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Meta-Analysis
. 2013 Feb 28;2013(2):CD001134.
doi: 10.1002/14651858.CD001134.pub3.

Psychosocial and psychological interventions for preventing postpartum depression

Cindy-Lee Dennis  1 , Therese Dowswell
Affiliations
Meta-Analysis

Psychosocial and psychological interventions for preventing postpartum depression

Cindy-Lee Dennis et al. Cochrane Database Syst Rev. .

Abstract

Background: Epidemiological studies and meta-analyses of predictive studies have consistently demonstrated the importance of psychosocial and psychological variables as postpartum depression risk factors. While interventions based on these variables may be effective treatment strategies, theoretically they may also be used in pregnancy and the early postpartum period to prevent postpartum depression.

Objectives: Primary: to assess the effect of diverse psychosocial and psychological interventions compared with usual antepartum, intrapartum, or postpartum care to reduce the risk of developing postpartum depression. Secondary: to examine (1) the effectiveness of specific types of psychosocial and psychological interventions, (2) the effectiveness of professionally-based versus lay-based interventions, (3) the effectiveness of individually-based versus group-based interventions, (4) the effects of intervention onset and duration, and (5) whether interventions are more effective in women selected with specific risk factors.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2011), scanned secondary references and contacted experts in the field. We updated the search on 31 December 2012 and added the results to the awaiting classification section of the review for assessment at the next update.

Selection criteria: All published and unpublished randomised controlled trials of acceptable quality comparing a psychosocial or psychological intervention with usual antenatal, intrapartum, or postpartum care.

Data collection and analysis: Review authors and a research co-ordinator with Cochrane review experience participated in the evaluation of methodological quality and data extraction. Additional information was sought from several trial researchers. Results are presented using risk ratio (RR) for categorical data and mean difference (MD) for continuous data.

Main results: Twenty-eight trials, involving almost 17,000 women, contributed data to the review. Overall, women who received a psychosocial or psychological intervention were significantly less likely to develop postpartum depression compared with those receiving standard care (average RR 0.78, 95% confidence interval (CI) 0.66 to 0.93; 20 trials, 14,727 women). Several promising interventions include: (1) the provision of intensive, individualised postpartum home visits provided by public health nurses or midwives (RR 0.56, 95% CI 0.43 to 0.73; two trials, 1262 women); (2) lay (peer)-based telephone support (RR 0.54, 95% CI 0.38 to 0.77; one trial, 612 women); and (3) interpersonal psychotherapy (standardised mean difference -0.27, 95% CI -0.52 to -0.01; five trials, 366 women). Professional- and lay-based interventions were both effective in reducing the risk to develop depressive symptomatology. Individually-based interventions reduced depressive symptomatology at final assessment (RR 0.75, 95% CI 0.61 to 0.92; 14 trials, 12,914 women) as did multiple-contact interventions (RR 0.78, 95% CI 0.66 to 0.93; 16 trials, 11,850 women). Interventions that were initiated in the postpartum period also significantly reduced the risk to develop depressive symptomatology (RR 0.73, 95% CI 0.59 to 0.90; 12 trials, 12,786 women). Identifying mothers 'at-risk' assisted the prevention of postpartum depression (RR 0.66, 95% CI 0.50 to 0.88; eight trials, 1853 women).

Authors' conclusions: Overall, psychosocial and psychological interventions significantly reduce the number of women who develop postpartum depression. Promising interventions include the provision of intensive, professionally-based postpartum home visits, telephone-based peer support, and interpersonal psychotherapy.

PubMed Disclaimer

Conflict of interest statement

Dr Dennis is a principal investigator for a multi‐site trial included in this review that evaluated the effect of telephone‐based peer (mother‐to‐mother) support in the prevention of postpartum depression among mothers identified as high‐risk (Dennis 2009).

