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Cited by 38Maternal Mental Health During Pregnancy and PostpartumMaternal and Perinatal Health InterventionsDigital Mental Health Interventions

Is group cognitive behaviour therapy for postnatal depression evidence-based practice? A systematic review

Open access
Scope, Alison, Leaviss, Joanna, Kaltenthaler, Eva, Parry, Glenys, Sutcliffe, Paul, Bradburn, Mike, Cantrell, Anna·2013·BMC Psychiatry
DOI 10.1186/1471-244x-13-321PMC PMC4219505
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Abstract

BACKGROUND: There is evidence that psychological therapies including cognitive behaviour therapy (CBT) may be effective in reducing postnatal depression (PND) when offered to individuals. In clinical practice, this is also implemented in a group therapy format, which, although not recommended in guidelines, is seen as a cost-effective alternative. To consider the extent to which group methods can be seen as evidence-based, we systematically review and synthesise the evidence for the efficacy of group CBT compared to currently used packages of care for women with PND, and we discuss further factors which may contribute to clinician confidence in implementing an intervention. METHODS: Seventeen electronic databases were searched. All full papers were read by two reviewers and a third reviewer was consulted in the event of a disagreement on inclusion. Selected studies were quality assessed, using the Cochrane Risk of Bias Tool, were data extracted by two reviewers using a standardised data extraction form and statistically synthesised where appropriate using the fixed-effect inverse-variance method. RESULTS: Seven studies met the inclusion criteria. Meta-analyses showed group CBT to be effective in reducing depression compared to routine primary care, usual care or waiting list groups. A pooled effect size of d = 0.57 (95% CI 0.34 to 0.80, p < 0.001) was observed at 10-13 weeks post-randomisation, reducing to d = 0.28 (95% CI 0.03 to 0.53, p = 0.025) at 6 months. The non-randomised comparisons against waiting list controls at 10-13 weeks was associated with a larger effect size of d = 0.94 (95% CI 0.42 to 1.47, p < 0.001). However due to the limitations of the available data, such as ill-specified definitions of the CBT component of the group programmes, these results should be interpreted with caution. CONCLUSIONS: Although the evidence available is limited, group CBT was shown to be effective. We argue, therefore, that there is sufficient evidence to implement group CBT, conditional upon routinely collected outcomes being benchmarked against those obtained in trials of individual CBT, and with other important factors such as patient preference, clinical experience, and information from the local context taken into account when making the treatment decision.

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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 [24]

    The Background (page unavailable) reports that a prior review found individual psychosocial and psychological interventions effective for postnatal depression, and the Discussion says group CBT appeared effective, while cautioning that the evidence was limited. The paper does not establish the effectiveness of antidepressants for postnatal depression—it describes them as validated for general depression—nor does it establish the effectiveness of educational home visits. Its Background also says earlier reviews reached no definite conclusions about the relative effectiveness of many non-biological approaches. (LLM, conf=0.87)

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1 of the 57 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. National Institute for Health and Clinical Excellence Commissioning antenatal and postnatal mental health services 2007 NICE http://www.nice.org.uk/usingguidance/commissioningguides/antenatalpostnatalmentalhealth/apmh.jsp 31990493
  2. Lueger RJ Barkham M Barkham M, Hardy GE, Mellor-Clark J Using benchmarks and benchmarking to imp[rove quality of practice and services Developing and Delivering Pracice-Based Evidence: A Guide for the Psychological Therapies 2010 London: Wiley Blackwell

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Authors
Scope, A., Leaviss, J., Kaltenthaler, E., Parry, G., Sutcliffe, P., Bradburn, M., & Cantrell, A.
Affiliations
  • University of Sheffield (GB)
  • University of Warwick (GB)
Corresponding author
Scope, Alison
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2013-11-28
Volume
13
Issue
1
Pages
321-321
ISSN
1471-244X (ISSN-L)
DOI
10.1186/1471-244x-13-321
PMC
PMC4219505
OpenAlex
W2016840848
Cited by
38
References
57
Citations by year
2026: 2 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 5 · 2020: 5 · 2019: 6 · 2018: 3 · 2017: 3 · 2016: 2 · 2015: 2 · 2014: 2
FWCI
0.29
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
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
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
group cognitive behavioral therapy, postpartum depression, evidence-based practice, psychotherapy, treatment efficacy, waiting list comparison, cost-effectiveness, clinician confidence, treatment decision-making
MeSH terms
Adult, Female, Humans, Postnatal Care, Psychotherapy, Group, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Women's Health, Depression, Postpartum

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