The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy

doi:10.1186/s12911-022-01870-1

. 2022 May 13;22(1):130.

doi: 10.1186/s12911-022-01870-1.

The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy

Neesha Hussain-Shamsy¹, Sarah Somerton², Donna E Stewart^{3

4}, Sophie Grigoriadis^{4

5

6}, Kelly Metcalfe^{6

7}, Tim F Oberlander^{8

9}, Carrie Schram⁶, Valerie H Taylor¹⁰, Cindy-Lee Dennis⁷, Simone N Vigod^{11

12

13}

Affiliations

¹ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, Canada.
² Garry Hurvitz Centre for Brain and Mental Health, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.
³ Centre for Mental Health, University Health Network, Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, ON, Canada.
⁴ Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.
⁵ Sunnybrook Health Sciences Centre and Research Institute, 2075 Bayview Avenue, Toronto, ON, Canada.
⁶ Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
⁷ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada.
⁸ BC Children's Hospital, 4500 Oak Street, Vancouver, BC, Canada.
⁹ Department of Pediatrics, Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada.
¹⁰ Department of Psychiatry, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada.
¹¹ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, Canada. simone.vigod@wchospital.ca.
¹² Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada. simone.vigod@wchospital.ca.
¹³ Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. simone.vigod@wchospital.ca.

PMID: 35562801
PMCID: PMC9099318
DOI: 10.1186/s12911-022-01870-1

The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy

Neesha Hussain-Shamsy et al. BMC Med Inform Decis Mak. 2022.

. 2022 May 13;22(1):130.

doi: 10.1186/s12911-022-01870-1.

Authors

Affiliations

¹ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, Canada.
² Garry Hurvitz Centre for Brain and Mental Health, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.
³ Centre for Mental Health, University Health Network, Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, ON, Canada.
⁴ Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.
⁵ Sunnybrook Health Sciences Centre and Research Institute, 2075 Bayview Avenue, Toronto, ON, Canada.
⁶ Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
⁷ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada.
⁸ BC Children's Hospital, 4500 Oak Street, Vancouver, BC, Canada.
⁹ Department of Pediatrics, Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada.
¹⁰ Department of Psychiatry, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada.
¹¹ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, Canada. simone.vigod@wchospital.ca.
¹² Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada. simone.vigod@wchospital.ca.
¹³ Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. simone.vigod@wchospital.ca.

PMID: 35562801
PMCID: PMC9099318
DOI: 10.1186/s12911-022-01870-1

Abstract

Background: People with moderate to severe depression in pregnancy must weigh potential risks of untreated or incompletely treated depression against the small, but uncertain risks of fetal antidepressant drug exposure. Clinical support alone appears insufficient for helping individuals with this complex decision. A patient decision aid (PDA) has the potential to be a useful tool for this population. The objective of our work was to use internationally recognized guidelines from the International Patient Decision Aids Standards Collaboration to develop an evidence-based PDA for antidepressant use in pregnancy.

Methods: A three-phased development process was used whereby, informed by patient and physician perspectives and evidence synthesis, a steering committee commissioned a web-based PDA for those deciding whether or not to start or continue antidepressant treatment for depression in pregnancy (Phase 1). A prototype was developed (Phase 2) and iteratively revised based on feedback during field testing based on a user-centred process (Phase 3).

Results: We developed a web-based PDA for people deciding whether to start or continue antidepressant use for depression in pregnancy. It has five interactive sections: (1) information on depression and treatment; (2) reasons to start/continue an antidepressant and to start/stop antidepressant medication; (3) user assessment of values regarding each issue; (4) opportunity to reflect on factors that contribute to decision making; and (5) a printable PDF that summarizes the user's journey through the PDA.

Conclusions: This tool, which exclusively focuses on depression treatment with Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors, can be used by individuals making decisions about antidepressant use to treat depression during pregnancy. Limitations of the PDA are that it is not for other conditions, nor other medications that can be used for depression, and in its pilot form cannot be used by women who do not speak English or who have a visual impairment. Pending further study, it has the potential to enhance quality of care and patient experience.

Keywords: Antidepressant; Depression; Online; Patient decision aid; Pregnancy.

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Conflict of interest statement

SNV and DES report royalties from UpToDate for authorship of materials related to antidepressants in pregnancy. SG reports royalties from UpToDate and Psychotherapy Essentials to Go for authorship of materials related to treatment of depression in pregnancy. DES serves on the Medical Advisory Committee of Lilly’s Cymbalta Pregnancy Registry. The other authors have no conflicts of interest to declare.

