Psychosocial interventions for perinatal common mental disorders delivered by providers who are not mental health specialists in low- and middle-income countries: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Perinatal common mental disorders (PCMDs) are a major cause of disability among women. Psychosocial interventions are one approach to reduce the burden of PCMDs. Working with care providers who are not mental health specialists, in the community or in antenatal health care facilities, can expand access to these interventions in low-resource settings. We assessed effects of such interventions compared to usual perinatal care, as well as effects of interventions based on intervention type, delivery method, and timing. METHODS AND FINDINGS: We conducted a systematic review, meta-analysis, and meta-regression. We searched databases including Embase and the Global Health Library (up to 7 July 2013) for randomized and non-randomized trials of psychosocial interventions delivered by non-specialist mental health care providers in community settings and antenatal health care facilities in low- and middle-income countries. We pooled outcomes from ten trials for 18,738 participants. Interventions led to an overall reduction in PCMDs compared to usual care when using continuous data for PCMD symptomatology (effect size [ES] -0.34; 95% CI -0.53, -0.16) but not binary categorizations for presence or absence of PCMDs (OR 0.62, 95% CI 0.35, 1.080 [corrected]. We found a significantly larger ES for psychological interventions (three studies; ES -0.46; 95% CI -0.58, -0.33) than for health promotion interventions (seven studies; ES -0.15; 95% CI -0.27, -0.02). Both individual (five studies; ES -0.18; 95% CI -0.34, -0.01) and group (three studies; ES -0.48; 95% CI -0.85, -0.11) interventions were effective compared to usual care, though delivery method was not associated with ES (meta-regression β coefficient -0.11; 95% CI -0.36, 0.14). Combined group and individual interventions (based on two studies) had no benefit compared to usual care, nor did interventions restricted to pregnancy (three studies). Intervention timing was not associated with ES (β 0.16; 95% CI -0.16, 0.49). The small number of trials and heterogeneity of interventions limit our findings. CONCLUSIONS: Psychosocial interventions delivered by non-specialists are beneficial for PCMDs, especially psychological interventions. Research is needed on interventions in low-income countries, treatment versus preventive approaches, and cost-effectiveness. Please see later in the article for the Editors' Summary.
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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 [16]
The Results (Comparison 2: Interventions by Type versus Usual Care; page unavailable) find benefits from health promotion and psychological interventions for perinatal common mental disorders, and Intervention Content identifies educational home visits, CBT, and IPT as examples. The review does not establish the effectiveness of antidepressant medication, and its pooled outcomes cover perinatal common mental disorders rather than postpartum depression alone. (LLM, conf=0.90)
Experimental — accuracy not yet measuredWhile half the psychiatric outpatients surveyed reported a positive view of mental health apps, only one in four had ever downloaded an app and only one in ten was currently using an app.
“While half the psychiatric outpatients surveyed reported a positive view of mental health apps, only one in four had ever downloaded an app and only one in ten was currently using an app. 644”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [644]
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- Authors
- Clarke, K., King, M., & Prost, A.
- Affiliations
- University College London (GB)
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-10-29
- Volume
- 10
- Issue
- 10
- Pages
- e1001541
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC3812075
- OpenAlex
- W2006651096
- Cited by
- 122
- References
- 84
- Citations by year
- 2026: 9 · 2025: 2 · 2024: 15 · 2023: 10 · 2022: 13 · 2021: 14 · 2020: 11 · 2019: 10 · 2018: 10 · 2017: 4 · 2016: 10 · 2015: 5 · 2014: 7 · 2013: 2
- FWCI
- 1.14
- Type
- journal article
- Language
- en
- Update notices
- correction (2014-06-25)
- Open access
- gold
- doi.org
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (NF-SI-0611-10210)
- Medical Research Council
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- psychosocial interventions, community-based intervention, prenatal care, low- and middle-income countries, psychological intervention, health promotion interventions, group intervention, individual interventions, intervention timing, access to mental health care, maternal mental health, postpartum depression, postpartum anxiety, perinatal anxiety
- MeSH terms
- Mental Disorders, Humans, Mental Health, Psychotherapy, Global Health
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