Psychosocial and psychological interventions for postpartum depression

Dennis C-L, Hodnett ED

Published Online:

January 21, 2009

Postpartum depression affects approximately 13% of all new mothers. Many women desire to try treatment options other than medication. Results from nine trials involving 956 women found that both psychosocial (e.g., peer support, non-directive counselling) and psychological (e.g., cognitive behavioural therapy and interpersonal psychotherapy) interventions appear to be effective in reducing symptoms of postpartum depression. The long-term benefits are unknown. Larger trials evaluating psychosocial and psychological treatments for postpartum depression are needed to provide clear conclusions about specific intervention benefits.

Abstract (click to read)

Background:

Postpartum depression is a major health issue for many women from diverse cultures. While pharmacological interventions are an effective treatment for depression, mothers are often reluctant to take antidepressant medication due to concerns about breast milk transmission or potential side-effects. It is important that non-pharmacologic interventions be evaluated for use with postpartum women experiencing depressive symptomatology.

Objectives:

Primary: to assess the effects of all psychosocial and psychological interventions compared with usual postpartum care in the reduction of depressive symptomatology.
Secondary: to examine (1) the effectiveness of specific types of psychosocial interventions; (2) the effectiveness of specific types of psychological interventions; (3) the effectiveness of specific types of psychosocial interventions versus psychological interventions; (4) the effects of intervention mode (e.g., individual versus group-based interventions); and (5) the effects of sample selection criteria (e.g., targeting women with clinically diagnosed depression versus self-reported depressive symptomatology).

Search strategy:

CCDANCTR-Studies and CCDANCTR-References were searched on 1/8/2007, the Cochrane Pregnancy and Childbirth Review Group trials register, CENTRAL, MEDLINE (1966 to 2006), EMBASE (1980 to 2006) and CINAHL (1982 to 2006) using various combinations of the terms 'postpartum/postnatal depression.' Secondary references and experts in the field were used to identify other published or unpublished trials.

Selection criteria:

All published, unpublished, and ongoing randomised controlled trials and quasi-randomised trials of psychosocial or psychological interventions where the primary or secondary aim was a reduction in depressive symptomatology.

Data collection and analysis:

Both review authors participated in the evaluation of methodological quality and data extraction. Additional information was sought from several trial researchers. Results are presented using relative risk for categorical data and weighted mean difference for continuous data.

Main results:

Ten trials met the inclusion criteria, of which nine trials reported outcomes for 956 women. Any psychosocial or psychological intervention, compared to usual postpartum care, was associated with a reduction in the likelihood of continued depression, however measured, at the final assessment within the first year postpartum. Both psychosocial and psychological interventions were effective in reducing depressive symptomatology. Trials selecting participants based on a clinical diagnosis of depression were just as effective in decreasing depressive symptomatology as those that enrolled women who met inclusion criteria based on self-reported depressive symptomatology.

Authors' conclusions:

Although the methodological quality of the majority of trials was, in general, not strong, the meta-analysis results suggest that psychosocial and psychological interventions are an effective treatment option for women suffering from postpartum depression. The long-term effectiveness remains unclear.

This record should be cited as:

Dennis C-L, Hodnett ED. Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006116. DOI: 10.1002/14651858.CD006116.pub2

Assessed as up to date:

August 2, 2007

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Primary Review Group:

Depression, Anxiety and Neurosis Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective are psychosocial and psychological interventions for postpartum depression?

Bottom line:

Compared to usual postpartum care, psychosocial (eg.peer support, non-directive counselling) and psychological (eg.cognitive behavioural therapy, interpersonal psychotherapy) interventions are effective in reducing the symptoms of postpartum depression (NNT=7 range 4 to 20). Trials selecting participants based on a clinical diagnosis of depression were just as effective in decreasing symptomatology as those that enrolled women who met inclusion criteria based on self-reported depressive symptomatology. Although the methodological quality of trials was, in general, not strong, the meta-analysis suggested these interventions were effective.

Caveat:

Follow-up was limited to one year postpartum. The long-term benefits are unknown.

Context:

Postpartum depression affects approximately 13% of all new mothers. Many women are keen to try treatment options other than medication due to concerns about breast milk transmission or potential side effects.

Cochrane Systematic Review:

Dennis C-L and Hodnett E. Psychosocial and psychological interventions for treating postpartum depression. Cochrane Reviews 2007, Issue 4. Art No : CD 006116. DOI : 10.1002/14651858. CD006116.pub2. This review contains 9 trials involving 956 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Mental health > Depression > Depressive disorders & major depression

Pregnancy & childbirth > Care after childbirth > Unhappiness after childbirth

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Psychosocial and psychological interventions for postpartum depression

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