Effectiveness of Psychological Interventions for Postnatal Depression in Primary Care: A Meta-Analysis

Abstract

PURPOSE Postnatal depression affects 10% to 15% of new mothers, and approximately 90% of cases are managed in primary care. Antidepressants are effective, but adherence is poor; therefore, psychological interventions must be investigated. In this systematic review, we assessed the efficacy of psychological therapies for postnatal depression in primary care. METHODSWe undertook a systematic search to identify articles published in English between 2000 and 2014 that reported studies meeting our eligibility criteria:(1) had a randomized controlled trial design; (2) assessed psychological interventions for postnatal depression against any other treatment or a wait-list control; (3) recruited patients in primary care; and (4) enrolled mothers with a diagnosed depressive episode or a score of at least 12 on the Edinburgh Postnatal Depression Scale or at least 10 on the Beck Depression Inventory at baseline who had a child younger than 12 months. Quality was assessed using an adapted Cochrane Collaboration Depression, Anxiety, and Neurosis (CCDAN) quality rating scale, and meta-analysis was carried out using RevMan 5.3 (The Cochrane Collaboration).RESULTS Screening of 5,919 articles identified 10 studies that met inclusion criteria. These studies reported on 14 psychological intervention arms: 7 using cognitive behavioral therapy, 2 using interpersonal therapy, 2 using counseling, and 3 using other interventions. Psychological interventions resulted in lower depressive symptomatology than control both immediately after treatment (standardized mean difference = -0.38; 95% CI, -0.49 to -0.27) and at 6 months of follow-up (standardized mean difference =-0.21; 95% CI, -0.37 to -0.05). We did not find any significant differences between the various types of therapy. Compared with control, the interventions also led to improvements in adjustment to parenthood, marital relationship, social support, stress, and anxiety.CONCLUSIONS Psychological interventions deliverable in the primary care setting are associated with a significant improvement in depressive symptomatology both immediately after completion and for up to 6 months of follow-up. Ann Fam Med 2016;14:463-472. doi: 10.1370/afm.1967. INTRODUCTIONA bout 13% of mothers experience postnatal depression during the first year after delivery.1 If left untreated, this condition can have an extensive negative impact on women, children, and wider society. A recent report found that the annual cost to UK society of perinatal depression was £73,822 ($104,574) per case, of which 70% was due to adverse impacts on the child.2 Effects on the child can arise because of impaired maternal-infant bonding, maternal withdrawal, disengagement, hostility, and shortening of the duration of breastfeeding. [3][4][5][6][7][8][9][10][11][12] Other consequences of postnatal depression include marital difficulties and an increased risk of future depression, with affected mothers twice as likely to experience further episodes of depression in the subsequent 5 years. 13 Research has shown tha...

Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review

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Women's Experiences of Seeking and Receiving Psychological and Psychosocial Interventions for Postpartum Depression: A Systematic Review and Thematic Synthesis of the Qualitative Literature

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Spouses' prenatal autonomous motivation to have a child and postpartum depression symptoms

“…Much attention has been paid to the problem of PPD in women, with meta‐analyses documenting PPD prevalence rates of 10%–15% (Gavin et al., ; Stephens, Ford, Paudyal, & Smith, ). As gender roles shift and paternal involvement in childcare becomes the norm, the experience of having a child requires major adjustments for men as well as women.…”