Figures

1
1
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Funnel plot of comparison: 1 All interventions versus usual care ‐ various study outcomes, outcome: 1.1 Depressive symptomatology at final study assessment.
4
4
Funnel plot of comparison: 1 All interventions versus usual care ‐ various study outcomes, outcome: 1.2 Mean depression scores at final study assessment.
5
5
Funnel plot of comparison: 2 All psychosocial interventions versus usual care ‐ variations in intervention type, outcome: 2.4 All psychosocial interventions: depressive symptomatology at final study assessment.
6
6
Funnel plot of comparison: 2 All psychosocial interventions versus usual care ‐ variations in intervention type, outcome: 2.5 All psychosocial interventions: mean depression scores.
1.1
1.1. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 1 Depressive symptomatology at final study assessment.
1.2
1.2. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 2 Mean depression scores at final study assessment.
1.3
1.3. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 3 Diagnosis of depression at final study assessment.
1.4
1.4. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 4 Depressive symptomatology at 8, 16, 24, and > 24 weeks.
1.5
1.5. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 5 Mean depression scores at 8, 16, 24, and > 24 weeks.
1.6
1.6. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 6 Diagnosis of depression at 8, 16, 24, and > 24 weeks.
1.7
1.7. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 7 Maternal mortality at > 24 weeks.
1.8
1.8. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 8 Maternal‐infant attachment at 8, 16, and 24 weeks.
1.9
1.9. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 9 Mean maternal‐infant attachment scores at 8, 16, 24, and > 24 weeks.
1.10
1.10. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 10 Anxiety at 8, 16, and 24 weeks.
1.11
1.11. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 11 Mean anxiety scores at 8, 16, 24, and > 24 weeks.
1.12
1.12. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 12 Maternal stress at 16 weeks.
1.13
1.13. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 13 Mean maternal stress scores at 24 and > 24 weeks.
1.14
1.14. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 14 Mean parental stress scores at 8, 24, and > 24 weeks.
1.15
1.15. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 15 Perceived social support at 8 and 16 weeks.
1.16
1.16. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 16 Mean perceived social support scores at 8, 16, 24, and > 24 weeks.
1.17
1.17. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 17 Maternal dissatisfaction with care provided at 8, 16, and 24 weeks.
1.18
1.18. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 18 Mean maternal dissatisfaction scores at 8 and 16 weeks.
1.19
1.19. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 19 Infant health parameters ‐ not fully immunized at > 24 weeks.
1.20
1.20. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 20 Infant development > 24 weeks.
1.21
1.21. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 21 Child abuse at 8 and > 24 weeks.
1.22
1.22. Analysis
Comparison 1 All psychosocial and psychological interventions versus usual care ‐ various study outcomes, Outcome 22 Mean marital discord scores at 8, 16, and 24 weeks.
2.1
2.1. Analysis
Comparison 2 All psychosocial interventions versus usual care ‐ variations in intervention type, Outcome 1 All psychosocial interventions ‐ depressive symptomatology.
2.2
2.2. Analysis
Comparison 2 All psychosocial interventions versus usual care ‐ variations in intervention type, Outcome 2 All psychosocial interventions ‐ mean depression scores.
2.3
2.3. Analysis
Comparison 2 All psychosocial interventions versus usual care ‐ variations in intervention type, Outcome 3 All psychosocial interventions ‐ diagnosis of depression.
2.4
2.4. Analysis
Comparison 2 All psychosocial interventions versus usual care ‐ variations in intervention type, Outcome 4 All psychosocial interventions: depressive symptomatology at final study assessment.
2.5
2.5. Analysis
Comparison 2 All psychosocial interventions versus usual care ‐ variations in intervention type, Outcome 5 All psychosocial interventions: mean depression scores.
3.1
3.1. Analysis
