Abstract
Purpose
Postnatal depression (PND) impacts numerous women after childbirth, leading to various impairments in their lives. Mental health interventions, such as cognitive behavioral therapy (CBT), need further evaluation in low- and middle-income countries (LMICs) where resources may be scarce. This study aimed to assess the effectiveness of CBT in treating PND in women from LMICs, comparing it to standard care.
Methods
A systematic review and meta-analysis were conducted following the PRISMA Statement 2020 guidelines. Databases such as PubMed, CINAHL Plus, Cochrane Library, and PsycINFO were searched until September 2022. A modified Delphi process was employed to identify relevant studies. The primary outcome was mean depression scores, measured by the Edinburgh postnatal depression scale at baseline and post-intervention.
Results
Out of 487 studies identified, five trials were included, totaling 1056 participants (520 in the intervention group and 536 in the comparator group). At baseline, a minor, insignificant positive effect size was found (Cohen’s d = 0.1, 95% CI = − 0.15, 0.35). Post-CBT, the intervention group showed significant improvements in depression scores (Cohen’s d = − 1.9, 95% CI = − 3.8, 0). When accounting for the influence of one study, (Ngai et al., Psychother Psychosom 84:294–303, 2015), which held substantial weight in the initial analysis, the effect size was adjusted to d = 0.5, highlighting a lesser but still significant difference.
Conclusions
CBT appears to be effective in improving PND symptoms among women in LMICs and may be considered a first-line treatment for at-risk mothers, including those who are displaced. However, the significant impact of one study on the results emphasizes the need for more rigorous research. The study also highlights the challenges and limitations of providing psychotherapies across LMICs, emphasizing the need for culturally adapted and contextually appropriate interventions to ensure successful implementation and sustainability of mental health care for postnatal women in these settings.
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Acknowledgements
The contributions by Bareea Mubashar, MBBS, Manal Tariq, MBBS, and Aniqah Riaz, MBBS are acknowledged in the early drafting of this paper.
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ZS, AS, and SZA contributed to the drafting, original draft preparation, methodology, and final review of the manuscript. ZS and AS performed the analysis, and were a major contributor in writing the manuscript. ZS supervised the study and the guarantor. All authors read and approved the final manuscript.
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Zouina Sarfraz and Azza Sarfraz are co-first authors
What is already known on this subject?
Postnatal depression (PND) is a prevalent mental health concern affecting many women after childbirth, leading to impairments in various aspects of their lives. Cognitive behavioral therapy (CBT) has been demonstrated as an effective treatment for PND in high-income countries. However, there is limited research on the accessibility and effectiveness of CBT in low- and middle-income countries (LMICs), where resources and mental health care services may be constrained.
What does this study add?
This study provides a comprehensive evaluation of CBT as a treatment for PND among women in LMICs through a systematic review and meta-analysis. It demonstrates that CBT is effective in reducing PND symptoms in these settings, indicating its potential as a first-line treatment for at-risk mothers, including those who are displaced. Furthermore, the study highlights the challenges and limitations of implementing psychotherapies like CBT in LMICs, emphasizing the necessity for culturally adapted and contextually appropriate interventions. This research contributes to the understanding of mental health care in LMICs, underscoring the need to develop and implement sustainable, effective treatments for PND in these regions.
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Sarfraz, Z., Sarfraz, A. & Amin, S.Z. Evaluating cognitive behavioral therapy as a solution for postnatal depression in economically disadvantaged regions. Arch Womens Ment Health 27, 459–475 (2024). https://doi.org/10.1007/s00737-024-01428-2
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DOI: https://doi.org/10.1007/s00737-024-01428-2