In a systematic evidence review conducted for the Agency for Healthcare Research and Quality and the US Preventive Services Task Force, Elizabeth O’ Connor, PhD, from the Kaiser Permanente Center for Health Research, Portland, Oregon, and colleagues found that although counseling interventions can be effective in preventing perinatal depression, the evidence to date is limited to women at increased risk for the disorder.
Between 9% and 10% of pregnant and postpartum women are estimated to experience depression. Women who experience postpartum depression are at increased risk for suicide and of having thoughts of harming their infants. They are also more likely to have lower levels of positive maternal behaviors, including play and praise, and are more likely to exhibit negative maternal behaviors, such as negative maternal affect and hostile or coercive behaviors and disengagement from their infants.
Risk factors for perinatal depression include a history of depression or of physical or sexual abuse, an unwanted pregnancy, stressful life events, poor social and financial support, intimate partner violence, pregestational or gestational diabetes, and complications during pregnancy.
The investigators identified and included 50 trials with 22,385 participants in the study. Counseling was the most common intervention and reduced the likelihood of perinatal depression by 39%. However, the absolute reduction in risk varied considerably across studies, from 1.3% greater reduction in the control group to 31.8% greater reduction in the intervention group. Four or more separate trials in the United States evaluated 2 specific counseling approaches: “Mothers and Babies,” based on cognitive behavioral therapy, and an interpersonal therapy-based program called “Reach Out, Stand Strong, Essentials for new mothers.” Pooled effects for those interventions were stronger than for the overall pooled results for all counseling interventions and had overlapping confidence intervals.
Other types of behavioral interventions, such as physical activity and peer counseling, showed promise, but the results were not statistically significant, and few have been replicated. A very small study of the use of the antidepressant sertraline given prophylactically right after childbirth did show a statistically significant benefit at 20 weeks postpartum, but there were increased adverse effects in mothers. Researchers determined that debriefing interventions and omega-3 fatty acids were not effective.
One limitation of the reviewed evidence was the small number of trials examining other potentially valuable interventions, such as infant sleep education and in-hospital perinatal depression education with follow-up.
The evidence was used by the task force to update the recommendations for preventing perinatal depression.
O’Connor EA, Senger CA, Henninger M, Gaynes BN, Coppola E, Soulsby Weyrich M. Interventions to prevent perinatal depression: a systematic evidence review for the U.S. Preventive Services Task Force. Evidence synthesis No. 172. AHRQ Report No. 18-05243-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2019.