Abstract
Previous studies have reported different effect sizes for self-help interventions designed to reduce postpartum depression symptoms; therefore, a comprehensive quantitative review of the research was required. A meta-analysis was conducted to examine the effectiveness of self-help interventions designed to treat and prevent postpartum depression, and identified nine relevant randomized controlled trials. Differences in depressive symptoms between self-help interventions and control conditions, changes in depressive symptoms following self-help interventions, and differences in postintervention recovery and improvement rates between self-help interventions and control conditions were assessed in separate analyses. In treatment trials, depression scores continued to decrease from baseline to posttreatment and follow-up assessment in treatment subgroups. Changes in treatment subgroups’ depression scores from baseline to postintervention assessment were greater relative to those observed in prevention subgroups. Self-help interventions produced larger overall effects on postpartum depression, relative to those observed in control conditions, in posttreatment (Hedges’ g = 0.51) and follow-up (Hedges’ g = 0.32) assessments; and self-help interventions were significantly more effective, relative to control conditions, in promoting recovery from postpartum depression. Effectiveness in preventing depression did not differ significantly between self-help interventions and control conditions.The findings suggested that self-help interventions designed to treat postpartum depression reduced levels of depressive symptoms effectively and decreased the risk of postpartum depression.
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References
Andersson L, Sundström-Poromaa I, Bixo M, Wulff M, Bondestam, ÅStrö M (2003) Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol 189:148–154. https://doi.org/10.1067/mob.2003.336
Andersson L, Sundström-Poromaa I, Wulff M, Åström M, Bixo M (2006) Depression and anxiety during pregnancy and six months postpartum: a follow-up study. Acta Obstet Gynecol Scand 85:937–944. https://doi.org/10.1080/00016340600697652
Beatty L, Binnion C (2016) A systematic review of predictors of, and reasons for, adherence to online psychological interventions. Int J Behav Med 23:776–794. https://doi.org/10.1007/s12529-016-9556-9
Beck AT, Haigh EAP (2014) Advances in cognitive theory and therapy: the generic cognitive model. ANNU REV CLIN PSYCHO 10:1–24. https://doi.org/10.1146/annurev-clinpsy-032813-153734
Bijl RV, Ravelli A (2000) Psychiatric morbidity, service use, and need for care in the general population: results of The Netherlands Mental Health Survey and Incidence Study. Am J Public Health 90:602–607. https://doi.org/10.2105/ajph.90.4.602
Bortolotti B, Menchetti M, Bellini F, Montaguti MB, Berardi D (2008) Psychological interventions for major depression in primary care: a meta-analytic review of randomized controlled trials. Gen Hosp Psychiatry 30:293–302. https://doi.org/10.1016/j.genhosppsych.2008.04.001
Brummelte S, Galea LAM (2016) Postpartum depression: etiology, treatment and consequences for maternal care. Horm Behav 77:153–166. https://doi.org/10.1016/j.yhbeh.2015.08.008
Cohen J (1988) Statistical power analysis for the behavioral sciences. J Am Stat Assoc 2:19–74
Costa D, Lowensteyn I, Abrahamowicz M et al (2009) A randomized clinical trial of exercise to alleviate postpartum depressed mood. J Psychosom Obstet Gynaecol 30:191–200. https://doi.org/10.1080/01674820903212136
Coull G, Morris PG (2011) The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: a systematic review. Psychol Med 41:2239–2252. https://doi.org/10.1017/s0033291711000900
Cowpertwait L, Clarke D (2013) Effectiveness of web-based psychological interventions for depression: a meta-analysis. Int J Ment Health Addict 11:247–268. https://doi.org/10.1007/s11469-012-9416-z
Cuijpers P, Schuurmans J (2007) Self-help interventions for anxiety disorders: an overview. Curr Psychiatry Rep 9:284–290. https://doi.org/10.1007/s11920-007-0034-6
Cuijpers P, Smit F, Van SA (2007a) Psychological treatments of subthreshold depression: a meta-analytic review. Acta Psychiatr Scand 115:434–441. https://doi.org/10.1111/j.1600-0447.2007.00998.x
Cuijpers P, Van SA, Warmerdam L (2007b) Behavioral activation treatments of depression: a meta-analysis. Clin Psychol Rev 27:318–326. https://doi.org/10.1016/j.cpr.2006.11.001
Cuijpers P, Donker T, Van SA, Li J, Andersson G (2010) Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychol Med 40:1943–1957
Daley AJ, Blamey RV, Jolly K, Roalfe AK, Turner KM, Coleman S, McGuinness M, Jones I, Sharp DJ, MacArthur C (2015a) A pragmatic randomized controlled trial to evaluate the effectiveness of a facilitated exercise intervention as a treatment for postnatal depression: the PAM-PeRS trial. Psychol Med 45:2413–2425. https://doi.org/10.1017/S0033291715000409