Comparison 3 All psychological interventions versus usual care ‐ variations in intervention type, Outcome 1 All psychological interventions ‐ depressive symptomatology.
3.2
3.2. Analysis
Comparison 3 All psychological interventions versus usual care ‐ variations in intervention type, Outcome 2 All psychological interventions ‐ mean depression scores.
3.3
3.3. Analysis
Comparison 3 All psychological interventions versus usual care ‐ variations in intervention type, Outcome 3 All psychological interventions ‐ diagnosis of depression.
4.1
4.1. Analysis
Comparison 4 Subgroup analysis: variations in psychosocial interventions, Outcome 1 TEST FOR SUBGROUP DIFFERENCES: depressive symptomatology at final study assessment.
4.2
4.2. Analysis
Comparison 4 Subgroup analysis: variations in psychosocial interventions, Outcome 2 TEST FOR SUBGROUP DIFFERENCES: mean depression score at final study assessment.
5.1
5.1. Analysis
Comparison 5 Subgroup analysis: variations in psychological interventions, Outcome 1 TEST FOR SUBGROUP DIFFERENCES: depressive symptomatology at final study assessment.
5.2
5.2. Analysis
Comparison 5 Subgroup analysis: variations in psychological interventions, Outcome 2 TEST FOR SUBGROUP DIFFERENCES: mean depression score at final study assessment.
6.1
6.1. Analysis
Comparison 6 Subgroup analysis: variations in intervention provider, Outcome 1 Professionally‐based interventions ‐ depressive symptomatology.
6.2
6.2. Analysis
Comparison 6 Subgroup analysis: variations in intervention provider, Outcome 2 Professionally‐based interventions ‐ mean depression scores.
6.3
6.3. Analysis
Comparison 6 Subgroup analysis: variations in intervention provider, Outcome 3 Professionally‐based interventions ‐ diagnosis of depression.
6.4
6.4. Analysis
Comparison 6 Subgroup analysis: variations in intervention provider, Outcome 4 Lay‐based interventions ‐ depressive symptomatology.
6.5
6.5. Analysis
Comparison 6 Subgroup analysis: variations in intervention provider, Outcome 5 Lay‐based interventions ‐ mean depression scores.
6.6
6.6. Analysis
Comparison 6 Subgroup analysis: variations in intervention provider, Outcome 6 Lay‐based interventions ‐ diagnosis of depression.
6.7
6.7. Analysis
Comparison 6 Subgroup analysis: variations in intervention provider, Outcome 7 TEST FOR SUBGROUP DIFFERENCES: depressive symptomatology: at final study assessment.
6.8
6.8. Analysis
Comparison 6 Subgroup analysis: variations in intervention provider, Outcome 8 TEST FOR SUBGROUP DIFFERENCES: mean depression scores: at final study assessment.
6.9
6.9. Analysis
Comparison 6 Subgroup analysis: variations in intervention provider, Outcome 9 TEST FOR SUBGROUP DIFFERENCES: diagnosis of depression: at final study assessment.
7.1
7.1. Analysis
Comparison 7 Subgroup analysis: variations in professionally‐based intervention provider, Outcome 1 TEST FOR SUBGROUP DIFFERENCES: depressive symptomatology at final study assessment.
7.2
7.2. Analysis
Comparison 7 Subgroup analysis: variations in professionally‐based intervention provider, Outcome 2 TEST FOR SUBGROUP DIFFERENCES: mean depression score at final study assessment.
8.1
8.1. Analysis
Comparison 8 Subgroup analysis: variations in intervention mode, Outcome 1 Individually‐based interventions ‐ depressive symptomatology.
8.2
8.2. Analysis
Comparison 8 Subgroup analysis: variations in intervention mode, Outcome 2 Individually‐based interventions ‐ mean depression scores.
8.3
8.3. Analysis
Comparison 8 Subgroup analysis: variations in intervention mode, Outcome 3 Individually‐based interventions ‐ diagnosis of depression.
8.4
8.4. Analysis
Comparison 8 Subgroup analysis: variations in intervention mode, Outcome 4 Group‐based interventions ‐ depressive symptomatology.
8.5
8.5. Analysis
Comparison 8 Subgroup analysis: variations in intervention mode, Outcome 5 Group‐based interventions ‐ mean depression scores.
8.6
8.6. Analysis
Comparison 8 Subgroup analysis: variations in intervention mode, Outcome 6 Group‐based interventions ‐ diagnosis of depression.
8.7
8.7. Analysis
Comparison 8 Subgroup analysis: variations in intervention mode, Outcome 7 TEST FOR SUBGROUP DIFFERENCES: depressive symptomatology: at final study assessment.
8.8
8.8. Analysis
Comparison 8 Subgroup analysis: variations in intervention mode, Outcome 8 TEST FOR SUBGROUP DIFFERENCES: mean depression scores: at final study assessment.
8.9
8.9. Analysis
