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Background: Interpersonal psychotherapy (IPT) has demonstrated efficacy for the prevention and treatment of perinatal depression. Previous systematic reviews have not evaluated the effects of IPT on other outcomes, most notably symptoms of anxiety and interpersonal functioning, or assessed moderators of treatment efficacy specific to IPT.
Method: A systematic review identified 28 studies assessing the efficacy of IPT during pregnancy or the first year postpartum. Random effects meta-analyses assessed the average change in outcomes (depression, anxiety, relationship quality, social adjustment, and social support) from pre- to post-treatment, the difference in the change in outcomes between treatment and comparison conditions, and the difference in prevalence of depressive episodes between treatment and comparison conditions. Study, intervention, and sample characteristics were evaluated as potential moderators of effect sizes.
Results: In prevention studies, IPT was effective for reducing depressive symptoms and the prevalence of depressive episodes. In treatment studies, IPT reduced symptoms of depression and anxiety and improved relationship quality, social adjustment and social support. Few significant moderators were identified, and results of moderation analyses were inconsistent across outcomes.
Limitations: There are insufficient studies to evaluate the effects of preventive IPT on anxiety and interpersonal outcomes. Analyses of potential moderators were limited by the number of studies available for subgroup comparisons.
Conclusions: IPT is an effective preventive intervention for perinatal depression. IPT is clearly effective for treating depressive symptoms and promising as a treatment for anxiety and improving interpersonal functioning. Further research is necessary to assess whether adaptations to IPT enhance its efficacy.
Many men experience depression and anxiety during the transition to parenthood, but characteristics associated with fathers’ distress are less well understood than those for mothers. Among perinatal women, both general cognitive biases and attitudes toward parenthood are associated with symptoms of depression and anxiety. The goal of this study was to assess whether these characteristics are associated with psychological distress among fathers. An Internet-based sample of expectant (n = 145) and new (n = 137) first-time fathers completed cross-sectional self-report measures of paternal attitudes, general cognitive biases, relationship quality, social support, and symptoms of depression and anxiety. General cognitive biases and relationship quality were associated with symptoms of depression and anxiety after controlling for other paternal characteristics. Although paternal attitudes were correlated with symptoms of depression and anxiety, they were not significantly associated with symptoms in overall multivariate analyses, and the relationship between paternal attitudes and anxiety differed between expectant and new fathers. These findings suggest that general cognitive biases and relationship quality are strongly associated with paternal distress. Couples-based and cognitive– behavioral interventions may be well-suited for adaptation for use in this population.
The Attitudes Toward Motherhood (AToM) Scale was developed to assess women’s beliefs about motherhood, a specific risk factor for emotional distress in perinatal populations. As the measure was initially developed and validated for use among first-time mothers, this study assessed the reliability and validity of the AToM Scale in a sample of multiparous women. Maternal attitudes were significantly associated with symptoms of depression, even after controlling for demographic, cognitive, and interpersonal risk factors. Maternal attitudes were also associated with symptoms of anxiety after controlling for demographic risk factors, but this association was not significant after accounting for cognitive and interpersonal risk factors. Compared to primiparous women from the initial validation study of the AToM Scale, multiparous women reported lower levels of social support and marital satisfaction. The relationships between cognitive and interpersonal risk factors and symptoms of depression and anxiety were comparable between multiparous and primiparous women.
Background: Cognitive behavioral therapy (CBT) is an empirically supported treatment for treating and preventing depression that has been widely studied in perinatal populations. Previous meta-analytic reviews of CBT interventions in this population have not investigated potential moderators of treatment efficacy specific to this type of therapy.
Method: Forty randomized and quasi-randomized controlled trials assessing the efficacy of CBT during pregnancy and the first year postpartum were included in the meta-analyses. Change in depressive symptoms from pre-treatment to post-treatment was assessed in both treatment and prevention trials, and the difference in prevalence of postpartum depressive episodes was assessed in prevention trials. Characteristics of included studies, interventions and samples were assessed as potential moderators of effect sizes.
Results: CBT interventions resulted in significant reductions in depressive symptoms compared to control conditions in both treatment and prevention studies. In prevention studies, individuals who received CBT had significantly lower rates of postpartum depressive episodes compared to control conditions. In both treatment and prevention trials, interventions initiated during the postpartum period were more effective than antenatal interventions. In prevention trials, individually-administered treatments were more effective than group interventions and greater reductions in depressive symptoms were found in studies that included higher proportions of nonwhite, single, and multiparous participants.
Limitations: The methodological quality of included studies varied widely among studies eligible for inclusion in the meta-analysis.
Conclusions: There is strong evidence that CBT interventions are effective for treating and preventing depression during the perinatal period. Further methodologically rigorous studies are needed to further investigate potential moderators of treatment efficacy.