Daley AJ, Foster L, Long G, Palmer C, Robinson O, Walmsley H, Ward R (2015b) The effectiveness of exercise for the prevention and treatment of antenatal depression: systematic review with meta-analysis. BJOG 122:57–62. https://doi.org/10.1111/1471-0528.12909
Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56:455–463. https://doi.org/10.1111/j.0006-341X.2000.00455.x
Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106:1071–1083. https://doi.org/10.1097/01.aog.0000183597.31630.db
Gellatly J, Bower P, Hennessy SUE, Richards D, Gilbody S, Lovell K (2007) What makes self help interventions effective in the management of depressive symptoms ? Meta-analysis and meta-regression. Psychol Med 37:1217–1228. https://doi.org/10.1017/S0033291707000062
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. Br Med J 327:557–560
Huffcutt AI, Arthur W (1995) Development of a new outlier statistic for meta-analytic data. J Appl Psychol 80:327–334
Kelly RH, Russo J, Katon W (2001) Somatic complaints among pregnant women cared for in obstetrics: normal pregnancy or depressive and anxiety symptom amplification revisited? Gen Hosp Psychiatry 23:107–113. https://doi.org/10.1016/s0163-8343(01)00129-3
King E (2009) The effectiveness of an internet-based stress management program in the prevention of postpartum stress, anxiety and depression for new. Walden University, Mothers
Leung BMY, Kaplan BJ (2009) Perinatal depression: prevalence, risks, and the nutrition link—a review of the literature. J Am Diet Assoc 109:1566–1575. https://doi.org/10.1016/j.jada.2009.06.368
Lewis BA, Gjerdingen DK, Avery MD, Sirard JR, Guo H, Schuver K, Marcus BH (2014) A randomized trial examining a physical activity intervention for the prevention of postpartum depression: the healthy mom trial. Ment Health Phys Act 7:42–49. https://doi.org/10.1016/j.mhpa.2013.11.002
Milgrom J, Danaher BG, Gemmill AW, Holt C, Holt CJ, Seeley JR, Tyler MS, Ross J, Ericksen J (2016) Internet cognitive behavioral therapy for women with postnatal depression: a randomized controlled trial of MumMoodBooster. J Med Internet Res 18(54):e54. https://doi.org/10.2196/jmir.4993
Mohammadi F, Malakooti J, Babapoor J, Mohammad-Alizadeh-Charandabi S (2015) The effect of a home-based exercise intervention on postnatal depression and fatigue: a randomized controlled trial. Int J Nurs Pract 21:478–485. https://doi.org/10.1111/ijn.12259
Moher D, Shamseer L, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4(1). https://doi.org/10.1186/2046-4053-4-1
O'Mahen HA, Woodford J, McGinley J, Warren FC, Richards DA, Lynch TR, Taylor RS (2013) Internet-based behavioral activation--treatment for postnatal depression (Netmums): a randomized controlled trial. J Affect Disord 150: 814-22. https://doi.org/10.1016/j.jad.2013.03.005
O’Mahen HA, Richards DA, Woodford J, Wilkinson E, McGinley J, Taylor RS, Warren FC (2014) Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression. Psychol Med 44:1675–1689. https://doi.org/10.1017/S0033291713002092
Peters J, Booth A, Peters R (2015) Potential for specific dihydropyridine calcium channel blockers to have a positive impact on cognitive function in humans: a systematic review. Ther Adv Chronic Dis 6:160–169. https://doi.org/10.1177/2040622315582353
Pugh NE, Hadjistavropoulos HD, Dirkse D (2016) A randomised controlled trial of therapist-assisted, Internet-delivered cognitive behavior therapy for women with maternal depression. PLoS One 11:1–14. https://doi.org/10.1371/journal.pone.0149186
Roness A, Mykletun A, Dahl AA (2005) Help-seeking behaviour in patients with anxiety disorder and depression. Acta Psychiatr Scand 111:51–58
Rosenthal R (1979) The file drawer problem and tolerance for null results. Psychol Bull 86:638–641
Rosenthal R (1991) Meta-analytic procedures for social research. Sage, Newbury Park, CA
Sockol LE (2015) A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. J Affect Disord 177:7–21. https://doi.org/10.1016/j.jad.2015.01.052
Sockol LE, Epperson CN, Barber JP (2011) A meta-analysis of treatments for perinatal depression. Clin Psychol Rev 31:839–849. https://doi.org/10.1016/j.cpr.2011.03.009
Verhagen AP, de Vet HCW, de Bie RA, Kessels AGH, Boers M, Bouter LM, Knipschild PG (2017) The Delphi list. J Clin Epidemiol 51:1235–1241. https://doi.org/10.1016/S0895-4356(98)00131-0
Wisner KL, Sit DKYY, Hanusa BH et al (2009) Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes. Am J Psychiatry 166:557–566. https://doi.org/10.1176/appi.ajp.2008.08081170
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This work was financially supported by grants from the Science and Technology Major Project of Shandong Province (grant number: 2015ZDXX0801A01).
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Lin, PZ., Xue, JM., Yang, B. et al. Effectiveness of self-help psychological interventions for treating and preventing postpartum depression: a meta-analysis. Arch Womens Ment Health 21, 491–503 (2018). https://doi.org/10.1007/s00737-018-0835-0
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DOI: https://doi.org/10.1007/s00737-018-0835-0