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Cited by 122Maternal Mental Health During Pregnancy and PostpartumMental Health Treatment and AccessGlobal Maternal and Child Health

The DOI matches its Crossref record; 84 of the 84 references it cites were found in a registry or an index.

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

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Clarke, Kelly, King, Michael, Prost, Audrey·2013·PLoS Medicine
DOI 10.1371/journal.pmed.1001541PMC PMC3812075
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Abstract

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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Figure 1 Flow diagram of search results. Out of 6,177 abstracts retrieved through a search of electronic databases, 11 articles were included in the systematic review, including one unpublished trial identified following personal communication with the author.
Figure 1 Flow diagram of search results. Out of 6,177 abstracts retrieved through a search of electronic databases, 11 articles were included in the systematic review, including one unpublished trial identified following personal communication with the author.CC BY · PubMed Central
Figure 2 Effects of psychosocial interventions on continuous PCMD outcomes. The pooled effect of interventions delivered by non-mental health specialists compared to usual perinatal care was a reduction in PCMD symptomatology compared to usual care, using effect estimates from assessments immediately following delivery of the intervention (ES −0.34; 95% CI −0.53, −0.16). CES-D, Center for Epidemiological Studies Depression Scale; EPDS, Edinburgh Postnatal Depression Scale; HDRS, Hamilton Depression Rating Scale; PHQ-9, nine-item Patient Health Questionnaire; SRQ, Self Reporting Questionnaire; STAI, State-Trait Anxiety Inventory.
Figure 2 Effects of psychosocial interventions on continuous PCMD outcomes. The pooled effect of interventions delivered by non-mental health specialists compared to usual perinatal care was a reduction in PCMD symptomatology compared to usual care, using effect estimates from assessments immediately following delivery of the intervention (ES −0.34; 95% CI −0.53, −0.16). CES-D, Center for Epidemiological Studies Depression Scale; EPDS, Edinburgh Postnatal Depression Scale; HDRS, Hamilton Depression Rating Scale; PHQ-9, nine-item Patient Health Questionnaire; SRQ, Self Reporting Questionnaire; STAI, State-Trait Anxiety Inventory.CC BY · PubMed Central
Figure 3 Effects of psychosocial interventions on binary PCMD outcomes. Using binary PCMD categorizations from assessments immediately following delivery of the intervention, the pooled effect for all interventions was significant (OR 0.59; 95% CI 0.26, 0.92) compared to usual care. CIS-R, Clinical Interview Schedule–Revised; EPDS, Edinburgh Postnatal Depression Scale; K-10, Kessler 10-Item Scale; SCID, Structured Clinical Interview for DSM Disorders.
Figure 3 Effects of psychosocial interventions on binary PCMD outcomes. Using binary PCMD categorizations from assessments immediately following delivery of the intervention, the pooled effect for all interventions was significant (OR 0.59; 95% CI 0.26, 0.92) compared to usual care. CIS-R, Clinical Interview Schedule–Revised; EPDS, Edinburgh Postnatal Depression Scale; K-10, Kessler 10-Item Scale; SCID, Structured Clinical Interview for DSM Disorders.CC BY · PubMed Central
Figure 4 Effects of psychological and health promotion interventions on continuous PCMD outcomes. The pooled effect of three health promotion interventions delivered by non-mental health specialists was significant compared to usual care (ES −0.15; 95% CI −0.27, −0.02). Three psychological interventions were associated with a larger overall ES (−0.46; 95% CI −0.58, −0.33). CES-D, Center for Epidemiological Studies Depression Scale; CIS-R, Clinical Interview Schedule–Revised; EPDS, Edinburgh Postnatal Depression Scale; HDRS, Hamilton Depression Rating Scale; K-10, Kessler 10-Item Scale; PHQ-9, nine-item Patient Health Questionnaire; SCID, Structured Clinical Interview for DSM Disorders; SRQ, Self Reporting Questionnaire; STAI, State-Trait Anxiety Inventory.
