Effectiveness and acceptability of cognitive–behavioural therapy based interventions for maternal peripartum depression: a systematic review, meta-analysis and thematic synthesis protocol

Pettman, Danelle; O’Mahen, Heather; Svanberg, Agneta Skoog; Essén, Louise von; Axfors, Cathrine; Blomberg, Oscar; Woodford, Joanne

doi:10.1136/bmjopen-2019-032659

Cited by 7 publications

(7 citation statements)

References 107 publications

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“…The review protocol is published [24] and registered in PROSPERO (CRD 42020152254). Methods are informed by Cochrane guidance [37], the Centre for Reviews and Dissemination guidance [38], and reporting follows the PRISMA 2021 statement [39] (Additional file 1).…”

Section: Methodsmentioning

confidence: 99%

“…Another limitation of the existing evidence base is that a number of important secondary outcomes have been largely unexamined [ 24 ], for example, anxiety, stress (individual and perceived parenting), parenting (e.g., sensitivity/responsiveness), perceived social support, and perceived parental competence. Given high comorbidity rates of PND and anxiety [ 4 ], the impact of stress on both mothers and the infant [ 28 , 29 ], the association between PND and parenting difficulties [ 7 ], and poor social support [ 30 ], it is suggested that PND interventions should also try to improve these important outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Conducting a systematic review and meta-analysis focusing on CBT-based interventions may potentially reduce the high levels of heterogeneity present in more "broad scope" reviews [17][18][19]. Reducing high levels of clinical heterogeneity may also facilitate an exploration of a number of novel moderators, for example, the potential effect of the type of health professional delivering intervention and including parenting intervention components [24].…”

Section: Introductionmentioning

confidence: 99%

“…Given the aforementioned gaps in the current evidence base, an updated systematic review and meta-analysis of CBT-based interventions for PND is warranted. This review seeks to overcome the aforementioned limitations of previous reviews by: (1) attempting to reduce clinical heterogeneity by only including CBT-based interventions and excluding third wave CBT interventions and preventative interventions; (2) restricting study inclusion to RCTs whereby allocation and concealment procedures were determined to have a low risk of bias [24] and examine study quality as a potential moderator; and (3) investigating a number of clinical and methodological moderators potentially associated with effectiveness that are currently neglected in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of cognitive behavioural therapy-based interventions for maternal perinatal depression: a systematic review and meta-analysis

et al. 2023

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Background Depression during the perinatal period (during pregnancy and the year after childbirth) is common and associated with a range of negative effects for mothers, infants, family members, and wider society. Although existing evidence suggests cognitive behavioral therapy (CBT) based interventions are effective for perinatal depression, less is known about the effect of CBT-based interventions on important secondary outcomes, and a number of potential clinical and methodological moderators have not been examined. Methods A systematic review and meta-analysis primarily examined the effectiveness of CBT-based interventions for perinatal depression on symptoms of depression. Secondary aims examined the effectiveness of CBT-based interventions for perinatal depression on symptoms of anxiety, stress, parenting, perceived social support, and perceived parental competence; and explored clinical and methodological moderators potentially associated with effectiveness. A systematic search of electronic databases and other sources was performed up to November 2021. We included randomized controlled trials comparing CBT-based interventions for perinatal depression with control conditions allowing for the isolation of the effects of CBT. Results In total, 31 studies (5291 participants) were included in the systematic review and 26 studies (4658 participants) were included in the meta-analysis. The overall effect size was medium (hedges g = − 0.53 [95% CI − 0.65 to − 0.40]); with high heterogeneity. Significant effects were also found for anxiety, individual stress, and perceived social support, however few studies examined secondary outcomes. Subgroup analysis identified type of control, type of CBT, and type of health professional as significant moderators of the main effect (symptoms of depression). Some concerns of risk of bias were present in the majority of studies and one study had a high risk of bias. Conclusions CBT-based interventions for depression during the perinatal period appear effective, however results should be interpreted with caution given high levels of heterogeneity and low quality of included studies. There is a need to further investigate possibly important clinical moderators of effect, including the type of health professional delivering interventions. Further, results indicate a need to establish a minimum core data set to improve the consistency of secondary outcome collection across trials and to design and conduct trials with longer-term follow-up periods. Trial registration CRD42020152254.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effectiveness of cognitive behavioural therapy-based interventions for maternal perinatal depression: a systematic review and meta-analysis

et al. 2023

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“…While some women, particularly those with mild and moderate symptoms of depression, will benefit from therapeutic modalities like Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT; Letourneau et al, 2017;Pettman et al, 2019;Sockol, 2015), others require pharmacologic intervention to control symptoms. As a result, there has been increasing interest in determining the safety of psychotropic treatment in pregnancy.…”

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confidence: 99%

Lack of psychotropic medication changes among mood disordered women across the peripartum period

Standeven

Payne

Pangtey

et al. 2021

Human Psychopharmacology

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Objective: Peripartum depression is a leading contributor to peripartum morbidity and mortality. Despite the evidence for relative safety, many patients and providers remain reluctant to use or modify psychotropics in the peripartum period. We hypothesized that depressed women in the peripartum period taking psychiatric medications would not experience dose adjustments.Methods: Women with a prior history of either Major Depressive Disorder or Bipolar Affective Disorder were followed through pregnancy and the postpartum period (N = 229). Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS), with a score ≥ 13 indicating likely depression. Data analysis included descriptive statistics, chi-square tests, and logistic regression.Results: Antepartum depression was more common than postpartum depression (PPD; 29% vs. 20%); 38% of women with antepartum depression also had PPD.Regression analysis revealed that, although depressed women in pregnancy were not more likely to have a dose adjustment than nondepressed women (OR: 1.9, 95% CI: 0.8-4.6), depressed women in the postpartum were more likely to receive a medication change than nondepressed women (OR: 6.3, 95% CI: 2.0-20.4). Conclusions:In a naturalistic study, more medication adjustments for depression occurred in the postpartum than in pregnancy. This may indicate that antepartum depression is undertreated.

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Postpartum depression and the role and position of cognitive behavioral therapy

Buhagiar

Mamo

2023

Handbook of Cognitive Behavioral Therapy by Disorder

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Effectiveness and acceptability of cognitive–behavioural therapy based interventions for maternal peripartum depression: a systematic review, meta-analysis and thematic synthesis protocol

Cited by 7 publications

References 107 publications

Effectiveness of cognitive behavioural therapy-based interventions for maternal perinatal depression: a systematic review and meta-analysis

Effectiveness of cognitive behavioural therapy-based interventions for maternal perinatal depression: a systematic review and meta-analysis

Lack of psychotropic medication changes among mood disordered women across the peripartum period

Postpartum depression and the role and position of cognitive behavioral therapy

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