Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression: I. Impact on maternal mood
Open accessAbstract
Background: Psychological interventions for postnatal depression can be beneficial in the short term but their longer-term impact is unknown. Aims: To evaluate the long-term effect on maternal mood of three psychological treatments in relation to routine primary care. Method: Women with post-partum depression (n=193) were assigned randomly to one of four conditions: routine primary care, non-directive counselling, cognitive–behavioural therapy or psychodynamic therapy. They were assessed immediately after the treatment phase (at 4.5 months) and at 9, 18 and 60 months post-partum. Results: Compared with the control, all three treatments had a significant impact at 4.5 months on maternal mood (Edinburgh Postnatal Depression Scale, EPDS). Only psychodynamic therapy produced a rate of reduction in depression (Structured Clinical Interview for DSM–III–R) significantly superior to that of the control. The benefit of treatment was no longer apparent by 9 months post-partum. Treatment did not reduce subsequent episodes of post-partum depression. Conclusions: Psychological intervention for post-partum depression improves maternal mood (EPDS) in the short term. However, this benefit is not superior to spontaneous remission in the long term.
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There has been large variability in the delivery method, structure, and primary targets of these interventions.
“There has also been large variability in the delivery method, structure, and primary targets of these interventions.”
From Motherhood and Me (Mom-Me): The Development of an Acceptance-Based Group for Women with Postpartum Mood and Anxiety Symptoms (2022) · cites this paper as [17]
The Treatment groups section (p. 427) describes interventions with different approaches and primary targets, including CBT focused on infant-management and mother–infant interaction problems and non-directive counselling open to broader concerns. But the paper says therapy was delivered in women’s homes weekly from 8 to 18 weeks postpartum; it does not establish large variability in delivery methods across interventions generally. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThere is strong evidence that perinatal mental health conditions can be prevented and effectively treated through psychotherapy and/or pharmacotherapy.
“Importantly, there is strong evidence that PMH conditions can be prevented52-54 and effectively treated through psychotherapy54-57 and/or pharmacotherapy.58,59”
From The transition to parenthood in obstetrics: enhancing prenatal care for 2-generation impact (2022) · cites this paper as [56]
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DIMIDJIAN, S., & GOODMAN, S. (2009) · Clinical Obstetrics & Gynecology · doi:10.1097/grf.0b013e3181b52da6 · Cited by 99 · see citing works
“Moreover, in some studies cognitive and behavioral strategies have not targeted depression specifically, but have focused on associated problems such as parenting.(7) Some studies have employed clinicians minimally trained in CBT.”
BackgroundMilgrom, J., Gemmill, A. W., Ericksen, J., Burrows, G., Buist, A., & Reece, J. (2015) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867414565474 · Cited by 94 · see citing works
“Similarly, Cooper and colleagues reported improvement with CBT treatment for PND (Cooper et al., 2003).”
BackgroundAstrachan-Fletcher, E. B., Veldhuis, C. B., Lively, N., Fowler, C., & Marcks, B. A. (2008) · Journal of Women s Health · doi:10.1089/jwh.2007.0550 · Cited by 94 · see citing works
Prevalence and predictors of postpartum depression in Riyadh, Saudi Arabia: A cross sectional study
Nasr, R. S. A., Altharwi, K., Derbah, M. S., Gharibo, S. O., Fallatah, S. A., Alotaibi, S. G., Almutairi, K. A., & Asdaq, S. M. B. (2020) · PLoS ONE · doi:10.1371/journal.pone.0228666 · Cited by 94 · see citing works
Antenatal Cognitive-behavioral Therapy for Prevention of Postpartum Depression: A Pilot Study
Cho, H., Kwon, J. H., & Lee, J. J. (2008) · Yonsei Medical Journal · doi:10.3349/ymj.2008.49.4.553 · Cited by 93 · see citing works
Austin, M., & Priest, S. R. (2005) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2005.00549.x · Cited by 91 · see citing works
“Postnatal studies using brief psychological interventions targeting women with high EPDS scores (64, 65) have led to improved maternal mood in the short-term but concerns remain that this does not necessarily improve maternal parenting behaviour.”
