Effectiveness of Psychological Therapies for Depression During the Perinatal Period : A Systematic Review and Meta-analysis.

Abstract

Perinatal depression can have a deleterious impact on mothers and infants. To evaluate psychological therapies for perinatal depression. 6 databases from January 2000 to March 2025. Randomized controlled trials (RCTs) of psychological therapies for people with depression during pregnancy and up to 1 year postpartum. 6 researchers extracted study data and assessed the risk of bias and strength of evidence (SoE). Forty-four RCTs were included. Cognitive behavioral therapy (CBT; <i>k</i> = 25, <i>n</i> = 2962) was probably more effective than treatment as usual (TAU) in reducing depressive symptoms by an equivalent -1.7 points (95% CI, -2.0 to -1.3 points) on the Edinburgh Postnatal Depression Scale (EPDS; range, 0 to 30 points) (moderate SoE) and may have greater recovery rates from depressive symptoms (relative risk [RR], 1.7 [CI, 1.3 to 2.3]) (low SoE). Behavioral activation (<i>k</i> = 3, <i>n</i> = 508) may be more effective than TAU in reducing depressive symptoms by an equivalent -1.5 EPDS points (CI, -2.6 to -0.5 points) (low SoE). There may be no differences in depressive symptoms between CBT and counseling (<i>k</i> = 3, <i>n</i> = 226; EPDS, -0.5 [CI, -1.5 to 0.5]) or counseling and TAU (<i>k</i> = 3, <i>n</i> = 247; EPDS, -0.8 [CI, -2.6 to 1.0) (low SoE). Interpersonal therapy (IPT; <i>k</i> = 9, <i>n</i> = 1003) was probably more effective than TAU in reducing depressive symptoms by an equivalent -1.7 EPDS points (CI, -2.9 to -0.5 points) (moderate SoE) and may have greater recovery rates from depressive symptoms (RR, 1.2 [CI, 0.97 to 1.5]) (low SoE). Participants were not blinded to treatment, study variation in country, interventions, populations, or reducing SoE. Differences may not be clinically important. For treatment of perinatal depression, CBT, behavioral activation, and IPT may be effective. Agency for Healthcare Research and Quality (AHRQ).