Comparison 8 Subgroup analysis: variations in intervention mode, Outcome 9 TEST FOR SUBGROUP DIFFERENCES: diagnosis of depression: at final study assessment.
9.1
9.1. Analysis
Comparison 9 Subgroup analysis: variations in intervention duration, Outcome 1 Single‐contact interventions ‐ depressive symptomatology.
9.2
9.2. Analysis
Comparison 9 Subgroup analysis: variations in intervention duration, Outcome 2 Single‐contact interventions ‐ mean depression scores.
9.3
9.3. Analysis
Comparison 9 Subgroup analysis: variations in intervention duration, Outcome 3 Multiple‐contact interventions ‐ depressive symptomatology.
9.4
9.4. Analysis
Comparison 9 Subgroup analysis: variations in intervention duration, Outcome 4 Multiple‐contact interventions ‐ mean depression scores.
9.5
9.5. Analysis
Comparison 9 Subgroup analysis: variations in intervention duration, Outcome 5 Multiple‐contact interventions ‐ diagnosis of depression.
9.6
9.6. Analysis
Comparison 9 Subgroup analysis: variations in intervention duration, Outcome 6 TEST FOR SUBGROUP DIFFERENCES: depressive symptomatology: at final study assessment.
9.7
9.7. Analysis
Comparison 9 Subgroup analysis: variations in intervention duration, Outcome 7 TEST FOR SUBGROUP DIFFERENCES: mean depression scores: at final study assessment.
10.1
10.1. Analysis
Comparison 10 Subgroup analysis: variations in intervention onset, Outcome 1 Interventions with antenatal only component ‐ mean depression scores.
10.2
10.2. Analysis
Comparison 10 Subgroup analysis: variations in intervention onset, Outcome 2 Interventions with antenatal only component ‐ diagnosis of depression.
10.3
10.3. Analysis
Comparison 10 Subgroup analysis: variations in intervention onset, Outcome 3 Interventions with antenatal and postnatal components ‐ depressive symptomatology.
10.4
10.4. Analysis
Comparison 10 Subgroup analysis: variations in intervention onset, Outcome 4 Interventions with antenatal and postnatal components ‐ mean depression scores.
10.5
10.5. Analysis
Comparison 10 Subgroup analysis: variations in intervention onset, Outcome 5 Interventions with antenatal and postnatal components ‐ diagnosis of depression.
10.6
10.6. Analysis
Comparison 10 Subgroup analysis: variations in intervention onset, Outcome 6 Interventions with postnatal only component ‐ depressive symptomatology.
10.7
10.7. Analysis
Comparison 10 Subgroup analysis: variations in intervention onset, Outcome 7 Interventions with postnatal only component ‐ mean depression scores.
10.8
10.8. Analysis
Comparison 10 Subgroup analysis: variations in intervention onset, Outcome 8 Interventions with postnatal only component ‐ diagnosis of depression.
10.9
10.9. Analysis
Comparison 10 Subgroup analysis: variations in intervention onset, Outcome 9 TEST FOR SUBGROUP DIFFERENCES: depressive symptomatology: at final study assessment.
10.10
10.10. Analysis
Comparison 10 Subgroup analysis: variations in intervention onset, Outcome 10 TEST FOR SUBGROUP DIFFERENCES: mean depression scores: at final study assessment.
10.11
10.11. Analysis
Comparison 10 Subgroup analysis: variations in intervention onset, Outcome 11 TEST FOR SUBGROUP DIFFERENCES: diagnosis of depression: at final study assessment.
11.1
11.1. Analysis
Comparison 11 Subgroup analysis: variations in sample selection criteria, Outcome 1 Interventions for at‐risk women ‐ depressive symptomatology.
11.2
11.2. Analysis
Comparison 11 Subgroup analysis: variations in sample selection criteria, Outcome 2 Interventions for at‐risk women ‐ mean depression scores.
11.3
11.3. Analysis
Comparison 11 Subgroup analysis: variations in sample selection criteria, Outcome 3 Interventions for at‐risk women ‐ diagnosis of depression.
11.4
11.4. Analysis
Comparison 11 Subgroup analysis: variations in sample selection criteria, Outcome 4 Interventions for general population ‐ depressive symptomatology.
11.5
11.5. Analysis
Comparison 11 Subgroup analysis: variations in sample selection criteria, Outcome 5 Interventions for general population ‐ mean depression scores.
11.6
11.6. Analysis
Comparison 11 Subgroup analysis: variations in sample selection criteria, Outcome 6 TEST FOR SUBGROUP DIFFERENCES: depressive symptomatology: at final study assessment.
11.7
11.7. Analysis
Comparison 11 Subgroup analysis: variations in sample selection criteria, Outcome 7 TEST FOR SUBGROUP DIFFERENCES: mean depression scores: at final study assessment.
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

