Intervention Review

Psychosocial and psychological interventions for treating postpartum depression

  1. Cindy-Lee Dennis*,
  2. Ellen D Hodnett

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 17 OCT 2007

Assessed as up-to-date: 1 AUG 2007

DOI: 10.1002/14651858.CD006116.pub2


How to Cite

Dennis CL, Hodnett ED. Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006116. DOI: 10.1002/14651858.CD006116.pub2.

Author Information

  1. University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada

*Cindy-Lee Dennis, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, Ontario, M5T 1P8, Canada. cindylee.dennis@utoronto.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 OCT 2007

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Postpartum depression is a major health issue for many women from diverse cultures. While pharmacological interventions are an effective treatment for depression, mothers are often reluctant to take antidepressant medication due to concerns about breast milk transmission or potential side-effects. It is important that non-pharmacologic interventions be evaluated for use with postpartum women experiencing depressive symptomatology.

Objectives

Primary: to assess the effects of all psychosocial and psychological interventions compared with usual postpartum care in the reduction of depressive symptomatology.
Secondary: to examine (1) the effectiveness of specific types of psychosocial interventions; (2) the effectiveness of specific types of psychological interventions; (3) the effectiveness of specific types of psychosocial interventions versus psychological interventions; (4) the effects of intervention mode (e.g., individual versus group-based interventions); and (5) the effects of sample selection criteria (e.g., targeting women with clinically diagnosed depression versus self-reported depressive symptomatology).

Search methods

CCDANCTR-Studies and CCDANCTR-References were searched on 1/8/2007, the Cochrane Pregnancy and Childbirth Review Group trials register, CENTRAL, MEDLINE (1966 to 2006), EMBASE (1980 to 2006) and CINAHL (1982 to 2006) using various combinations of the terms 'postpartum/postnatal depression.' Secondary references and experts in the field were used to identify other published or unpublished trials.

Selection criteria

All published, unpublished, and ongoing randomised controlled trials and quasi-randomised trials of psychosocial or psychological interventions where the primary or secondary aim was a reduction in depressive symptomatology.

Data collection and analysis

Both review authors participated in the evaluation of methodological quality and data extraction. Additional information was sought from several trial researchers. Results are presented using relative risk for categorical data and weighted mean difference for continuous data.

Main results

Ten trials met the inclusion criteria, of which nine trials reported outcomes for 956 women. Any psychosocial or psychological intervention, compared to usual postpartum care, was associated with a reduction in the likelihood of continued depression, however measured, at the final assessment within the first year postpartum. Both psychosocial and psychological interventions were effective in reducing depressive symptomatology. Trials selecting participants based on a clinical diagnosis of depression were just as effective in decreasing depressive symptomatology as those that enrolled women who met inclusion criteria based on self-reported depressive symptomatology.

Authors' conclusions

Although the methodological quality of the majority of trials was, in general, not strong, the meta-analysis results suggest that psychosocial and psychological interventions are an effective treatment option for women suffering from postpartum depression. The long-term effectiveness remains unclear.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Psychosocial and psychological interventions for postpartum depression

Postpartum depression affects approximately 13% of all new mothers. Many women desire to try treatment options other than medication. Results from nine trials involving 956 women found that both psychosocial (e.g., peer support, non-directive counselling) and psychological (e.g., cognitive behavioural therapy and interpersonal psychotherapy) interventions appear to be effective in reducing symptoms of postpartum depression. The long-term benefits are unknown. Larger trials evaluating psychosocial and psychological treatments for postpartum depression are needed to provide clear conclusions about specific intervention benefits.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

治療產後憂鬱症的心理社會與心理介入

對許多來自不同文化的女性而言,產後憂鬱是重要的健康議題。儘管以藥物治療憂鬱症是有效的,產婦經常會因為擔心抗憂鬱劑進入乳汁,或可能的副作用而不願服用抗憂鬱劑。因此,產後憂鬱的非藥物治療,其療效評估便很重要。

目標

主要目標:比較所有減少產後憂鬱症狀的心理社會及心理處置與一般產後照護的效果。次要目標:檢驗1)特定形式的心理社會介入的效果(2)特定形式的心理介入效果(3)比較前兩者的效果(4)處置模式的效果(如個別治療與團體治療),以及(5)選擇樣本標準的效果(如臨床診斷為憂鬱症,以及自陳憂鬱症狀者)

搜尋策略

2007年1月8日搜尋CCDANCTRStudies and CCDANCTRReferences,以‘postpartum/postnatal depression’作各種組合搜尋Cochrane Pregnancy and Childbirth Review Group 臨床試驗登錄, CENTRAL, MEDLINE (1966 – 2006), EMBASE (1980 – 2006) 以及CINAHL (1982 – 2006)。以該領域的專家及衍生的參考文獻作為確認其他發表或未發表的試驗。

選擇標準

所有已發表、未發表,以及正在進行的隨機控制試驗(randomised controlled trials)以及半隨機試驗,其主要或次要目標在於減少憂鬱症狀的心理或心理社會介入措施。

資料收集與分析

2個文獻回顧的作者皆參與了研究方法品質的評估並抽出資料。向研究者尋找額外的資訊. 結果的呈現,分類性的資料以相對危險度(relative risk)來表現,連續性的資料則以加權平均差異(weighted mean difference)來表現.

主要結論

有10個試驗符合納入標準,其中9個試驗共956名婦女。任何心理或心理社會介入跟一般的產後照護相比較,在產後第一年做最後的評量,發現與憂鬱症狀持續的可能性減少有關。在減輕憂鬱症狀方面,心理與心理社會介入都是有效的。選擇基於臨床診斷憂鬱症或自陳憂鬱的婦女為納入標準的研究,都有效地減輕了憂鬱症狀。

作者結論

雖然主要試驗的方法品質並不強,後設分析的結果認為,對產後憂鬱的婦女施予心理或心理社會介入是有效的。長期的療效則不清楚。

翻譯人

本摘要由彰化基督教醫院陳美貴翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

產後憂鬱的心理與心理社會介入。產後憂鬱影響了近13%的新手媽媽。很多婦女期待除了藥物以外的治療方式。從9個試驗,956名婦女的研究結果發現,心理社會(如同儕支持,非指導性諮商)與心理(如:認知行為治療與人際互動心理治療)介入措施對減輕產後憂鬱症狀都是有效的。長期效益則不清楚。需要更大型的試驗針對產後憂鬱的心理與心理社會介入評估提供針對特定介入效益清楚的結論。