Psychosocial and psychological interventions for treating postpartum depression

Psychosocial and psychological interventions may be effective treatment options for women suffering from postpartum depression.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and by imprecise results (few patients and wide confidence intervals).

Comment: The recommendation attaches a relatively high value on mother and baby wellbeing.

A Cochrane review included 10 studies with a total of 956 subjects. Five trials selected participants based on a clinical diagnosis of depression while five trials enrolled women who met inclusion criteria based on self-reported depressive symptomatology. Follow-up times ranged from immediately post-treatment to five years. Any psychosocial or psychological intervention, compared to usual postpartum care (variously defined), was associated with a reduction in the likelihood of depressive symptomatology at the final assessment within the first year postpartum (9 trials; n=956, RR 0.70, 95% CI 0.60 to 0.81). Psychosocial interventions together showed a decrease in the likelihood of depressive symptomatology at the final assessment in the first year postpartum (5 trials, n=506; RR=0.61, 95% CI 0.39 to 0.94). The three types of psychological interventions were cognitive behavioural therapy, interpersonal psychotherapy, and psychodynamic therapy. Cognitive behavioural therapy appeared to have a beneficial effect on depressive symptomatology (5 trials, n = 482; RR=0.72, 95% CI 0.57 to 0.90). One trial demonstrated a beneficial effect with interpersonal psychotherapy (n = 120; RR=0.80, 95% CI 0.66 to 0.98). One trial evaluating psychodynamic therapy did not show a beneficial effect at final assessment (n = 91; RR = 0.67, 95% CI 0.33 to 1.37). Combining the standard psychological interventions of cognitive behavioural therapy and interpersonal psychotherapy, a beneficial effect was found in reducing postpartum depressive symptomatology at final assessment (six trials, n = 602; RR = 0.75, 95% CI 0.63 to 0.88). The results suggested no significant difference in beneficial effect in reducing depressive symptomatology at final assessment between a psychosocial intervention (non-directive counselling) and a psychological intervention (cognitive behavioural therapy) (n= 358; RR = 1.13, 95% CI 0.84 to 1.52).

Ədəbiyyat

1. Dennis CL, Hodnett E. Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database Syst Rev 2007 Oct 17;(4):CD006116.