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Ajh 2006 {published data only}
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Appleby 1998 {published data only}
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Bang 2009 {published data only}
    1. Bang KS. Effects of an early nursing intervention program for infants' development and mother's child rearing in poverty. Journal of Korean Academy of Nursing 2009;39(6):796‐804. - PubMed
Barnes 2009 {published and unpublished data}
    1. Barnes J, Senior R, MacPherson K. The utility of volunteer home‐visiting support to prevent maternal depression in the first year of life. Child: Care, Health & Development 2009;35(6):807‐16. - PubMed
Bastani 2005 {published data only}
    1. Bastani F, Hidarnia A, Kazemnejad A, Vafaei M, Kashanian M. A randomized controlled trial of the effects of applied relaxation training on reducing anxiety and perceived stress in pregnant women. Journal of Midwifery & Women's Health 2005;50(4):e36‐40. - PubMed
Buist 1999 {published data only}
    1. Buist A, Westley D, Hill C. Antenatal prevention of postnatal depression. Archives of Women's Mental Health 1999;1:167‐73.
Bulgay‐Morschel 2010 {published data only}
    1. Bulgay‐Morschel M, Langlotz F, Ekkehard S. Influence of progressive muscle relaxation training on anxiety and depression levels during pregnancy and puerperium [conference abstract]. Archives of Gynecology and Obstetrics 2010;282:S83.
Chabrol 2002 {published data only}
    1. Chabrol H, Teissedre F, Saint‐Jean M, Teisseyre N, Roge B, Mullet E. Prevention and treatment of post‐partum depression: a controlled randomized study on women at risk. Psychological Medicine 2002;32(6):1039‐47. - PubMed
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Chabrol 2007 {published data only}
    1. Chabrol H, Coroner N, Rusibane S, Sejourne N. A pilot study of prevention of postpartum blues. Gynecologie, Obstetrique & Fertilite 2007;35(12):1242‐4. - PubMed
Cho 2008 {published data only}
    1. Cho HJ, Kwon JH, Lee JJ. Antenatal cognitive‐behavioral therapy for prevention of postpartum depression: a pilot study. Yonsei Medical Journal 2008;49(4):553‐62. - PMC - PubMed
Cooper 2002 {published data only}
    1. Cooper PJ, Landman M, Tomlinson M, Molteno C, Swartz L, Murray L. Impact of a mother‐infant intervention in an indigent peri‐urban South African context: pilot study. British Journal of Psychiatry 2002;180:76‐81. - PubMed
D'Andrea 1994 {published data only}
    1. D'Andrea M. The family development project: a comprehensive mental health counseling program for pregnant adolescents. Journal of Mental Health Counseling 1994;16:184‐95.
Dennis 2003 {published data only}
    1. Dennis CL. The effect of peer support on postpartum depression: a pilot randomized controlled trial. Canadian Journal of Psychiatry ‐ Revue Canadienne de Psychiatrie 2003;48(2):115‐24. - PubMed
Duggan 2009 {published data only}
    1. Duggan AK, Berlin LJ, Cassidy J, Burrell L, Tandon SD. Examining maternal depression and attachment insecurity as moderators of the impacts of home visiting for at‐risk mothers and infants. Journal of Consulting and Clinical Psychology 2009;77(4):788‐99. - PMC - PubMed
Elliott 2000 {published data only}
    1. Elliott S, Leverton T, Sanjack M, Turner H, Cowmeadow P, Hopkins J, et al. Promoting mental health after childbirth: a controlled trial of primary prevention of postnatal depression. British Journal of Clinical Psychology 2000;39:223‐41. - PubMed
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El‐Mohandes 2006 {published data only}
    1. El‐Mohandes AAE. A psycho‐behavioral intervention on African American pregnant women with a history of intimate partner violence (IPV) improves birth weight distribution of their newborns [abstract]. Pediatric Academic Societies Annual Meeting; 2006 April 29‐May 2; San Francisco, CA, USA. 2006.
El‐Mohandes 2008 {published data only}
    1. El‐Mohandes AA, Kiely M, Blake SM, Gantz MG, El‐Khorazaty MN. An intervention to reduce environmental tobacco smoke exposure improves pregnancy outcomes. Pediatrics 2010;125(4):721‐8. - PMC - PubMed
    1. El‐Mohandes AA, Kiely M, Joseph JG, Subramanian S, Johnson AA, Blake SM, et al. An intervention to improve postpartum outcomes in African‐American mothers: a randomized controlled trial. Obstetrics & Gynecology 2008;112(3):611‐20. - PMC - PubMed
    1. Joseph JG, El‐Mohandes AA, Kiely M, El‐Khorazaty MN, Gantz MG, Johnson AA, et al. Reducing psychosocial and behavioral pregnancy risk factors: results of a randomized clinical trial among high‐risk pregnant African American women. American Journal of Public Health 2009;99(6):1053‐61. - PMC - PubMed
    1. Kiely M, El‐Khorazaty MN, El‐Mohandes AAE. Depression and smoking during pregnancy impact the efficacy of an integral behavioral intervention to resolve risks. Pediatric Academic Societies Annual Meeting; 2007 May 5‐8; Toronto, Canada. 2007.
Fagan 2010 {published data only}
    1. Fagan J, Lee Y. Perceptions and satisfaction with father involvement and adolescent mothers' postpartum depressive symptoms. Journal of Youth and Adolescence 2010;39(9):1109‐21. - PubMed
Gordon 1960 {published data only}
    1. Gordon R, Gordon K. Social factors in prevention of postpartum emotional problems. Obstetrics & Gynecology 1960;15(4):433‐8. - PubMed
Gordon 1999 {published data only}
    1. Gordon N, Walton D, McAdam E, Derman J, Gallitero G, Garrett L. Effects of providing hospital‐based doulas in health maintenance organization hospitals. Obstetrics & Gynecology 1999;93(3):422‐6. - PubMed
