RT Journal Article
SR Electronic
T1 Effectiveness of Psychological Interventions for Postnatal Depression in Primary Care: A Meta-Analysis
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 463
OP 472
DO 10.1370/afm.1967
VO 14
IS 5
A1 Stephens, Sian
A1 Ford, Elizabeth
A1 Paudyal, Priya
A1 Smith, Helen
YR 2016
UL http://www.annfammed.org/content/14/5/463.abstract
AB PURPOSE Postnatal depression affects 10% to 15% of new mothers, and approximately 90% of cases are managed in primary care. Antidepressants are effective, but adherence is poor; therefore, psychological interventions must be investigated. In this systematic review, we assessed the efficacy of psychological therapies for postnatal depression in primary care.METHODS We undertook a systematic search to identify articles published in English between 2000 and 2014 that reported studies meeting our eligibility criteria: (1) had a randomized controlled trial design; (2) assessed psychological interventions for postnatal depression against any other treatment or a wait-list control; (3) recruited patients in primary care; and (4) enrolled mothers with a diagnosed depressive episode or a score of at least 12 on the Edinburgh Postnatal Depression Scale or at least 10 on the Beck Depression Inventory at baseline who had a child younger than 12 months. Quality was assessed using an adapted Cochrane Collaboration Depression, Anxiety, and Neurosis (CCDAN) quality rating scale, and meta-analysis was carried out using RevMan 5.3 (The Cochrane Collaboration).RESULTS Screening of 5,919 articles identified 10 studies that met inclusion criteria. These studies reported on 14 psychological intervention arms: 7 using cognitive behavioral therapy, 2 using interpersonal therapy, 2 using counseling, and 3 using other interventions. Psychological interventions resulted in lower depressive symptomatology than control both immediately after treatment (standardized mean difference = −0.38; 95% CI, −0.49 to −0.27) and at 6 months of follow-up (standardized mean difference =−0.21; 95% CI, −0.37 to −0.05). We did not find any significant differences between the various types of therapy. Compared with control, the interventions also led to improvements in adjustment to parenthood, marital relationship, social support, stress, and anxiety.CONCLUSIONS Psychological interventions deliverable in the primary care setting are associated with a significant improvement in depressive symptomatology both immediately after completion and for up to 6 months of follow-up.