Treatment of Postpartum Depression, Part 2: A Critical Review of Nonbiological Interventions
Abstract
Article AbstractBackground: While postpartum depression is a common mental condition with significant burden, it often remains undiagnosed and untreated. The objective of this article is to critically review the literature to determine the current state of scientific knowledge related to the treatment of postpartum depression from a nonbiological perspective. Data Sources: Databases searched for this review included Medline, PubMed, CINAHL, PsycINFO, EMBASE, ProQuest, the Cochrane Library, and the WHO Reproductive Health Library from 1966 to 2003. The search terms used were postpartum/postnatal depression and randomized controlled/clinical trials. Published peer-reviewed articles in English from 1990 to 2003 were included in the review, although select earlier studies were also included based on good methodological quality and/or the absence of more recent work. Method: The criteria used to evaluate the interventions were based on the standardized methodology developed by the U.S. Preventive Services Task Force and the Canadian Task Force on Preventive Health Care. Results: Twenty-one studies that met inclusion criteria were examined. These studies included interpersonal psychotherapy, cognitive-behavioral therapy, peer and partner support, nondirective counseling, relaxation/massage therapy, infant sleep interventions, infant-mother relationship therapy, and maternal exercise. Although some of these interventions have been better studied for depression unrelated to childbirth, methodological limitations render their efficacy equivocal for postpartum depression. Conclusions: Definite conclusions cannot be reached about the relative effectiveness of most of the nonbiological treatment approaches due to the lack of well-designed investigations. Randomized controlled trials are needed to compare different treatment modalities, examine the effectiveness of individual treatment components, and determine which treatments are most useful for women with different risk factors or clinical presentations of postpartum depression.
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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”
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Dennis, C., & Chung‐Lee, L. (2006) · Birth · doi:10.1111/j.1523-536x.2006.00130.x · Cited by 881 · see citing works
Self-citationPsychosocial and psychological interventions for treating postpartum depression
Dennis, C.-L., & Hodnett, E. D. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006116.pub2 · Cited by 565 · see citing works
Self-citationDennis, C.-L., & McQueen, K. (2009) · Pediatrics · doi:10.1542/peds.2008-1629 · Cited by 533 · see citing works
Self-citationPostpartum Depression: What We Know
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Dennis, C. (2005) · BMJ · doi:10.1136/bmj.331.7507.15 · Cited by 319 · see citing works
Self-citationA meta-analysis of treatments for perinatal depression
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Regulation of anxiety during the postpartum period
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Psychological treatment of postpartum depression: a meta‐analysis
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“It also can result in attachment insecurity (Hipwell, Goossens, Melhuish, & Kumar, 2000; Murray, 1992), social-interaction difficulties (Cummings & Davies, 1994; Dennis, 2004), and a negative influence on cognitive skills (Whiffen & Gotlib, 1989) and on expressive language development (Cox, Puckering, Pound, & Mills,…”
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“Psychotherapies appear efficacious, but have not received a large amount of study (Stuart et al., 2003; Dennis, 2004).”
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“Despite these serious consequences of PND, many women go untreated (Dennis 2004).”
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“Recent reviews of open trials, case series and case reports of antidepressant medication in women with PPD suggest efficacy (Abreu & Stuart, 2005; Dennis & Stewart, 2004).”
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“…those based on mother-to-mother peer support have been reported in systematic reviews and meta-analyses (Cuijpers, Brännmark, & van Straten, 2008; Dennis, 2004; Lumley, Austin, & Mitchell, 2004) and appear to have moderate effects, but the women included in these studies were over the age of 18.”
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Effects of Postpartum Exercise Program on Fatigue and Depression During “Doing-the-Month” Period
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“Although some interventions for depression have been better studied, methodological limitations render their efficacy equivocal for postpartum depression (Dennis, 2004).”
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“In this analysis, we examined publications previously identified in systematic literature reviews of postpartum depression risk factors (9) and trials related to prevention (2,3) and treatment (4,5).”