Goyal 2009 {published data only}
    1. Goyal D, Gay C, Lee K. Fragmented maternal sleep is more strongly correlated with depressive symptoms than infant temperament at three months postpartum. Archives of Women's Mental Health 2009;12(4):229‐37. - PMC - PubMed
Grote 2009 {published data only}
    1. Grote NK, Swartz HA, Geibel SL, Zuckoff A, Houck PR, Frank E. A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatric Services 2009;60(3):313‐21. - PMC - PubMed
Hayes 2001 {published data only}
    1. Hayes B, Muller R, Bradley B. Perinatal depression: a randomized controlled trial of an antenatal education intervention for primiparas. Birth 2001;28(1):28‐35. - PubMed
    1. Hayes BA, Muller R. Prenatal depression: a randomized controlled trial in the emotional health of primiparous women. Research & Theory for Nursing Practice 2004;18(2/3):165‐83. - PubMed
Heh 2003 {published data only}
    1. Heh S, Fu Y. Effectiveness of informational support in reducing the severity of postnatal depression. Journal of Advanced Nursing 2003;42:30‐6. - PubMed
Hiscock 2001 {published data only}
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    1. Hiscock H, Wake M. The impact of an infant sleep intervention on postnatal depression: A randomized controlled trial. Journal of Paediatrics & Child Health 2001;37(6):A1.
Ho 2009 {published data only}
    1. Ho S‐M, Heh S‐S, Jevitt CM, Huang L‐H, Fu Y‐Y, Wang L‐L. Effectiveness of a discharge education program in reducing the severity of postpartum depression. A randomized controlled evaluation study. Patient Education and Counseling 2009;77(1):68‐71. - PubMed
Hodnett 2002 {published data only}
    1. Hodnett E, Lowe N, Hannah M, Willan AR, Stevens B, Weston JA, et al. Effectiveness of nurses as providers of birth labor support in North American hospitals. JAMA 2002;288(11):1373‐81. - PubMed
Imura 2006 {published data only}
    1. Imura M, Misao H, Ushijima H. The psychological effects of aromatherapy‐massage in healthy postpartum mothers. Journal of Midwifery & Women's Health 2006;51(2):e21‐7. - PubMed
Izzo 2005 {published data only}
    1. Izzo CV, Eckenrode JJ, Smith EG, Henderson CR, Cole R, Kitzman H, et al. Reducing the impact of uncontrollable stressful life events through a program of nurse home visitation for new parents. Prevention Science 2005;6(4):269‐74. - PubMed
Katz 2009 {published data only}
    1. Katz KS, Gantz M, Rodan M, Blake S, El‐Khorazaty N, Kiely M, et al. Depression reduction and adherence to treatment in pregnant African American women. Pediatric Academic Societies Annual Meeting; 2009 May 2‐5; Baltimore, Maryland, USA. 2009.
Katz 2009a {published data only}
    1. Katz KS, Rodan M, Blake S, El‐Khorazaty N, Gantz M, Kiely M, et al. Depression treatment for low income African American women in prenatal care: who fails to benefit?. Pediatric Academic Societies Annual Meeting; 2009 May 2‐5; Baltimore, Maryland, USA. 2009.
Kealy 2003 {published data only}
    1. Kealy M, Small R, Lumley J. Health and recovery after caesarean ‐ is it as straightforward as we might want to believe?. Perinatal Society of Australia and New Zealand. 7th Annual Congress; 2003 March 9‐12; Tasmania, Australia. 2003:A28.
Keller 2011 {published data only}
    1. Keller C, Records K, Ainsworth B, Belyea M, Permana P, Coonrod D, et al. Madres para la Salud: design of a theory‐based intervention for postpartum Latinas. Contemporary Clinical Trials 2011;32(3):418‐27. - PMC - PubMed
Kershaw 2005 {published data only}
    1. Kershaw K, Jolly J, Bhabra K, Ford J. Randomised controlled trial of community debriefing following operative delivery. BJOG: an international journal of obstetrics and gynaecology 2005;112(11):1504‐9. - PubMed
King 2009 {published data only}
    1. King E. The effectiveness of an internet‐based stress management program in the prevention of postpartum stress, anxiety and depression for new mothers [thesis]. Kentucky: Walden University, 2009.
Kleeb 2005 {published data only}
    1. Kleeb B, Rageth CJ. Influence of prophylactic information on the frequency of baby blues [Einfluss eines prophylaktischen Aufklarungsgesprachs auf den Baby Blues.]. Zeitschrift fur Geburtshilfe und Neonatologie 2005;209(1):22‐8. - PubMed
Koltyn 1997 {published data only}
    1. Koltyn KF, Schultes SS. Psychological effects of an aerobic exercise session and a rest session following pregnancy. Journal of Sports Medicine & Physical Fitness 1997;37(4):287‐91. - PubMed
Lara 2010 {published data only}
    1. Lara MA, Navarro C, Navarrete L. Outcome results of a psycho‐educational intervention in pregnancy to prevent PPD: a randomized control trial. Journal of Affective Disorders 2010;122(1‐2):109‐17. - PubMed
    1. Lara MA, Navarro C, Navarrete L, Le HN. Retention rates and potential predictors in a longitudinal randomized control trial to prevent postpartum depression. Salud Mental 2010;33:429‐36.
Leung 2011 {published data only}
    1. Leung SSK, Lee AM, Chiang VCL, Wong DFK, Lam SK. Efficacy of a brief cognitive‐behavioural intervention on pregnant women to prevent postnatal depression. Journal of Obstetrics and Gynaecology 2011;31(Suppl 1):19.
Lewis 2011 {published data only}
    1. Lewis B, Avery M, Gjerdingen D, Sirard J. Innovative methods for recruiting pregnant and postpartum women for behavioral intervention trials. Annals of Behavioral Medicine 2011;41 Suppl 1:S114.
Lieu 2000 {published data only}