Maternal psychopathology is a risk factor for impaired mother-infant bonding, but not all women with this illness experience impaired bonding. This study investigated correlates of mother-infant bonding among 180 postpartum women treated in a psychiatric partial hospitalization program. Women completed self-report measures of depressive symptoms and mother-infant bonding, and a retrospective chart review assessed demographic characteristics, clinician-rated diagnoses, and obstetric factors. Symptoms of depression, self-reported suicidality, demographic characteristics, and mode of delivery were significantly associated with impaired bonding.
Two studies examined the relationship between maternal attitudes and symptoms of depression and anxiety during pregnancy and the early postpartum period. In the first study, a measure of maternal attitudes, the Attitudes Toward Motherhood Scale (AToM),was developed and validated in a sample of first-time mothers. The AToM was found to have good internal reliability and convergent validity with cognitive biases and an existing measure of maternal attitudes. Exploratory and confirmatory factor analyses determined that the measure comprises three correlated factors: beliefs about others’ judgments, beliefs about maternal responsibility, and maternal role idealization. In the second study, we used the AToM to assess the relationship between maternal attitudes and other psychological variables. The factor structure of the measure was confirmed. Maternal attitudes predicted symptoms of depression and anxiety, and these attitudes had incremental predictive validity over general cognitive biases and interpersonal risk factors. Overall, the results of these studies suggest that maternal attitudes are related to psychological distress among first-time mothers during the transition to parenthood and may provide a useful means of identifying women who may benefit from intervention during the perinatal period.
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.
In this study, we evaluated the association between prenatal depression symptoms adverse birth outcomes in African–American women. We conducted a retrospective cohort study of 261 pregnant African–American women who were screened with the Edinburgh Postnatal Depression Scale (EPDS) at their initial prenatal visit. Medical records were reviewed to assess pregnancy and neonatal outcomes, specifically preeclampsia, preterm birth, intrauterine growth retardation, and low birth weight. Using multivariable logistic regression models, an EPDS score ≥10 was associated with increased risk for preeclampsia, preterm birth, and low birth weight. An EPDS score ≥10 was associated with increased risk for intrauterine growth retardation, but after controlling for behavioral risk factors, this association was no longer significant. Patients who screen positive for depression symptoms during pregnancy are at increased risk for multiple adverse birth outcomes. In a positive, patient-rated depression screening at the initial obstetrics visit, depression is associated with increased risk for multiple adverse birth outcomes. Given the retrospective study design and small sample size, these findings should be confirmed in a prospective cohort study.
This meta-analysis assessed efficacy of pharmacologic and psychological interventions for treatment of perinatal depression. A systematic review identified 27 studies, including open trials (n = 9), quasi-randomized trials (n = 2), and randomized controlled trials (n = 16) assessing change from pretreatment to posttreatment or comparing these interventions to a control group. Uncontrolled and controlled effect sizes were assessed in separate meta-analyses. There was significant improvement in depressive symptoms from pretreatment to posttreatment, with an uncontrolled overall effect size (Hedges' g) of 1.61 after removal of outliers and correction for publication bias. Symptom levels at posttreatment were below cutoff levels indicative of clinically significant symptoms. At posttreatment, intervention groups demonstrated significantly greater reductions in depressive symptoms compared to control groups, with an overall controlled effect size (Hedges' g) of 0.65 after removal of outliers. Individual psychotherapy was superior to group psychotherapy with regard to changes in symptoms from pretreatment to posttreatment. Interventions including an interpersonal therapy component were found to have greater effect sizes, compared to control conditions, than interventions including a cognitive–behavioral component. Implications of the findings for clinical practice and future research are discussed.
Objective: Given the data that depression is common during pregnancy and that pregnant women prefer non-medication treatment options, we hypothesize repetitive transcranial magnetic stimulation (TMS) may be a treatment option. Given the novelty of TMS, we sought to assess whether patient acceptability would be a barrier to enrolling pregnant women in TMS studies.
Methods: In Study 1, 500 pregnant women were surveyed in an outpatient, urban obstetrics clinic using the Edinburgh Depression Rating Scale (EPDS) and a treatment acceptability survey. In Study 2, 51 women were surveyed with the EPDS and acceptability survey using an informational video to increase participant knowledge about TMS.
Results: Approximately 25% of participants had an EPDS score of ≥12 in both studies. Psychotherapy was identified as the most acceptable treatment option. TMS was considered an unacceptable treatment option to virtually all women before the informational video. After the video, 15.7% considered TMS an acceptable treatment option.
Conclusion: Psychotherapy is the most acceptable treatment option for depression to pregnant women. Increasing participant knowledge about TMS increased its acceptability significantly. Large-scale multi-center trials are needed for confirmation of these results.
