Preventing postpartum depression: a meta-analytic review

Abstract

This meta-analysis assessed the efficacy of a wide range of preventive interventions designed to reduce the severity of postpartum depressive symptoms or decrease the prevalence of postpartum depressive episodes. A systematic review identified 37 randomized or quasi-randomized controlled trials in which an intervention was compared to a control condition. Differences between treatment and control conditions in the level of depressive symptoms and prevalence of depressive episodes by 6 months postpartum were assessed in separate analyses. Depressive symptoms were significantly lower at post-treatment in intervention conditions, with an overall effect size in the small range after exclusion of outliers (Hedges' g=0.18). There was a 27% reduction in the prevalence of depressive episodes in intervention conditions by 6 months postpartum after removal of outliers and correction for publication bias. Later timing of the postpartum assessment was associated with smaller differences between intervention and control conditions in both analyses. Among studies that assessed depressive symptoms using the EPDS, higher levels of depressive symptoms at pre-treatment were associated with smaller differences in depressive symptoms by 6 months postpartum. These findings suggest that interventions designed to prevent postpartum depression effectively reduce levels of postpartum depressive symptoms and decrease risk for postpartum depressive episodes.

Keywords: Meta-analysis; Postpartum depression; Prevention.

Fig. 1

Flow chart illustrating identification of included studies.

Fig. 2

Funnel plot for studies assessing the difference between depressive symptoms between treatment and control conditions by 6 months postpartum. The asymmetric distribution of studies in the lower half of the funnel plot suggests that there are missing studies with negative effect sizes, in which control conditions would be superior to treatment conditions.

Fig. 3

Funnel plot for studies assessing the difference in prevalence of depressive episodes between treatment and control conditions by 6 months postpartum. The asymmetric distribution of studies in the lower half of the funnel plot suggests that there are missing studies with odds ratios greater than 0, in which control conditions would be superior to treatment conditions.