    1. Lieu T, Braveman P, Escobar G, Fischer A, Jensvold N, Capra A. A randomized comparison of home and clinic follow‐up visits after early postpartum hospital discharge. Pediatrics 2000;105(5):1058‐65. - PubMed
Logsdon 2005 {published data only}
    1. Logsdon MC, Birkimer JC, Simpson T, Looney S. Postpartum depression and social support in adolescents. JOGNN ‐ Journal of Obstetric, Gynecologic, & Neonatal Nursing 2005;34(1):46‐54. - PubMed
Marks 2003 {published data only}
    1. Marks MN, Siddle K, Warwick C. Can we prevent postnatal depression? A randomized controlled trial to assess the effect of continuity of midwifery care on rates of postnatal depression in high‐risk women. Journal of Maternal‐Fetal & Neonatal Medicine 2003;13:119‐27. - PubMed
McKee 2006 {published data only}
    1. McKee MD, Zayas LH, Fletcher J, Boyd RC, Nam SH. Results of an intervention to reduce perinatal depression among low‐income minority women in community primary care. Journal of Social Service Research 2006;32(4):63‐81.
    1. Zayas LH, McKee MD, Jankowski KR. Adapting psychosocial intervention research to urban primary care environments: a case example. Annals of Family Medicine 2004;2(5):504‐8. - PMC - PubMed
Milgrom 2010 {published data only}
    1. Milgrom J. Toward parenthood: delivering an antenatal self‐help intervention with telephone support for depression, anxiety and parenting difficulties ‐ facilitating the perinatal health journey. Australian New Zealand Clinical Trials Registry (www.anzctr.org.au) (accessed 19 February 2008).
    1. Milgrom J, Ericksen J, Leigh B, Romeo Y, Loughlin E, McCarthy R, et al. Development and Feasibility Study of a Monitored Self‐Help Antenatal Intervention Program to Enhance Emotional Health and Reduce Parenting Stress. Parent Infant Research Institute, Victoria, Australia (http://www.piri.org.au/Research_Findings_and_Publications.php) (accessed 26 Jan 2011).
Milgrom 2011 {published data only}
    1. Milgrom J, Schembri C, Ericksen J, Ross J, Gemmill AW. Towards parenthood: an antenatal intervention to reduce depression, anxiety and parenting difficulties. Journal of Affective Disorders 2011;130(3):385‐94. - PubMed
Mohammadi 2010 {published data only}
    1. Mohammadi F. Effect of exercise on postnatal depression and fatigue in clients of health centers: a randomized controlled clinical trial. IRCT Iranian Registry of Clinical Trials (www.irct.ir) (accessed 6 December 2010) 2010.
Morrell 2009 {published data only}
    1. Brugha TS, Morrell CJ, Slade P, Walters SJ. Universal prevention of depression in women postnatally: cluster randomized trial evidence in primary care. Psychological Medicine 2011;41(4):739‐48. - PMC - PubMed
    1. Morrell CJ, Slade P, Warner R, Paley G, Dixon S, Walters SJ, et al. Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care. BMJ 2009;338:a3045. - PMC - PubMed
    1. Morrell CJ, Warner R, Mathers N, Parry G, Dixon S, Slade P, et al. PoNDER: postnatal depression economic evaluation and randomised trial. Journal of Reproductive and Infant Psychology 2004;22(3):236.
    1. Morrell CJ, Warner R, Mathers N, Parry G, Dixon S, Slade P, et al. The PoNDER Trial ‐ the early evidence. Society for Academies in Primary Care (SAPC) Annual Scientific Meeting; 2004 July 14‐16; Glasgow, Scotland. 2004.
    1. Morrell CJ, Warner R, Mathers N, Parry G, Dixon S, Slade P, et al. The PoNDER trial ‐ depression in session. Society for Social Medicine 48th Annual Scientific Meeting; 2004 September 15‐17; Birmingham, UK. 2004.
Munoz 2007 {published and unpublished data}
    1. Munoz RF, Le HN, Ippen CG, Diaz MA, Urizar Jr GG, Soto J, et al. Prevention of postpartum depression in low‐income women: development of the mamas y bebes/mothers and babies course. Cognitive and Behavioral Practice 2007;14:70‐83.
Murphy 1989 {published data only}
    1. Murphy FL. Effects of Post‐Discharge Nursing Visits on Emotional and Parental Adjustment of Postpartum Women [thesis]. Denton, Texas: Texas Woman's University, 1989.
Ngai 2009 {published data only}
    1. Ngai FW, Chan SW, Ip WY. The effects of a childbirth psychoeducation program on learned resourcefulness, maternal role competence and perinatal depression: a quasi‐experiment. International Journal of Nursing Studies 2009;46(10):1298‐306. - PubMed
Norman 2010 {published data only}
    1. Norman E, Sherburn M, Osborne RH, Galea MP. An exercise and education program improves well‐being of new mothers: a randomized controlled trial. Physical Therapy 2010;90(3):348‐55. - PubMed
Oakley 1991 {published data only}
    1. Oakley AR. Trial to reduce depression among mothers of young children ‐ an intervention study. Personal communication 1991.
Okano 1998 {published data only}
    1. Okano T, Nagata S, Hasegawa M, Nomura J, Kumar R. Effectiveness of antenatal education about postnatal depression: a comparison of two groups of Japanese mothers. Journal of Mental Health 1998;7(2):191‐8.
Parry 2010 {published data only}
    1. Parry B, Meliska C, Sorenson D, Lopez A, Orff H, Martinez F. Early versus late wake therapy effects on mood and sleep in pregnancy and postpartum depression. Journal of Sleep Research 2010;19:272.
Rees 1995 {published data only}
    1. Rees BL. Effect of relaxation with guided imagery on anxiety, depression, and self‐esteem in primiparas. Journal of Holistic Nursing 1995;13(3):255‐67. - PubMed
Roman 2009 {published data only}
    1. Roman LA, Gardiner JC, Lindsay JK, Moore JS, Luo Z, Baer LJ, et al. Alleviating perinatal depressive symptoms and stress: a nurse‐community health worker randomized trial. Archives of Women's Mental Health 2009;12(6):379‐91. - PubMed
