Is group cognitive behaviour therapy for postnatal depression evidence-based practice? A systematic review

Abstract

BackgroundThere is evidence that psychological therapies including cognitive behaviour therapy (CBT) may be effective in reducing postnatal depression (PND) when offered to individuals. In clinical practice, this is also implemented in a group therapy format, which, although not recommended in guidelines, is seen as a cost-effective alternative. To consider the extent to which group methods can be seen as evidence-based, we systematically review and synthesise the evidence for the efficacy of group CBT compared to currently used packages of care for women with PND, and we discuss further factors which may contribute to clinician confidence in implementing an intervention.MethodsSeventeen electronic databases were searched. All full papers were read by two reviewers and a third reviewer was consulted in the event of a disagreement on inclusion. Selected studies were quality assessed, using the Cochrane Risk of Bias Tool, were data extracted by two reviewers using a standardised data extraction form and statistically synthesised where appropriate using the fixed-effect inverse-variance method.ResultsSeven studies met the inclusion criteria. Meta-analyses showed group CBT to be effective in reducing depression compared to routine primary care, usual care or waiting list groups. A pooled effect size of d = 0.57 (95% CI 0.34 to 0.80, p < 0.001) was observed at 10–13 weeks post-randomisation, reducing to d = 0.28 (95% CI 0.03 to 0.53, p = 0.025) at 6 months. The non-randomised comparisons against waiting list controls at 10–13 weeks was associated with a larger effect size of d = 0.94 (95% CI 0.42 to 1.47, p < 0.001). However due to the limitations of the available data, such as ill-specified definitions of the CBT component of the group programmes, these results should be interpreted with caution.ConclusionsAlthough the evidence available is limited, group CBT was shown to be effective. We argue, therefore, that there is sufficient evidence to implement group CBT, conditional upon routinely collected outcomes being benchmarked against those obtained in trials of individual CBT, and with other important factors such as patient preference, clinical experience, and information from the local context taken into account when making the treatment decision.

Psychological Treatment Trials for Hypoactive Sexual Desire Disorder: A Sexual Medicine Critique and Perspective

“…Active‐control designs have been used to test CBT for depression and insomnia. Supportive psychotherapy [34,35], routine primary care, or usual care provide professional contact time, and opportunity for therapeutic alliance [36–41]. Whatever control is used, it should provide the non‐specific effects of placebo by requiring the same amounts of time in peer and professional contact as in the active treatment group.…”

Psychological Therapy for Postnatal Depression in UK Primary Care Mental Health Services: A Qualitative Investigation Using Framework Analysis

“…The finding that the group format for CBT was acceptable in the current study suggests that the advantages and disadvantages of attending a group, as well as previous clients' experiences, should be discussed with potential attendees. Little research has directly compared the effectiveness or acceptability of group CBT to individual CBT for PND, or indeed depression in general, although it has been reported to be more effective than treatment as usual (Scope et al 2013).…”

“…Both individual and group-based psychological interventions have been shown to be effective in reducing symptoms of depression (Cuijpers et al 2008; Dennis and Hodnett 2007;Scope et al 2013). Historically, psychological therapies for PND have focused on depression symptoms and less on mother-infant outcomes, including the mother-infant-relationship or the infant's development (e.g., see Tsivos et al 2015).…”

Cost-Utility Analyses of Cognitive-Behavioural Therapy of Depression: A Systematic Review

“…Cognitive behavioural therapy (CBT) is an important and effective treatment approach for MDD [3,4,5,6,7,8,9]. It is a psychotherapeutic intervention aiming at the modification of cognitions to influence emotions and behaviour [10].…”