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Cited by 565Maternal Mental Health During Pregnancy and PostpartumMaternal and Perinatal Health InterventionsMaternal and Neonatal Healthcare

Psychosocial and psychological interventions for treating postpartum depression

Open access
Dennis, Cindy-Lee, Hodnett, Ellen D·2007·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd006116.pub2PMC PMC11936315
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Abstract

BACKGROUND: Epidemiological studies and meta-analyses of predictive studies have consistently demonstrated the importance of psychosocial and psychological variables as postpartum depression risk factors. While interventions based on these variables may be effective treatment strategies, theoretically they may also be used in pregnancy and the early postpartum period to prevent postpartum depression. OBJECTIVES: Primary: to assess the effect of diverse psychosocial and psychological interventions compared with usual antepartum, intrapartum, or postpartum care to reduce the risk of developing postpartum depression. Secondary: to examine (1) the effectiveness of specific types of psychosocial and psychological interventions, (2) the effectiveness of professionally-based versus lay-based interventions, (3) the effectiveness of individually-based versus group-based interventions, (4) the effects of intervention onset and duration, and (5) whether interventions are more effective in women selected with specific risk factors. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2011), scanned secondary references and contacted experts in the field. We updated the search on 31 December 2012 and added the results to the awaiting classification section of the review for assessment at the next update. SELECTION CRITERIA: All published and unpublished randomised controlled trials of acceptable quality comparing a psychosocial or psychological intervention with usual antenatal, intrapartum, or postpartum care. DATA COLLECTION AND ANALYSIS: Review authors and a research co-ordinator with Cochrane review experience participated in the evaluation of methodological quality and data extraction. Additional information was sought from several trial researchers. Results are presented using risk ratio (RR) for categorical data and mean difference (MD) for continuous data. MAIN RESULTS: Twenty-eight trials, involving almost 17,000 women, contributed data to the review. Overall, women who received a psychosocial or psychological intervention were significantly less likely to develop postpartum depression compared with those receiving standard care (average RR 0.78, 95% confidence interval (CI) 0.66 to 0.93; 20 trials, 14,727 women). Several promising interventions include: (1) the provision of intensive, individualised postpartum home visits provided by public health nurses or midwives (RR 0.56, 95% CI 0.43 to 0.73; two trials, 1262 women); (2) lay (peer)-based telephone support (RR 0.54, 95% CI 0.38 to 0.77; one trial, 612 women); and (3) interpersonal psychotherapy (standardised mean difference -0.27, 95% CI -0.52 to -0.01; five trials, 366 women). Professional- and lay-based interventions were both effective in reducing the risk to develop depressive symptomatology. Individually-based interventions reduced depressive symptomatology at final assessment (RR 0.75, 95% CI 0.61 to 0.92; 14 trials, 12,914 women) as did multiple-contact interventions (RR 0.78, 95% CI 0.66 to 0.93; 16 trials, 11,850 women). Interventions that were initiated in the postpartum period also significantly reduced the risk to develop depressive symptomatology (RR 0.73, 95% CI 0.59 to 0.90; 12 trials, 12,786 women). Identifying mothers 'at-risk' assisted the prevention of postpartum depression (RR 0.66, 95% CI 0.50 to 0.88; eight trials, 1853 women). AUTHORS' CONCLUSIONS: Overall, psychosocial and psychological interventions significantly reduce the number of women who develop postpartum depression. Promising interventions include the provision of intensive, professionally-based postpartum home visits, telephone-based peer support, and interpersonal psychotherapy.

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  • The evidence base for psychological therapies in the perinatal context has largely focused on the prevention and treatment of mild-to-moderate depression, particularly postnatal depression.

    “The evidence base for psychological therapies in the perinatal context has largely focused on the prevention and treatment of mild-to-moderate depressionparticularly postnatal depression (Dennis, & Hodnett, 2007;O'Connor et al., 2016).”

    From Acceptance and Commitment Therapy for perinatal mood and anxiety disorders: A feasibility and proof of concept study. (2020) · cites this paper as Dennis, & Hodnett, 2007

    The Background describes psychological interventions for treating postpartum depression, and the review's objectives and results address its prevention. However, the copy does not establish that the wider perinatal evidence base has largely focused on depression rather than other conditions, or specifically on mild-to-moderate depression. The reviewed trials primarily concerned prevention, not treatment. (LLM, conf=0.86)

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  • Existing reviews highlight the effectiveness of a number of interventions for peripartum depression, including medication, health promotion interventions and psychological interventions.

    “Existing reviews highlight the effectiveness of a number of interventions for PPD including medication (eg, antidepressant medication), health promotion interventions (eg, educational home visits) and psychological interventions (eg, cognitive–behavioural therapy (CBT) and interpersonal therapy.16–27”

    From Effectiveness and acceptability of cognitive-behavioural therapy based interventions for maternal peripartum depression: A systematic review, meta-analysis and thematic synthesis protocol (2019) · cites this paper as [20]

    The Background and Discussion report that psychosocial and psychological interventions reduced the risk of postpartum depression, with promising results for professional home visits and interpersonal psychotherapy. They do not establish the effectiveness of antidepressant medication alone, and the Discussion says the preventive effect of CBT remains uncertain. Most of the review assesses prevention rather than treatment of existing depression. (LLM, conf=0.85)

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Research works printed but not linked: 13

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Authors
Dennis, C.-L., & Hodnett, E. D.
Affiliations
University of Toronto (CA)
ORCID
Dennis, Cindy-Lee
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2007-10-17
Issue
2
Pages
CD001134-CD001134
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd006116.pub2
PMC
PMC11936315
OpenAlex
W2138850303
Cited by
565
References
207
Citations by year
2026: 6 · 2025: 24 · 2024: 22 · 2023: 36 · 2022: 31 · 2021: 29 · 2020: 31 · 2019: 42 · 2018: 44 · 2017: 30 · 2016: 36 · 2015: 44 · 2014: 29 · 2013: 45 · 2012: 27
FWCI
3.13
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
postpartum depression, psychosocial interventions, psychological intervention, depression prevention, postpartum home visits, peer support, telephone support, midwives, public health nurses, group intervention, individual interventions, risk factors, prenatal care, postpartum care, maternal mental health
MeSH terms
Female, Humans, Psychotherapy, Randomized Controlled Trials as Topic, Treatment Outcome, Depression, Postpartum

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