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“However, systematic reviews of clinical studies investigating the effects of exercise during pregnancy have been inconclusive regarding whether prenatal exercise or postnatal exercise prevents PPD (Dennis, 2004; Ersek and Brunner Huber, 2009; Daley et al., 2015; Hinman et al., 2015).”
BackgroundDifferentiation and Clinical Implications of Postpartum Depression and Postpartum Psychosis
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Self-citationQuasi‐experimental evaluation of a telephone‐based peer support intervention for maternal depression
Letourneau, N. L., Secco, L. M., Colpitts, J., Aldous, S., Stewart, M., & Dennis, C. (2015) · Journal of Advanced Nursing · doi:10.1111/jan.12622 · Cited by 52 · see citing works
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“The corresponding figure for studies of psychological treatments for postnatal depression was 61% (Dennis, 2004).”
Psychosocial and psychological interventions for treating postpartum depression
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“In the mental health arena, peer support has been used for individuals with depression and psychological distress (Dennis, 2004; Molassiotis et al., 2002, Moneyham, 1999) and for persons with traumatic brain injury and their families (Hibbard et al., 2002).”
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“A large range of treatment trials, some involving group treatment, have been reported in earlier systematic reviews of women with PND [24,25].”
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“Of the 30 PPD treatment studies found in the extant literature [43,123], 83 % (n= 25) used a self-report measure to evaluate whether the intervention was effective.”
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“A review of non-biological interventions for the treatment of PND identified four evaluations of the effectiveness of peer-support interventions [19].”
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“Despite the high prevalence and negative impacts of PND, several reviews of the evidence have generally concluded that the quality and quantity of treatment research is very limited (Boath & Henshaw, 2001; Craig & Howard, 2009; Cuijpers, Brannmark, & Van Straten, 2008; Dennis, 2004; Dennis & Stewart, 2004; Pope, 2000).”
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“PND is estimated to occur in approximately 13% of the population (O’Hara and Swain 1996; Dennis 2004), and its incidence is reported to rise to 30% where there is a past history of PND, with the risk in subsequent pregnancies appearing even higher among women whose first ever depressive episode was…”
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“Due to disturbed maternal sensitivity, the child may develop an insecure attachment to its mother, which may affect the child’s later emotional and cognitive development (Dennis, 2004; McLearn et al., 2006).”
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“Two meta-analyses of PTIP have been published, one on “nonbio-logical interventions” for postpartum depression (Dennis, 2004) and one on Parent–Infant Interaction Interventions (PIII; Singleton, 2005).”
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“Postpartum depression is associated with an increased risk of insecure attachment patterns due to disturbed maternal sensitivity (Campbell, Brownell, Hungerford, Spieker, Mohan, & Blessing, 2004; Dennis, 2004; McLearn, Minkovitz, Strobino, Marks, & Hou, 2006; Murray & Cooper, 1997; Smith-Nielsen, Tharner, Steele, Cord…”
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“Researchers have reported improved symptoms when a woman receives adequate support from a partner or spouse but this support has not demonstrated an impact on the maternal-child interaction quality.[22] It is important to study whether quality of social support influences ICC for mothers with depression.”
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- Authors
- Dennis, C.-L. E.
- Affiliations
- University of Toronto (CA)
- Corresponding author
- Dennis, Cindy-Lee E.
- ORCID
- Dennis, Cindy-Lee E.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2004-09-15
- Volume
- 65
- Issue
- 9
- Pages
- 1252-1265
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W4251802380
- Cited by
- 77
- References
- 0
- Citations by year
- 2022: 1 · 2021: 2 · 2020: 1 · 2019: 4 · 2018: 1 · 2017: 3 · 2016: 2 · 2015: 4 · 2014: 5 · 2013: 6 · 2012: 7
- FWCI
- 5.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- 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, interpersonal psychotherapy, cognitive behavioral therapy, peer support, partner support, non-directive counseling, relaxation training, maternal physical activity, treatment efficacy
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