Ryding 2004 {published data only}
    1. Ryding EL, Wiren E, Johansson G, Ceder B, Dahlstrom AM. Group counseling for mothers after emergency cesarean section: a randomized controlled trial of intervention. Birth 2004;31(4):247‐53. - PubMed
Saisto 2001 {published data only}
    1. Saisto T, Salmela‐Aro K, Nurmi J, Kononen T, Halmesmaki E. A randomized controlled trial of intervention in fear of childbirth. Obstetrics & Gynecology 2001;98(5 Pt 1):820‐6. - PubMed
Selkirk 2006 {published data only}
    1. Selkirk R, McLaren S, Ollerenshaw A, McLachlan AJ. The longitudinal effects of midwife‐led postnatal debriefing on the psychological health of mothers. Journal of Reproductive and Infant Psychology 2006;24(2):133‐47.
Serwint 1991 {published data only}
    1. Serwint J, Wilson M, Duggan A, Mellits E, Baumgardner R, DeAngelis C. Do postpartum nursery visits by the primary care provider make a difference?. Pediatrics 88;3:444‐9. - PubMed
Shields 1997 {published data only}
    1. Shields N, Reid M, Cheyne H, Holmes A. Impact of midwife‐managed care in the postnatal period: an exploration of psychosocial outcomes. Journal of Reproductive & Infant Psychology 1997;15(2):91‐108.
Spinelli 1997 {published data only}
    1. Spinelli, M. Interpersonal psychotherapy for depressed antepartum women: a pilot study. American Journal of Psychiatry 1997;154(7):1028‐30. - PubMed
Spinelli 2003 {published data only}
    1. Spinelli MG, Endicott J. Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. American Journal of Psychiatry 2003;160(3):555‐62. - PubMed
Sun 2004 {published data only}
    1. Sun Y, Li H. Influence of psychological intervention on role adaption of mother in primipara. Chinese Nursing Research 2004;18(11B):2023‐4.
Taghizadeh 2008 {published data only}
    1. Taghizadeh Z, Jafarbegloo M, Arbabi M, Faghihzadeh S. The effect of counseling on post traumatic stress disorder after a traumatic childbirth. Hayat: Faculty of Nursing & Midwifery Quarterly 2008;13(4):23‐31.
Tandon 2011 {published data only}
    1. Tandon SD, Perry DF, Mendelson T, Kemp K, Leis JA. Preventing perinatal depression in low‐income home visiting clients: A randomized controlled trial. Journal of Consulting and Clinical Psychology 2011;79(5):707‐12. - PubMed
Tang 2009 {published data only}
    1. Tang YF, Shi SX, Lu W, Chen Y, Wang QQ, Zhu YY, et al. Prenatal psychological prevention trial on postpartum anxiety and depression. Chinese Mental Health Journal 2009; Vol. 23, issue 2:83‐9.
Teissedre 2004 {published data only}
    1. Teissedre F, Chabrol H. Screening, prevention and postpartum treatment: a randomized comparative study on 450 women [Depistage, prevention et traitement des depressions du post‐partum: une etude comparative randomisee chez 450 femmes]. Neuropsychiatrie de l'enfance et de l'adolescence 2004;52:266‐73.
Tezel 2006 {published data only}
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Tseng 2010 {published data only}
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    1. Urech C, Alder J, Bitzer J, Hosli I. The effect of relaxation exercises on psychological wellbeing during pregnancy [Entspannungs‐Ubungen wahrend der Schwangerschaft: Der Einfluss auf das psychobiologische Wohlbefinden]. Geburtshilfe und Frauenheilkunde 2009;69:163.
Vieten 2008 {published data only}
    1. Vieten C, Astin J. Effects of a mindfulness‐based intervention during pregnancy on prenatal stress and mood: results of a pilot study. Archives of Women's Mental Health 2008;11(1):67‐74. - PubMed
Webster 2003 {published data only}
    1. Webster J, Linnane J, Roberts J, Starrenburg S, Hinson J, Dibley L. IDentify, Educate, and Alert (IDEA) trial: an intervention to reduce postnatal depression. BJOG: an international journal of obstetrics and gynaecology 2003;110:842‐6. - PubMed
Wiggins 2005 {published data only}
    1. Wiggins M, Oakley A, Roberts I, Turner H, Rajan L, Austerberry H, et al. Postnatal support for mothers living in disadvantaged inner city areas: a randomised controlled trial. Journal of Epidemiology & Community Health 2005;59:288‐95. - PMC - PubMed
Wolman 1993 {published data only}
    1. Nikodem C, Nolte A, Wolman W, Gulmezoglu A, Hofmeyr G. Companionship by a lay labour supporter to modify the clinical birth environment: long‐term effects on mother and child. Curationis 1998;21(1):8‐12. - PubMed
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Xu 2003 {published data only}
    1. Xu FS, Liu JX, Zhang SP, Li J, Su Q. Effects of intervening measures on postpartum depression. Chung‐Hua Fu Chan Ko Tsa Chih [Chinese Journal of Obstetrics & Gynecology] 2003;38(12):724‐6. - PubMed
Zayas 2002 {published data only}
    1. Zayas LH, Cunningham M, McKee MD, Jankowski KR. Depression and negative life events among pregnant african‐american and hispanic women. Womens Health Issues 2002;12(1):16‐22. - PubMed

References to studies awaiting assessment

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Kozinszky 2012 {published data only}
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Zlotnick 2008 {published data only}
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References to ongoing studies

Griffiths 2009 {unpublished data only}
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References to other published versions of this review

Dennis 2001
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Dennis 2004
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