CRD summary

The authors concluded that the largest effects in women with non-psychotic depression during pregnancy, or postpartum, were seen with medication, alone or with cognitive-behavioural therapy (CBT); group therapy with CBT, educational and transactional analysis components; interpersonal psychotherapy; and CBT. Several limitations mean that these results should be interpreted with caution.

Authors' objectives

To determine the efficacy of current treatment interventions for non-psychotic major depression in pregnancy and the postpartum period. A secondary aim was to the compare the efficacy of the different interventions, while a tertiary aim was to determine the effect of timing during pregnancy or postpartum on the efficacy of these interventions.

Searching

The Cochrane CENTRAL Register, MEDLINE, PsycLIT and Social Work Abstracts were searched for studies published within the previous 15 years (no dates provided); the search terms were reported. The references of all selected papers were also checked, while letters were sent to experts in an attempt to locate any additional relevant studies.

Study selection

Assessment of study quality

The quality of the primary studies was evaluated based on the following criteria: presence of randomisation, presence of a control group, number of participants and year of publication. The studies were given a quality rating of high, medium or low.

Data extraction

One reviewer extracted the data. In addition to standard data, information on the types and timing of the intervention were extracted. The data were reported as presented in the original studies.

Methods of synthesis

Results of the review

Eleven studies, describing 16 interventions, were included in the review: 7 RCTs (n=703), 3 open-label before-and-after studies (n=36) and 1 open-label trial (n=6).

Six studies were considered high quality, 4 studies medium quality and 1 study low quality.

The overall effect size of treatment was 0.673 (p<0.01); 14 interventions had a positive effect size.

When different intervention types were compared, a statistically significant effect size was found for medication (3.485, p<0.001; 2 studies, n=45), medication plus CBT (3.871, p<0.001; 1 study, n=30), group therapy (2.046, p<0.001; 1 study, n=30), IPT (1.260, p<0.001; 4 studies, n=181) and CBT (0.642, p<0.001; 3 studies, n=172). Medication, alone or in combination with CBT, was found to have the largest effect size. Psychodynamic therapy (1 study, n=95), counselling (2 studies, n=147) and education did not demonstrate statistically significant effect sizes of treatment: 0.53 (p=0.14), 0.418 (p=0.14) and 0.100 (p=0.457), respectively.

A statistically significant effect size was found for interventions implemented in the postpartum period (0.837, p<0.001; 8 studies, n=837). A small reduction in the effect size was seen when interventions with medication were removed from the analysis. A statistically significant effect size was found for interventions implemented during pregnancy (0.377, p=0.002; 5 studies, n=304).

Authors' conclusions

Preliminary findings suggested that medication (alone or in combination with CBT), group therapy with CBT, educational and transactional analysis components, IPT and CBT produce the greatest effect sizes for women with non-psychotic depression during pregnancy or the postpartum, although further research is needed to validate the results of this review.

CRD commentary

The review question was supported by fairly broad inclusion criteria. Several electronic databases were searched for relevant studies. Although two reviewers were involved in selecting the primary studies, it was unclear whether this process was conducted independently. The methods reported for the data extraction were unlikely to have minimised the possibility of reviewer error or bias. The authors did not report how many reviewers assessed study quality. The authors also did not report sufficient information to assess whether the analysis conducted was appropriate or not, or whether differences between the studies were formally assessed. Few details of the participants were provided, which makes it more difficult for the reader to interpret the results. In addition, the conclusions were based on a small number of studies with small datasets; the authors themselves suggested that these results should be interpreted with caution.

Implications of the review for practice and research

Practice: The authors did not indicate any implications for practice.

Research: The authors stated that future research should consider other available measures of depression; examine other variables such as occupational and social functioning, social support and the cost-effectiveness of the interventions; and continue to address the safety of pharmacological treatment for major depression during pregnancy and the postpartum. They also suggested that research into non-pharmacological treatments for major depression in the perinatal period is needed, and that culturally relevant treatments should be explored.

Funding

National Institute of Mental Health, grant numbers 5T32MH014623-24 and K23 MH67595.

Bibliographic details

Bledsoe S E, Grote N K. Treating depression during pregnancy and the postpartum: a preliminary meta-analysis. Research on Social Work Practice 2006; 16(2): 109-120.

Indexing Status

Subject indexing assigned by CRD

MeSH

Adult; Anxiety Disorders /prevention & control; Depression, Postpartum /prevention & control; Depressive Disorder /prevention & control; Female; Pregnancy; Pregnancy Complications /prevention & control; Prenatal Care /methods

AccessionNumber

12006006053

Database entry date

31/10/2007

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.