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Cited by 212Maternal Mental Health During Pregnancy and PostpartumMaternal and Perinatal Health InterventionsMaternal and Neonatal Healthcare

Preventing postpartum depression: Review and recommendations

Open access
Werner, Elizabeth, Miller, Maia, Osborne, Lauren M., Kuzava, Sierra, Monk, Catherine·2015·Archives of Women's Mental Health
DOI 10.1007/s00737-014-0475-yPMC PMC4308451
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Abstract

Nearly 20 % of mothers will experience an episode of major or minor depression within the first 3 months postpartum, making it the most common complication of childbearing. Postpartum depression (PPD) is significantly undertreated, and because prospective mothers are especially motivated for self-care, a focus on the prevention of PPD holds promise of clinical efficacy. This study is a qualitative review of existing approaches to prevent PPD. A PubMed search identified studies of methods of PPD prevention. The search was limited to peer-reviewed, published, English-language, randomized controlled trials (RCTs) of biological, psychological, and psychosocial interventions. Eighty articles were initially identified, and 45 were found to meet inclusion criteria. Eight RCTs of biological interventions were identified and 37 RCTs of psychological or psychosocial interventions. Results were mixed, with 20 studies showing clear positive effects of an intervention and 25 showing no effect. Studies differed widely in screening, population, measurement, and intervention. Among biological studies, anti-depressants and nutrients provided the most evidence of successful intervention. Among psychological and psychosocial studies, 13/17 successful trials targeted an at-risk population, and 4/7 trials using interpersonal therapy demonstrated success of the intervention versus control, with a further two small studies showing trends toward statistical significance. Existing approaches to the prevention of PPD vary widely, and given the current literature, it is not possible to identify one approach that is superior to others. Interpersonal therapy trials and trials that targeted an at-risk population appear to hold the most promise for further study.

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Crossref · 10.1007/s00737-014-0475-y

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  • Current interventions for PMADs have only exhibited small effects on PMADs symptoms.

    “First, these interventions have only exhibited small effects on PMADs symptoms [14] (despite being conducted with small samples–which should inflate effect sizes) [13–15].”

    From Acceptance-based process variables on postpartum well-being and distress: The mediating role of psychological flexibility (2024) · cites this paper as [15]

    The Conclusion (page unavailable) reports that 17 of 37 psychological and psychosocial prevention trials found a positive effect and 20 did not, supporting a limited and inconsistent record of benefit. It does not conclude that the effects were uniformly small or quantify their overall size. The review addresses prevention of postpartum depression, not PMADs broadly. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Interventions to prevent postpartum depression are most effective when they target women considered to be at risk.

    “interventions to prevent PPD are the most effective when they target women considered to be at risk [16]”

    From The Efficacy of Be a Mom, a Web-Based Intervention to Prevent Postpartum Depression: Examining Mechanisms of Change in a Randomized Controlled Trial (2023) · cites this paper as [16]

    The Conclusion reports that 13 of 17 successful prevention trials involved at-risk populations and suggests that targeting women by risk criteria may improve effectiveness. It does not establish that such interventions are the most effective; the claim states a tentative finding as a comparative fact. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • To overcome high attrition rates and improve effectiveness, interventions should be aimed primarily at at-risk women and should fit the unique preferences and needs of pregnant women.

    “From previous trials, we also know that to overcome high attrition rates and improve effectiveness, interventions should be aimed primarily at at-risk women (e.g., women with subclinical depression) and should fit the unique preferences and needs of pregnant women [22–24].”

    From Effectiveness of a guided ACT-based self-help resilience training for depressive symptoms during pregnancy: Study protocol of a randomized controlled trial embedded in a prospective cohort. (2020) · cites this paper as [23]

    The Conclusion reports that 13 of 17 successful trials involved at-risk women and suggests that targeting women by risk criteria may improve postpartum-depression prevention. The review also notes attrition and low attendance in some trials, and its Interpersonal Therapy section describes one study that changed to individual sessions after participants expressed that preference. It does not establish that tailoring interventions to pregnant women’s unique preferences and needs overcomes attrition or improves effectiveness generally. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • In a systematic review of CBT interventions to prevent PPD, Werner et al noted that 4 out of 6 studies reporting success in the alleviation of PPD targeted only women considered to be at risk, with sample sizes ranging from 27 to 241 participants.

    “In a systematic review of CBT interventions to prevent PPD, Werner et al [16] noted that 4 out of 6 studies reporting success in the alleviation of PPD targeted only women considered to be at risk (with sample sizes ranging from 27 to 241 participants).”

    From The Efficacy of Be a Mom, a Web-Based Intervention to Prevent Postpartum Depression: Examining Mechanisms of Change in a Randomized Controlled Trial (2023) · cites this paper as [16]

  • None of the face-to-face studies examined the mechanisms of change underlying the observed reductions in depressive symptoms.

    “Nevertheless, none of these face-to-face studies examined the mechanisms of change underlying the observed reductions in depressive symptoms.”

    From The Efficacy of Be a Mom, a Web-Based Intervention to Prevent Postpartum Depression: Examining Mechanisms of Change in a Randomized Controlled Trial (2023) · cites this paper as [16]

    The Cognitive-Behavioral Therapy section and Conclusion report reductions in depressive symptoms in some psychological-intervention studies. They do not say whether any of the face-to-face studies examined mechanisms of change. Searches for mechanisms, mediators, and mediation did not establish the claim. (LLM, conf=0.70)

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Authors
Werner, E., Miller, M., Osborne, L. M., Kuzava, S., & Monk, C.
Affiliations
  • Columbia University Irving Medical Center (US)
  • Johns Hopkins University (US)
Corresponding author
  • Werner, Elizabeth
  • Kuzava, Sierra
ORCID
Venue
Archives of Women's Mental Health
Publisher
Springer Science and Business Media LLC
Published
2014-11-25
Volume
18
Issue
1
Pages
41-60
ISSN
  • 1434-1816 (ISSN-L)
  • 1435-1102
DOI
10.1007/s00737-014-0475-y
PMC
PMC4308451
OpenAlex
W2042783002
Cited by
212
References
94
Citations by year
2026: 7 · 2025: 20 · 2024: 27 · 2023: 27 · 2022: 21 · 2021: 26 · 2020: 17 · 2019: 24 · 2018: 18 · 2017: 12 · 2016: 7 · 2015: 6
FWCI
1.31
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Archives of Women s Mental Health (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R21MH092665, T32MH015144)
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, prevention, antidepressants, nutrients, interpersonal psychotherapy, vulnerable populations, psychological intervention, psychosocial interventions, biological interventions, screening, maternal mental health
MeSH terms
Female, Humans, Mothers, Psychotherapy, Social Support, Randomized Controlled Trials as Topic, Depression, Postpartum

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