Figure 4 Effects of psychological and health promotion interventions on continuous PCMD outcomes. The pooled effect of three health promotion interventions delivered by non-mental health specialists was significant compared to usual care (ES −0.15; 95% CI −0.27, −0.02). Three psychological interventions were associated with a larger overall ES (−0.46; 95% CI −0.58, −0.33). CES-D, Center for Epidemiological Studies Depression Scale; CIS-R, Clinical Interview Schedule–Revised; EPDS, Edinburgh Postnatal Depression Scale; HDRS, Hamilton Depression Rating Scale; K-10, Kessler 10-Item Scale; PHQ-9, nine-item Patient Health Questionnaire; SCID, Structured Clinical Interview for DSM Disorders; SRQ, Self Reporting Questionnaire; STAI, State-Trait Anxiety Inventory.CC BY · PubMed Central
Figure 5 Effects of group and individually based psychosocial interventions on continuous PCMD outcomes. Individual (ES −0.18; 95% CI −0.34, −0.01) and group-based (ES −0.48; 95% CI −0.85, −0.11) psychosocial interventions were associated with significant ESs for PCMDs compared to usual care. Interventions combining group and individual components had no significant effect compared to usual care. CES-D, Center for Epidemiological Studies Depression Scale; CIS-R, Clinical Interview Schedule–Revised; EPDS, Edinburgh Postnatal Depression Scale; HDRS, Hamilton Depression Rating Scale; K-10, Kessler 10-Item Scale; PHQ-9, nine-item Patient Health Questionnaire; SRQ, Self Reporting Questionnaire; STAI, State-Trait Anxiety Inventory.
Figure 5 Effects of group and individually based psychosocial interventions on continuous PCMD outcomes. Individual (ES −0.18; 95% CI −0.34, −0.01) and group-based (ES −0.48; 95% CI −0.85, −0.11) psychosocial interventions were associated with significant ESs for PCMDs compared to usual care. Interventions combining group and individual components had no significant effect compared to usual care. CES-D, Center for Epidemiological Studies Depression Scale; CIS-R, Clinical Interview Schedule–Revised; EPDS, Edinburgh Postnatal Depression Scale; HDRS, Hamilton Depression Rating Scale; K-10, Kessler 10-Item Scale; PHQ-9, nine-item Patient Health Questionnaire; SRQ, Self Reporting Questionnaire; STAI, State-Trait Anxiety Inventory.CC BY · PubMed Central
Figure 6 Effects of antenatal and postnatal psychosocial interventions on continuous PCMD outcomes. Antenatal interventions were not effective for PCMDs compared to usual care (ES −0.46; 95% CI −0.94, 0.01), whereas interventions delivered both antenatally and postnatally were (ES −0.26; 95% CI −0.42, −0.10). Only one trial assessed an intervention delivered in the postnatal period only. CES-D, Center for Epidemiological Studies Depression Scale; CIS-R, Clinical Interview Schedule–Revised; EPDS, Edinburgh Postnatal Depression Scale; HDRS, Hamilton Depression Rating Scale; K-10, Kessler 10-Item Scale; PHQ-9, nine-item Patient Health Questionnaire; SRQ, Self Reporting Questionnaire; STAI, State-Trait Anxiety Inventory.
Figure 6 Effects of antenatal and postnatal psychosocial interventions on continuous PCMD outcomes. Antenatal interventions were not effective for PCMDs compared to usual care (ES −0.46; 95% CI −0.94, 0.01), whereas interventions delivered both antenatally and postnatally were (ES −0.26; 95% CI −0.42, −0.10). Only one trial assessed an intervention delivered in the postnatal period only. CES-D, Center for Epidemiological Studies Depression Scale; CIS-R, Clinical Interview Schedule–Revised; EPDS, Edinburgh Postnatal Depression Scale; HDRS, Hamilton Depression Rating Scale; K-10, Kessler 10-Item Scale; PHQ-9, nine-item Patient Health Questionnaire; SRQ, Self Reporting Questionnaire; STAI, State-Trait Anxiety Inventory.CC BY · PubMed Central

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Research works printed but not linked: 3

  1. Goldberg D, Huxley P (1992) Common mental disorders: a biosocial model. London: Tavistock/Routledge.
  2. L Wu, 2007, Effectiveness of informational support for maternal anxiety and postpartum depression in Chinese mothers of premature infants: a quasi-experimental study, Asian J Nurs, 10, 251
  3. Hughes MW (2008) A randomised controlled trial of a perinatal psycho-social interventoin for postnatal depression in Goa, India [PhD dissertation]. London: Kings College London.

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Metadata

Authors
Clarke, K., King, M., & Prost, A.
Affiliations
University College London (GB)
ORCID
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
DOI
10.1371/journal.pmed.1001541
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
Licence
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
  • Health Sciences › Medicine › Psychiatry and Mental health › 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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