Sian Stephens1, Elizabeth Ford2, Priya Paudyal1, Helen Smith1. 1. Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom. 2. Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom e.m.ford@bsms.ac.uk.
Abstract
PURPOSE: Postnatal depression affects 10% to 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. In this systematic review, we assessed the efficacy of psychological therapies for postnatal depression in primary care. METHODS: We undertook a systematic search to identify articles published in English between 2000 and 2014 that reported studies meeting our eligibility criteria: (1) had a randomized controlled trial design; (2) assessed psychological interventions for postnatal depression against any other treatment or a wait-list control; (3) recruited patients in primary care; and (4) enrolled mothers with a diagnosed depressive episode or a score of at least 12 on the Edinburgh Postnatal Depression Scale or at least 10 on the Beck Depression Inventory at baseline who had a child younger than 12 months. Quality was assessed using an adapted Cochrane Collaboration Depression, Anxiety, and Neurosis (CCDAN) quality rating scale, and meta-analysis was carried out using RevMan 5.3 (The Cochrane Collaboration). RESULTS: Screening of 5,919 articles identified 10 studies that met inclusion criteria. These studies reported on 14 psychological intervention arms: 7 using cognitive behavioral therapy, 2 using interpersonal therapy, 2 using counseling, and 3 using other interventions. Psychological interventions resulted in lower depressive symptomatology than control both immediately after treatment (standardized mean difference = -0.38; 95% CI, -0.49 to -0.27) and at 6 months of follow-up (standardized mean difference =-0.21; 95% CI, -0.37 to -0.05). We did not find any significant differences between the various types of therapy. Compared with control, the interventions also led to improvements in adjustment to parenthood, marital relationship, social support, stress, and anxiety. CONCLUSIONS: Psychological interventions deliverable in the primary care setting are associated with a significant improvement in depressive symptomatology both immediately after completion and for up to 6 months of follow-up.
PURPOSE:Postnatal depression affects 10% to 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. In this systematic review, we assessed the efficacy of psychological therapies for postnatal depression in primary care. METHODS: We undertook a systematic search to identify articles published in English between 2000 and 2014 that reported studies meeting our eligibility criteria: (1) had a randomized controlled trial design; (2) assessed psychological interventions for postnatal depression against any other treatment or a wait-list control; (3) recruited patients in primary care; and (4) enrolled mothers with a diagnosed depressive episode or a score of at least 12 on the Edinburgh Postnatal Depression Scale or at least 10 on the Beck Depression Inventory at baseline who had a child younger than 12 months. Quality was assessed using an adapted Cochrane Collaboration Depression, Anxiety, and Neurosis (CCDAN) quality rating scale, and meta-analysis was carried out using RevMan 5.3 (The Cochrane Collaboration). RESULTS: Screening of 5,919 articles identified 10 studies that met inclusion criteria. These studies reported on 14 psychological intervention arms: 7 using cognitive behavioral therapy, 2 using interpersonal therapy, 2 using counseling, and 3 using other interventions. Psychological interventions resulted in lower depressive symptomatology than control both immediately after treatment (standardized mean difference = -0.38; 95% CI, -0.49 to -0.27) and at 6 months of follow-up (standardized mean difference =-0.21; 95% CI, -0.37 to -0.05). We did not find any significant differences between the various types of therapy. Compared with control, the interventions also led to improvements in adjustment to parenthood, marital relationship, social support, stress, and anxiety. CONCLUSIONS: Psychological interventions deliverable in the primary care setting are associated with a significant improvement in depressive symptomatology both immediately after completion and for up to 6 months of follow-up.
Authors: Jeannette Milgrom; Christopher J Holt; Alan W Gemmill; Jennifer Ericksen; Bronwyn Leigh; Anne Buist; Charlene Schembri Journal: BMC Psychiatry Date: 2011-05-27 Impact factor: 3.630
Authors: Nicola Wiles; Laura Thomas; Anna Abel; Maria Barnes; Fran Carroll; Nicola Ridgway; Sofie Sherlock; Nicholas Turner; Katherine Button; Lang'o Odondi; Chris Metcalfe; Amanda Owen-Smith; John Campbell; Anne Garland; Sandra Hollinghurst; Bill Jerrom; David Kessler; Willem Kuyken; Jill Morrison; Katrina Turner; Chris Williams; Tim Peters; Glyn Lewis Journal: Health Technol Assess Date: 2014-05 Impact factor: 4.014