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Evidence toolbox: talking therapies in antenatal depression

Is there any evidence that psychosocial or psychological interventions work for the treatment of women who become depressed in pregnancy?

Although pregnancy was once thought of as a time of emotional wellbeing for many women, conferring ‘protection' against psychiatric disorders, a recent meta-analysis of 21 studies suggests the mean prevalence rate for depression across the antenatal period is 10.7%, ranging from 7.4% in the first trimester to a high of 12.8% in the second . Because of maternal treatment preferences and potential concerns about fetal and infant health outcomes, non-pharmacological treatment options are needed.

The objective of this review is to assess the effects on mothers and their families of psychosocial and psychological interventions compared with usual antepartum care.

Method We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2006), the Cochrane Collaboration Depression Anxiety and Neurosis Group's Trials Registers (CCDANCTR-Studies and CCDANCTR-References) (July 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, issue 3), MEDLINE (1966 to July 2006), EMBASE (1980 to July 2006) and CINAHL (1982 to July 2006). We also scanned secondary references and contacted experts in the field to identify other published or unpublished trials.

We looked at all published, unpublished and ongoing randomised controlled trials of preventive psychosocial or psychological interventions in which the primary or secondary aim is to treat antenatal depression. We excluded quasi-randomised trials (for example, those randomised by delivery date, or odd versus even medical record numbers).

All review authors participated in the evaluation of methodological quality and data extraction. Results are presented using relative risk for categorical data and weighted mean difference for continuous data.

Results One US trial was included in this review, incorporating 38 outpatient antenatal women who met the Diagnostic and Statistical Manual for Mental Disorders-IV criteria for major depression. Interpersonal psychotherapy, compared with a parenting education programme, was associated with a reduction in the risk of depressive symptomatology immediately post-treatment using the Clinical Global Impression Scale (one trial, n=38; relative risk (RR) 0.46, 95% confidence interval (CI) 0.26 to 0.83) and the Hamilton Rating Scale for Depression (one trial, n=38; RR 0.82, 95% CI 0.65 to 1.03).

Authors' conclusions The evidence is inconclusive to allow us to make recommendations for interpersonal psychotherapy for antenatal depression. The one trial included was too small, with a non-generalisable sample.

Reference: Dennis C-L, Ross LE, Grigoriadis S. Psychosocial and psychological interventions for treating antenatal depression. Cochrane Database of Systematic Reviews 2007, issue 3 CD006309. DOI: 10.1002/ 14651858 CD006309 pub2.

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