Efficacy of psychological treatments for perinatal depression and anxiety: systematic review and network meta-analysis.

Abstract

Perinatal depression and anxiety affect one-fifth of women globally, yet the comparative efficacy of psychological treatments remains inadequately synthesised. To compare short- and long-term efficacy of psychological treatments for clinically significant perinatal depression and anxiety using Bayesian network meta-analysis of randomised controlled trials (RCTs). PubMed, Embase, MEDLINE and PsycInfo were searched from January 1990 to January 2025. Eligible RCTs included pregnant or postpartum women (≤12 months) with clinically significant depression or anxiety. Primary outcomes were post-intervention symptom severity, secondary outcomes were symptoms at the longest follow-up (3<b>-</b>12 months). Standardised mean differences (s.m.d.) with 95% credible intervals (CrI) were estimated. Evidence certainty was evaluated using the Confidence in Network Meta-Analysis framework. 78 RCTs (11 345 participants) were included. Cognitive-behavioural therapy (CBT) demonstrated consistent efficacy for post-intervention perinatal depression (s.m.d.: -0.55, 95% CrI [-0.77, -0.33]; moderate confidence) and anxiety (-0.54, [-1.00, -0.06]; moderate) compared with treatment-as-usual (TAU), with sustained effects for depression. Interpersonal psychotherapy (IPT; -0.65, [-1.09, -0.20]; low) and mindfulness-based intervention (MBI; -2.02, [-2.65, -1.42]; low) also outperformed TAU for short-term depression. For anxiety, behavioural therapy (-1.02, [-1.96, -0.07]; low) and MBI (-1.67, [-2.55, -0.84]; very low) also showed short-term superiority over TAU, whereas only behavioural therapy showed a sustained effect. Heterogeneity was partly explained by participant age, country income level and study risk of bias. This network meta-analysis identifies CBT as the most consistently supported psychological treatment for perinatal depression and anxiety. IPT, MBI and behavioural therapy show preliminary promise but require confirmation via rigorously designed trials with extended follow-ups.