Figures

**Fig. 1**
The development process used for this PDA on antidepressant use in pregnancy, adapted from the IPDAS model development process for decision aids

**Fig. 2**
Participant flow through field testing (Phase 3)

See this image and copyright information in PMC

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References

1. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obs Gynecol. 2004;103(4):698–709. doi: 10.1097/01.AOG.0000116689.75396.5f. - DOI - PubMed
1. Orr ST, Miller CA. Maternal depressive symptoms and the risk of poor pregnancy outcome: review of the literature and preliminary findings. Epidemiol Rev. 1995;17(1):165–171. doi: 10.1093/oxfordjournals.epirev.a036172. - DOI - PubMed
1. Wisner KL, Sit DKY, Hanusa BH, Moses-Kolko EL, Bogen DL, Hunker DF, et al. Major depression and antidepressant treatment: Impact on pregnancy and neonatal outcomes. Am J Psychiatry. 2009;166(5):557–566. doi: 10.1176/appi.ajp.2008.08081170. - DOI - PMC - PubMed
1. Jarde A, Morais M, Kingston D, Giallo R, MacQueen GM, Giglia L, et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: A systematic review and meta-analysis. JAMA Psychiat. 2016;73(8):826–837. doi: 10.1001/jamapsychiatry.2016.0934. - DOI - PubMed
1. Meltzer-Brody S, Stuebe A. The long-term psychiatric and medical prognosis of perinatal mental illness. Best Pr Res Clin Obs Gynaecol. 2014;28(1):49–60. doi: 10.1016/j.bpobgyn.2013.08.009. - DOI - PMC - PubMed

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[1] Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obs Gynecol. 2004;103(4):698–709. doi: 10.1097/01.AOG.0000116689.75396.5f. - DOI - PubMed

[2] Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obs Gynecol. 2004;103(4):698–709. doi: 10.1097/01.AOG.0000116689.75396.5f. - DOI - PubMed

[3] Orr ST, Miller CA. Maternal depressive symptoms and the risk of poor pregnancy outcome: review of the literature and preliminary findings. Epidemiol Rev. 1995;17(1):165–171. doi: 10.1093/oxfordjournals.epirev.a036172. - DOI - PubMed

[4] Orr ST, Miller CA. Maternal depressive symptoms and the risk of poor pregnancy outcome: review of the literature and preliminary findings. Epidemiol Rev. 1995;17(1):165–171. doi: 10.1093/oxfordjournals.epirev.a036172. - DOI - PubMed

[5] Wisner KL, Sit DKY, Hanusa BH, Moses-Kolko EL, Bogen DL, Hunker DF, et al. Major depression and antidepressant treatment: Impact on pregnancy and neonatal outcomes. Am J Psychiatry. 2009;166(5):557–566. doi: 10.1176/appi.ajp.2008.08081170. - DOI - PMC - PubMed

[6] Wisner KL, Sit DKY, Hanusa BH, Moses-Kolko EL, Bogen DL, Hunker DF, et al. Major depression and antidepressant treatment: Impact on pregnancy and neonatal outcomes. Am J Psychiatry. 2009;166(5):557–566. doi: 10.1176/appi.ajp.2008.08081170. - DOI - PMC - PubMed

[7] Jarde A, Morais M, Kingston D, Giallo R, MacQueen GM, Giglia L, et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: A systematic review and meta-analysis. JAMA Psychiat. 2016;73(8):826–837. doi: 10.1001/jamapsychiatry.2016.0934. - DOI - PubMed

[8] Jarde A, Morais M, Kingston D, Giallo R, MacQueen GM, Giglia L, et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: A systematic review and meta-analysis. JAMA Psychiat. 2016;73(8):826–837. doi: 10.1001/jamapsychiatry.2016.0934. - DOI - PubMed

[9] Meltzer-Brody S, Stuebe A. The long-term psychiatric and medical prognosis of perinatal mental illness. Best Pr Res Clin Obs Gynaecol. 2014;28(1):49–60. doi: 10.1016/j.bpobgyn.2013.08.009. - DOI - PMC - PubMed

[10] Meltzer-Brody S, Stuebe A. The long-term psychiatric and medical prognosis of perinatal mental illness. Best Pr Res Clin Obs Gynaecol. 2014;28(1):49–60. doi: 10.1016/j.bpobgyn.2013.08.009. - DOI - PMC - PubMed

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The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy

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The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy

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