Effectiveness of psychological interventions in preventing postpartum depression in non-depressed women: a systematic review and meta-analysis of randomized controlled trials

Abstract

Postpartum depression (PPD) is one of the most common disorders following childbirth. This systematic review and meta-analysis (SR/MA) aimed to assess the effectiveness of psychological interventions in preventing PPD in non-depressed women. PRISMA guidelines were followed. MEDLINE (Ovid and PubMed), PsycINFO, Web of Science, Scopus, CINAHL, CENTRAL, OpenGrey, Australian New Zealand Clinical Trial Registry and clinicaltrial.gov were searched. Randomized controlled trials (RCTs) conducted with pregnant or postpartum (up to 12 months) women who were non-depressed at baseline were selected. The outcomes were the incidence of PPD and/or the reduction of postpartum depressive symptoms. The standardized mean difference (SMD) using random-effect models was calculated. Sensitivity, sub-group and meta-regression analyses were performed. 17 RCTs were included in the SR and 15 in the MA, representing 4958 participants from four continents. The pooled SMD was −0.175 [95% confidence interval (CI) −0.266 to −0.083; p < 0.001] and sensitivity analyses confirmed the robustness of this result. Heterogeneity was low (I2 = 21.20%) and was fully explained by a meta-regression model including one variable (previous deliveries). The meta-regression model and MA stratified by previous deliveries indicated that interventions focused on primiparous women are more effective. There was no evidence of publication bias. Few RCTs had an overall low risk of bias. According to GRADE, the quality of evidence was moderate. Psychological interventions have very little effectiveness in preventing PPD in non-depressed women, although this effectiveness is greater in interventions focused on primiparous women. Further RCTs with a low risk of bias and more effective interventions are needed.

Effectiveness of interventions to prevent perinatal depression: An umbrella review of systematic reviews and meta-analysis

“…A total of 1247 articles were identified after excluding duplicates. Of these, 126 articles were included for full-text review and 19 different SRs and MAs met the inclusion criteria [ [23] , [24] , [25] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] ] (see Fig. 1 ).…”

“…The list of the countries is available in Supplementary Table S4. Only two SR&MA [ 23 , 36 ] provided information regarding ethnic minorities. One SR&MA [ 23 ] included five RCTs focused on African American women, American Indians, and Latinas in the United States.…”

“…Only two SR&MA [ 23 , 36 ] provided information regarding ethnic minorities. One SR&MA [ 23 ] included five RCTs focused on African American women, American Indians, and Latinas in the United States. In addition, one SR [ 36 ] included five RCTs focusing on the American Indian population, eight on the African American population, and four on the Hispanic population.…”

“…The other only included six SR&MA focused on mainly psychological interventions during the perinatal period that included randomized and nonrandomized controlled trials published before June 2020 [ 21 ]. In addition, new SR&MA on RCTs for the prevention of perinatal depression have been recently published [ [23] , [24] , [25] ]. Thus, the evidence on existing preventive interventions for depression in perinatal period remains unclear.…”

Global prevalence of perinatal depression and anxiety during the COVID‐19 pandemic: An umbrella review and meta‐analytic synthesis

“…Clinical practice guidelines on perinatal mental health disorders must consider the impact of the pandemic or public health crisis on mental health 70 and consider special vulnerable groups, such as refugees or minority groups. The cultural and organizational differences between countries can still lead to legitimate variations in clinical recommendations, even in the presence of the same evidence 71,72 …”