Psychosocial and psychological interventions for treating postpartum depression

Cindy‐Lee Dennis; Ellen D Hodnett

doi:10.1002/14651858.CD006116.pub2

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Analysis 1.1

Comparison 1 All interventions versus usual care ‐ all trials, Outcome 1 Evidence of depression at final assessment within first year.

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Analysis 1.2

Comparison 1 All interventions versus usual care ‐ all trials, Outcome 2 Mean EPDS score at final assessment within first year.

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Analysis 1.3

Comparison 1 All interventions versus usual care ‐ all trials, Outcome 3 Evidence of depression at assessment immediately post‐treatment.

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Analysis 1.4

Comparison 1 All interventions versus usual care ‐ all trials, Outcome 4 Maternal self‐esteem.

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Analysis 1.5

Comparison 1 All interventions versus usual care ‐ all trials, Outcome 5 Maternal loneliness.

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Analysis 1.6

Comparison 1 All interventions versus usual care ‐ all trials, Outcome 6 Maternal anxiety.

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Analysis 1.7

Comparison 1 All interventions versus usual care ‐ all trials, Outcome 7 Childcare stress.

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Analysis 1.8

Comparison 1 All interventions versus usual care ‐ all trials, Outcome 8 Maternal social adjustment.

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Analysis 1.9

Comparison 1 All interventions versus usual care ‐ all trials, Outcome 9 Relationship quality with partner.

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Analysis 2.1

Comparison 2 Psychosocial interventions versus usual care ‐ variations in intervention type, Outcome 1 Evidence of depression at final assessment within first year.

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Analysis 2.2

Comparison 2 Psychosocial interventions versus usual care ‐ variations in intervention type, Outcome 2 Evidence of depression at final assessment ‐ sensitivity analysis.

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Analysis 2.3

Comparison 2 Psychosocial interventions versus usual care ‐ variations in intervention type, Outcome 3 Evidence of depression at assessment immediately post‐treatment.

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Analysis 3.1

Comparison 3 Psychological interventions versus usual care ‐ variations in intervention type, Outcome 1 Evidence of depression at final assessment within first year.

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Analysis 3.2

Comparison 3 Psychological interventions versus usual care ‐ variations in intervention type, Outcome 2 Evidence of depression at assessment immediately post‐treatment.

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Analysis 4.1

Comparison 4 Psychosocial interventions versus psychological interventions, Outcome 1 Non‐directive counselling versus cognitive behavioural therapy at last assessment in first year.

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Analysis 5.1

Comparison 5 All interventions versus usual care ‐ variations in intervention mode, Outcome 1 Evidence of depression at final assessment within first year.

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Analysis 6.1

Comparison 6 All interventions versus usual care ‐ variations in selection criteria, Outcome 1 Evidence of depression at final assessment within first year.

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Comparison 1. All interventions versus usual care ‐ all trials

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Evidence of depression at final assessment within first year Show forest plot	9		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Any measure of depressive symptomatology	9	956	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.60, 0.81]
1.2 EPDS>12	2	81	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.24, 0.80]
2 Mean EPDS score at final assessment within first year Show forest plot	3	238	Mean Difference (IV, Fixed, 95% CI)	‐0.46 [‐1.87, 0.95]

3 Evidence of depression at assessment immediately post‐treatment Show forest plot	8		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.1 Any measure of depressive symptomatology	8	555	Risk Ratio (M‐H, Fixed, 95% CI)	0.68 [0.58, 0.79]
4 Maternal self‐esteem Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	1.43 [‐1.04, 3.90]

5 Maternal loneliness Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	‐3.54 [‐7.00, ‐0.08]

6 Maternal anxiety Show forest plot	1	35	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.48, 1.24]

7 Childcare stress Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	‐1.53 [‐3.48, 0.42]

8 Maternal social adjustment Show forest plot	1	99	Mean Difference (IV, Fixed, 95% CI)	‐0.42 [‐0.58, ‐0.26]

9 Relationship quality with partner Show forest plot	1	99	Mean Difference (IV, Fixed, 95% CI)	12.5 [2.93, 22.07]

Comparison 1. All interventions versus usual care ‐ all trials

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Comparison 2. Psychosocial interventions versus usual care ‐ variations in intervention type

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Evidence of depression at final assessment within first year Show forest plot	5	506	Risk Ratio (M‐H, Random, 95% CI)	0.61 [0.39, 0.94]

1.1 Peer support	1	42	Risk Ratio (M‐H, Random, 95% CI)	0.30 [0.10, 0.92]
1.2 Non‐directive counselling	4	464	Risk Ratio (M‐H, Random, 95% CI)	0.67 [0.43, 1.04]
2 Evidence of depression at final assessment ‐ sensitivity analysis Show forest plot	2	328	Odds Ratio (M‐H, Fixed, 95% CI)	0.57 [0.36, 0.88]

3 Evidence of depression at assessment immediately post‐treatment Show forest plot	4	231	Risk Ratio (M‐H, Random, 95% CI)	0.49 [0.28, 0.85]

3.1 Peer support	1	42	Risk Ratio (M‐H, Random, 95% CI)	0.24 [0.06, 1.00]
3.2 Non‐directive counselling	3	189	Risk Ratio (M‐H, Random, 95% CI)	0.55 [0.32, 0.94]

Comparison 2. Psychosocial interventions versus usual care ‐ variations in intervention type

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Comparison 3. Psychological interventions versus usual care ‐ variations in intervention type

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Evidence of depression at final assessment within first year Show forest plot	6		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Cognitive‐behavioural therapy	5	482	Risk Ratio (M‐H, Fixed, 95% CI)	0.72 [0.57, 0.90]
1.2 Interpersonal psychotherapy	1	120	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.66, 0.98]
1.3 Psychodynamic therapy	1	91	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.33, 1.37]
1.4 Cognitive‐behavioural therapy and interpersonal psychotherapy	6	602	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.63, 0.88]
2 Evidence of depression at assessment immediately post‐treatment Show forest plot	5		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Cognitive‐behavioural therapy	4	209	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.62, 1.01]
2.2 Interpersonal psychotherapy	1	120	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.66, 0.98]
2.3 Psychodynamic therapy	1	95	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.29, 0.80]

Comparison 3. Psychological interventions versus usual care ‐ variations in intervention type

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Comparison 4. Psychosocial interventions versus psychological interventions

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Non‐directive counselling versus cognitive behavioural therapy at last assessment in first year Show forest plot	2	358	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.84, 1.52]

Comparison 4. Psychosocial interventions versus psychological interventions

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Comparison 5. All interventions versus usual care ‐ variations in intervention mode

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Evidence of depression at final assessment within first year Show forest plot	9		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Individually‐based interventions	8	917	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.61, 0.82]
1.2 Group‐based interventions	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	0.55 [0.28, 1.10]

Comparison 5. All interventions versus usual care ‐ variations in intervention mode

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Comparison 6. All interventions versus usual care ‐ variations in selection criteria

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Evidence of depression at final assessment within first year Show forest plot	9		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Clinical diagnosis of depression	4	246	Risk Ratio (M‐H, Random, 95% CI)	0.67 [0.46, 0.97]
1.2 Self‐reported depressive symptomatology	5	710	Risk Ratio (M‐H, Random, 95% CI)	0.72 [0.58, 0.88]

Comparison 6. All interventions versus usual care ‐ variations in selection criteria

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