 per family with universal standardized screening.

Given this context, it is shocking that the Canadian Task Force on Preventive Health Care currently recommends against universal standardized screening for perinatal depression. This recommendation contradicts screening recommendations within Canada as well as worldwide, including in the U.S., the U.K. and Australia.

At the B.C. reproductive mental health program, we set the standard of care for British Columbia through clinical practice guidelines, resources and interdisciplinary education. We're a national leader in perinatal mental health care, providing over 5,000 direct patient care visits per year and indirect care for countless patients through a rapid consultation service to B.C. primary care providers. As determined by the reproductive mental health program, the standard of care in B.C. includes universal standardized screening for perinatal depression.

In contrast, the Canadian task force recommends that perinatal depression screening occur “as part of usual care”. This means that only patients flagged by their primary care provider will receive additional attention. This is simply not enough. A study in Alberta in 2021 documented that in “usual care”, approximately two-thirds of cases of perinatal depression were missed. This study estimated that 2,000 cases of postpartum depression could have been detected with universal standardized screening.

“Usual care” places the burden of advocating for their mental health on Canadian women. We know that our health care system is strained, and the reality is that under “usual care” conditions, it's the patients who need to bring perinatal depression to the attention of health care providers. What's more, “usual care” is inequitable care. Research has demonstrated that when perinatal depression screening is left to the discretion of the health care provider, racialized patients are less likely to get screened. White women are more likely to have their concerns taken seriously, and women with socio-economic privilege have the greatest capacity to advocate for their own care. This perpetuates health inequalities and further marginalizes Canada's most vulnerable.

You might think that we just don't like the conclusions that the task force reached, but it's more than that. Their conclusions are not justified. The systematic review on which the guideline was based identified a single randomized controlled trial, or RCT, which found that participants who had universal standardized screening had improved maternal mental health outcomes at six months postpartum. Further, the patient values and preferences studies conducted by the Canadian task force highlighted that participants felt the potential benefits of screening outweighed the potential risks. Participants characterized potential harms of screening as trivial. Our perspective aligns with that of the patients in this study, who felt that “risks of overdiagnosis or its resulting treatment were not considered critical in comparison with failure to diagnose depression”.

In summary, the task force prioritized concerns about speculative harms over documented benefits, the perspectives of patients and the opinions of experts.

We need to take the burden off Canadian women. Universal standardized screening promotes equitable access for all Canadians to have a mentally healthy pregnancy and postpartum. We need a Canadian task force guideline that prioritizes preventive health care.

Thank you.