BackgroundTreatment of Perinatal Mood and Anxiety Disorders: A Review
Misri, S. K., & Kendrick, K. (2007) · The Canadian Journal of Psychiatry · doi:10.1177/070674370705200803 · Cited by 87 · see citing works
Foster, C. E., Webster, M. C., Weissman, M. M., Pilowsky, D. J., WICKRAMARATNE, P. J., Talati, A., Rush, A. J., Hughes, C. W., Garber, J., Malloy, E., et al. (2008) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374410802359726 · Cited by 83 · see citing works
“Some studies used psychotherapies specifically designed to target parenting (Cooper, Murray, Wilson, & Romaniuk, 2003 ; Murray et al, 2003 ), whereas others relied only on antidepressant medications (Kaplan et al, 2001 ), and a final study used an evidence-based psychotherapy for depression (interpersonal psychotherap…”
BackgroundMental Disorders in Early Childhood
von Klitzing, K., Döhnert, M., Kröll, M., & Grube, M. (2015) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2015.0375 · Cited by 81 · see citing works
Milgrom, J., Holt, C. J., Gemmill, A. W., Ericksen, J., Leigh, B., Buist, A., & Schembri, C. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-95 · Cited by 82 · see citing works
“Interestingly, Cooper et al. [ 10 ] found an expertise effect, such that women treated by non-specialists showed significantly greater reduction in depressive symptoms compared with those treated by specialists (however treatment allocation was not randomised).”
Leichsenring, F., & Schauenburg, H. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.08.007 · Cited by 81 · see citing works
“TAU: 21% HAMDZ14 HAMD-clin. sig. change SET: 44% TAU: 36% Cooper et al. (2003) Maternal depression (MDD) PDT: 50 Cramer et al. (1990) 10 Remission (no MDD) Counselling: 48 exploring the mother's representation of and relationship to her infant taking her own attachment history into account CBT: 43…”
BackgroundGlavin, K., Smith, L., Falk, R. S., & Ellefsen, B. (2010) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2010.03332.x · Cited by 80 · see citing works
Psychological treatments for perinatal depression
Stuart, S. P., & Koleva, H. K. (2013) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2013.09.004 · Cited by 80 · see citing works
Preventing postnatal depression in mothers of very preterm infants: a randomised controlled trial
Hagan, R., Evans, S. F., & Pope, S. (2004) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2004.00165.x · Cited by 79 · see citing works
Intervening to reduce depression after birth: A systematic review of the randomized trials
Lumley, J. M., Austin, M., & Mitchell, C. (2004) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462304000911 · Cited by 75 · see citing works
A randomized clinical trial of exercise to alleviate postpartum depressed mood
Costa, D. D., Lowensteyn, I., Abrahamowicz, M., Ionescu‐Ittu, R., Dritsa, M., Rippen, N., Cervantes, P., & Khalifé, S. (2009) · Journal of Psychosomatic Obstetrics & Gynecology · doi:10.1080/01674820903212136 · Cited by 74 · see citing works
“This is important as many women are reluctant to take medication in the postpartum period, particularly if they are breastfeeding [8].”
BackgroundHarkness, E. F., & Bower, P. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000532.pub2 · Cited by 74 · see citing works
A mother–infant therapy group model for postpartum depression
Clark, R., Tluczek, A., & Brown, R. (2008) · Infant Mental Health Journal · doi:10.1002/imhj.20189 · Cited by 74 · see citing works
Counselling for mental health and psychosocial problems in primary care
Bower, P., Knowles, S. E., Coventry, P. A., & Rowland, N. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001025.pub3 · Cited by 77 · see citing works
Antenatal and postnatal depression in women with obesity: a systematic review
Steinig, J., Nagl, M., Linde, K., Zietlow, G., & Kersting, A. (2017) · Archives of Women s Mental Health · doi:10.1007/s00737-017-0739-4 · Cited by 75 · see citing works
Group interpersonal psychotherapy for postnatal depression: a pilot study
Reay, R. E., Fisher, Y., Robertson, M. S., Adams, E., & Owen, C. (2005) · Archives of Women s Mental Health · doi:10.1007/s00737-005-0104-x · Cited by 72 · see citing works
“In a rigorous, randomised controlled trial by Cooper et al. (2003), women with PND were randomly assigned to one of four conditions: routine primary care, non-directive counselling, cognitive-behavioural therapy or psychodynamic therapy.”
