Effectiveness of psychological interventions for postnatal depression in primary care: a meta-analysis

Purpose: Postnatal depression (PND) affects 10-15% of new mothers, and approximately 90% of cases are managed in primary care. Antidepressants are effective but adherence is poor, therefore psychological interventions must be investigated. This systematic review assessed the efficacy of psychological treatments for PND in primary care. Methods: A systematic search was undertaken to identify articles published in English between 2000 and 2014, which met eligibility criteria: 1) RCTs; 2) assessing psychological interventions for PND against any other treatment or wait-list control; 3) recruitment in primary care; 4) participants with diagnosed depressive episode or score on Edinburgh Postnatal Depression Scale =12 or Beck Depression Inventory =10 at baseline, and a child <12 months. Quality was assessed using an adapted CCDAN quality rating scale and meta-analysis was carried out using RevMan 5.3. Results: After examining 5919 papers, 10 studies met inclusion criteria, reporting 14 psychological intervention arms: 7 cognitive behavioral therapy, 2 interpersonal therapy, 2 counselling and 3 other interventions. Psychological interventions resulted in lower depressive symptomatology than control (standardized mean difference (SMD) -0.38 (95% CI -0.49, -0.27)) directly following treatment, and after 6 months follow up (SMD -0.21 (-0.37, -0.05)). No significant differences were found between different types of therapy. Improvements were also found in adjustment to parenthood, marital relationship, social support, stress and anxiety in the intervention arms compared to control. Conclusions: Psychological interventions deliverable in the primary care setting are linked to significant improvement in depressive symptomatology both immediately and for up to six months of follow up.