A Cochrane review [Abstract] 1 included 28 studies on the effect of diverse psychosocial and psychological interventions to reduce the risk of developing postpartum depression, with a total of 17 000 subjects.
Overall, women who received a psychosocial intervention were less likely to develop postpartum depression as those receiving standard care (average RR 0.78, 95% CI 0.66 to 0.93; 20 trials, n=14 727). Several promising interventions include: the provision of intensive, individualised postpartum home visits provided by public health nurses or midwives (RR 0.56, 95% CI 0.43 to 0.73; 2 trials, n=1262); lay (peer)-based telephone support (RR 0.54, 95% CI 0.38 to 0.77; 1 trial, n=612); and interpersonal psychotherapy (standardised mean difference -0.27, 95% CI -0.52 to -0.01; 5 trials, n=366). Professional- and lay-based interventions were both effective. Individually-based interventions reduced depressive symptomatology at final assessment (RR 0.75, 95% CI 0.61 to 0.92; 14 trials, n=12 914) as did multiple-contact interventions (RR 0.78, 95% CI 0.66 to 0.93; 16 trials, n=11 850). Interventions that were initiated in the postpartum period also significantly reduced the risk to develop depressive symptomatology (RR 0.73, 95% CI 0.59 to 0.90; 12 trials, n=12786). Identifying mothers 'at-risk' assisted the prevention of postpartum depression (RR 0.66, 95% CI 0.50 to 0.88; 8 trials, n=1853).
A meta-analysis 5 assessed effectiveness of mother-infant psychotherapy on postpartum depression. A total of 13 RCTs were included. In the short-term effect analysis, mother-infant psychotherapy reduced standardized mean depressive scores (-0.25, 95% CI -0.40 to -0.09) and risk ratio (0.71, 95% CI 0.55 to 0.91). In the long-term effect analysis, mother-infant psychotherapy did not improve maternal mood, mother-infant interaction and infant attachment.
A systematic review 3 assessed depression screening and treatment for pregnant and postpartum women. In 6 trials among pregnant and postpartum women (n= 11 869) screening programs showed 18% to 59% relative reductions, or 2.1% to 9.1% absolute reductions, in the risk of depression at follow-up (3-5 months) after participation in programs involving depression screening, with or without additional treatment components, compared with usual care. Based on 23 studies (n = 5398), a cutoff of 13 on the English-language Edinburgh Postnatal Depression Scale demonstrated sensitivity ranging from 0.67 (95% CI, 0.18 to 0.96) to 1.00 (95% CI, 0.67 to 1.00) and specificity consistently 0.87 or higher. Data were sparse for Patient Health Questionnaire instruments. Pooled results for the benefit of cognitive behavioral therapy (CBT) for pregnant and postpartum women with screen-detected depression showed an increase in the likelihood of remission (pooled relative risk 1.34, 95% CI 1.19 to 1.50; 10 trials, I² = 7.9%) compared with usual care, with absolute increases ranging from 6.2% to 34.6%.
In a clinical trial 4, 85 nulliparous pregnant women at 30-35 weeks were randomly divided into 3 groups: cognitive-behavioural counselling (n = 25), solution-focused counselling (n = 25) and control (n = 35). Counselling meetings were held on a weekly basis. The CBT group received 4 sessions and the solution-focused group received 3 sessions. The control group received only routine pregnancy healthcare services. Maternity blues and postpartum depression were, respectively, measured on postpartum days 5 and 15 through the Austin Inventory and Edinburgh Postnatal Depression Scale. The maternity blues mean scores of the cognitive-behavioural counselling, solution-focused counselling and control groups were 6.1 ± 4.6, 4.2 ± 3.6 and 6.7 ± 4.9, respectively, and the difference between the scores was significant. The mean scores of postnatal depression on the 15th postpartum day in the three groups were 6.7 ± 5.3, 4.4 ± 4.4 and 10.4 ± 5.9, respectively. The odds ratio of being depressed in women with maternity blues was 7.6 (95% CI 2.1 to 27.5).
In a trial 2 249 primiparous women with mild to moderate postpartum depression were randomly assigned to a control group (n=128), which received conventional postpartum care, or to a psychological intervention group (n=121), which received conventional postpartum care combined with psychological intervention. The Edinburgh Postnatal Depression Scale (EPDS) and Pittsburgh Sleep Quality Index (PSQI) were employed to evaluate depression and sleep quality, respectively.After intervention, the EPDS score, PSQI score, sleep quality score, sleep latency score, sleep duration score, habitual sleep efficiency score, sleep disturbance score, and daytime dysfunction score were significantly lower in the intervention group than in the control group.
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