Optimizing cognitive and behavioral approaches for perinatal depression: A systematic review and meta-regression analysis

Abstract

Cognitive behavioural therapies (CBT) have been demonstrated efficacious in treating perinatal depression (PND). This has been demonstrated in several meta-analyses of randomized controlled trials and quasi-experimental studies. However, there is a need for up-to-date meta-analytical evidence providing reliable estimates for CBT's effectiveness in treating and preventing PND. Furthermore, with the world moving towards precision medicine, approaches require a critical synthesis of psychotherapies, especially to unpack their mechanisms of action and to understand what approaches work best for whom. Therefore, the present systematic review and meta-regression analyses aim to answer these research questions. We searched six academic databases through February 2022 and identified 56 studies for an in-depth review. Using pretested data extraction sheets, we extracted patient-level and intervention-level characteristics and effect size data from each study. Random effects meta-analyses and mixed effect subgroup analyses were run to delineate the effectiveness and moderators of CBT interventions for PND, respectively. CBT based interventions yielded a strong effect size (SMD= -0.74, 95% CI: -0.91 to -0.56, n= 9,722) in alleviating depressive symptoms. These interventions were effective across different delivery formats (individual, group, and electronic) and could be delivered effectively by specialists and non-specialists. Longer duration CBT interventions may not necessarily be more effective than shorter ones. Moreover, CBT-based interventions should consider including various behavioural ingredients to maximize intervention benefits.