BackgroundWan, M. W., Abel, K. M., & Green, J. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.09.001 · Cited by 67 · see citing works
Antenatal depression: a rationale for studying exercise
Shivakumar, G., Brandon, A. R., Snell, P. G., Santiago-Munoz, P. C., Johnson, N. L., Trivedi, M. H., & Freeman, M. P. (2010) · Depression and Anxiety · doi:10.1002/da.20777 · Cited by 68 · see citing works
Psychological Health of Men with Partners who have Post-Partum Depression
Roberts, S. L. E., Roberts, S. L. E., Bushnell, J., Roberts, S. L. E., Bushnell, J., Collings, S. C., & Purdie, G. (2006) · Australian & New Zealand Journal of Psychiatry · doi:10.1111/j.1440-1614.2006.01871.x · Cited by 68 · see citing works
Beeber, L. S., Schwartz, T. A., Holditch-Davis, D., Canuso, R., Lewis, V., & Hall, H. W. (2013) · Nursing Research · doi:10.1097/nnr.0b013e31828324c2 · Cited by 62 · see citing works
“The capacity of mild, nonspecific comparison conditions to significantly reduce depressive symptoms in populations undergoing severe economic hardship has been found previously (Cooper et al., 2003; Spinelli & Endicott, 2003).”
BackgroundRepetitive transcranial magnetic stimulation treats postpartum depression
Garcia, K. S., Flynn, P., Pierce, K. J., & Caudle, M. (2010) · Brain Stimulation · doi:10.1016/j.brs.2009.06.001 · Cited by 63 · see citing works
“In addition, only limited information regarding the durability of IPT exists and it has been shown that its beneficial effects may be time limited.(15) Physicians generally prefer pharmacotherapy to treat women with PPD.”
BackgroundSmith‐Nielsen, J., Tharner, A., Krogh, M. T., & Væver, M. S. (2016) · Scandinavian Journal of Psychology · doi:10.1111/sjop.12321 · Cited by 63 · see citing works
Detection and treatment of postnatal depression (perinatal depression or anxiety)
Matthey, S. (2003) · Current Opinion in Psychiatry · doi:10.1097/00001504-200401000-00005 · Cited by 59 · see citing works
The Neurobiological Impact of Postpartum Maternal Depression
Drury, S. S., Scaramella, L. V., & Zeanah, C. H. (2016) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2015.11.001 · Cited by 62 · see citing works
“Improvement in infant cognitive outcomes has been demonstrated after treatment of PPD in several, but not all, studies that evaluated CBT and other therapies.(144,151,152) In a randomized controlled trial comparing CBT, nondirective supportive therapy, and psychodynamic therapy with routine primary care for lowrisk mo…”
Prevention of postnatal depression
Mallikarjun, P. K., & Oyebode, F. (2005) · The Journal of the Royal Society for the Promotion of Health · doi:10.1177/146642400512500514 · Cited by 59 · see citing works
Perinatal Dyadic Psychotherapy for postpartum depression: a randomized controlled pilot trial
Goodman, J. H., Prager, J., Goldstein, R., & Freeman, M. (2015) · Archives of Women's Mental Health · doi:10.1007/s00737-014-0483-y · Cited by 58 · see citing works
“Most women instead prefer psychotherapy (Battle et al. 2013; Cooper et al. 2003a; Goodman 2009), but the logistics of getting to therapy appointments can be overwhelming for a depressed mother of a newborn.”
Stevenson, M., Scope, A., Sutcliffe, P., Booth, A., Slade, P., Parry, G., Saxon, D., & Kalthenthaler, E. (2010) · Health Technology Assessment · doi:10.3310/hta14440 · Cited by 57 · see citing works
Gordon, M., Henderson, R., Holmes, J. H., Wolters, M. K., Bennett, I. M., & the SPIRIT (Stress in Pregnancy: Improving Results with Interactive Technology) Group (2015) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocv109 · Cited by 57 · see citing works
Postpartum Depression and Adolescent Mothers: A Review of Assessment and Treatment Approaches
Yozwiak, J. A. (2009) · Journal of Pediatric and Adolescent Gynecology · doi:10.1016/j.jpag.2009.09.003 · Cited by 56 · see citing works
- Authors
- Cooper, P. J., Murray, L., Wilson, A., & Romaniuk, H.
- Affiliations
- University of Reading (GB)
- University of Cambridge (GB)
- Corresponding author
- Cooper, Peter J.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2003-05
- Volume
- 182
- Issue
- 5
- Pages
- 412-419
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W4302417458
- Cited by
- 356
- References
- 28
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 14 · 2023: 16 · 2022: 21 · 2021: 16 · 2020: 16 · 2019: 15 · 2018: 14 · 2017: 12 · 2016: 11 · 2015: 25 · 2014: 10 · 2013: 17 · 2012: 15
- FWCI
- 12.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- Funders
- Medical Research Council
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- postpartum depression, psychological intervention, psychodynamic psychotherapy, cognitive behavioral therapy, non-directive counseling, maternal mood, long-term treatment outcomes, spontaneous regression, primary care, Edinburgh Postnatal Depression Scale
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