DiscussionReflections

Effectiveness of Psychological Interventions for Postnatal Depression in Primary Care: A Meta-Analysis

Sian Stephens, Elizabeth Ford, Priya Paudyal and Helen Smith
The Annals of Family Medicine September 2016, 14 (5) 463-472; DOI: https://doi.org/10.1370/afm.1967

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Study selection flow diagram.

    RCT = randomized controlled trial.

  • Figure 2
    Figure 2

    Forest plot of scores comparing psychological interventions vs control conditions immediately postintervention, fixed effects analysis.

    aCognitive behavioral therapy arms of those trials.

    bCounseling arm (Cooper et al) or individual counseling arm (Milgrom et al).

    cGroup counseling arm (Milgrom et al) or psychodynamic therapy arm (Cooper et al).

  • Figure 3
    Figure 3

    Forest plot of scores comparing psychological interventions vs control conditions at longer-term follow-up (median time 6 mo), fixed effects analysis.

    aCognitive behavioral therapy arms of those trials.

    bCounseling arm.

    cPsychodynamic therapy arm.

  • Figure 4
    Figure 4

    Forest plot of the odds ratio of patients being above diagnostic threshold (variously defined) comparing psychological interventions with control conditions, fixed effects analysis.

    aCognitive behavioral therapy arms of those trials.

    bCounseling arm (Cooper et al) or individual counseling arm (Milgrom et al).

    cGroup counseling arm (Milgrom et al) or psychodynamic therapy arm (Cooper et al).

    * Diagnostic threshold: clinical interview.

    † Diagnostic threshold: Edinburgh Postnatal Depression Scale score ≥12.

    ‡ Diagnostic threshold: Beck Depression Inventory score ≥10.

    § Diagnostic threshold: Beck Depression Inventory, second version score ≥14.

    ¶ Diagnostic threshold: Edinburgh Postnatal Depression Scale score ≥10.

  • Figure 5
    Figure 5
    Figure 5
    Figure 5
    Figure 5

    Forest plots of data comparing psychological and psychosocial interventions vs control conditions for anxiety and stress, social support, adjustment to parenthood, and marital relationship, fixed effects analysis.

    Note: Scales used: (A) anxiety and stress: Perceived Stress Scale,44 Beck Anxiety Inventory,38 Depression Anxiety and Stress Scales36; (B) social support: Interpersonal Support Evaluation List,37,44 Social Provisions Scale38; (C) adjustment to parenthood: Parenting Stress Index - short form,40 Maternal Attachment Inventory37; (D) marital relationship: Dyadic Adjustment Scale.37,45

    aCognitive behavioral therapy arms of those trials.

    bIndividual counseling arm.

    cGroup counseling arm.

Tables

  • Table 1

    Characteristics of the 10 Included Studies

    Study, Year, and CountrySample SizeIntervention (No.)Control (No.)Age, Mean (SD), yFollow-upMeasurement ToolAttrition, %Quality Scorea
    Horowitz et al,43 2013, USA134Communicating and Relating Effectively (CARE) (66)Treatment as usual (68)31.0 (5.7)3, 6, and 9 moEPDS636
    Milgrom et al,36 2011, Australia68General practitioner management with adjunctive CBT with nurse (22)
    General practitioner management with adjunctive CBT with psychologist (23)    		General practitioner management (23)31.5 (4.7)3 and 8 wkBDI-II2832
    Mulcahy et al,37 2010, Australia57Group IPT (29)Treatment as usual (28)32.2 (3.4)4 and 8 wkEPDS, BDI-II, DAS, ISEL, MAI1230
    Morrell et al,40 2009, UK418CBT/person-centered therapy (271)Treatment as usual (147)30.9 (5.4)6, 12, and 18 moEPDS, STAI, PSI2834
    Milgrom et al,38 2005, Australia192CBT (46)
    Group-based counseling (47)
    Individual counseling (66)    		Treatment as usual (33)29.7 (5.4)12 wk and 12 moBDI, BAI, SPS7033
    Cooper et al,41 2003, UK193CBT (43)
    Psychodynamic therapy (50)
    Counseling (48)    		Treatment as usual (52)27.7 (5.4)4.5, 9, and 18 mo, and 5 yEPDS1235
    Honey et al,39 2002, UK45CBT (23)Treatment as usual (22)27.9 (5.5)8 wk and 6 moEPDS, DAS–21
    Prendergast and Austin,35 2001, Australia37CBT (17)Ideal standardized care (20)32.2b6 wk and 6 moEPDS1023
    O’Hara et al,42 2000, USA120IPT (60)Wait-list control (60)29.6 (4.7)4, 8, and 12 wkBDI1826
    Chen et al,44 2000, Taiwan60Support group (30)Treatment as usual (30)29.1 (4.2)4 wkBDI, PSS, ISEL, SEI–24

    • BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory, original version; BDI-II = Beck Depression Inventory, second version; DAS = Dyadic Adjustment Scale; EPDS = Edinburgh Postnatal Depression Scale; ISEL = Interpersonal Support Evaluation List; MAI = Maternal Attachment Inventory; PSI = Parenting Stress Index; PSS = Perceived Stress Scale; SEI = Coopersmith Postnatal Self-Esteem Inventory; SPS = Social Provisions Scales; STAI = State-Trait Anxiety Inventory.

    • ↵a On the modified Quality Rating Scale. Possible scores range from 0 to 40, where higher scores indicate higher quality.

    • ↵b SD not given.

Additional Files

  • Supplemental Appendixes 1-2

    Supplemental Appendixes

    Files in this Data Supplement:

  • The Article in Brief

    Effectiveness of Psychological Interventions for Postnatal Depression in Primary Care: A Meta-Analysis

    Elizabeth Ford , and colleagues

    Background With approximately 13 percent of mothers experiencing postnatal depression during the first year after delivery and 90 percent of cases managed in primary care, this study analyzed existing research to assess the efficacy of psychological therapies for postnatal depression in primary care. While antidepressant medication is commonly used as a first-line treatment for postnatal depression, potential adverse effects of medication are worrisome to both mothers and clinicians, making it important to evaluate the efficacy of non-drug therapies.

    What This Study Found The study, which included 10 clinical trials involving 1,324 depressed new mothers, found that psychological interventions delivered in community settings are effective treatment for postnatal depression. Compared with treatment as usual or a wait-list control, psychological interventions resulted in lower levels of depressive symptoms and higher levels of remission immediately after treatment. Improvements in symptoms at four to six months of follow-up were still significant but less robust. No particular type of therapy emerged as the most effective, but interpersonal therapy and cognitive behavioral therapy showed promising results. There were also improvements in anxiety and stress, marital relationships, adjustment to parenthood, and perceived social support.

    Implications

    • The small number of studies available means that caution is required when interpreting the secondary results and longer-term follow-up.
    • The authors recommend that primary care clinicians make psychological therapies available to their patients.
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Get Permissions

Jump to section

Subjects

Keywords