Women with postpartum depression were found to benefit from an online, 1-day cognitive behavioral therapy (CBT)-based workshop added to treatment as usual, according to research published in JAMA Psychiatry.
To evaluate the impact of the workshop, investigators conducted a randomized clinical trial in 2020 in Ontario, Canada, of adult women who had given birth within the past 12 months and who had an Edinburg Postnatal Depression Scale (EPDS) score of at least 10. The primary study outcome was change in symptoms of depression as measured by EPDS score. Secondary outcomes included anxiety, social support, quality of parent/child relationship, and infant temperament.
The workshop included didactic teaching, group exercises/discussion, role playing, modifiable cognitive risk factors, cognitive restructuring, behavioral skills (problem solving, behavioral activation, and assertiveness), and goal setting. The workshops were facilitated by a registered psychotherapist, psychologist, or clinical psychology graduate student and occurred every 3 weeks.
Participants (aged mean 31.8±4.4 years, 22% using antidepressants, 41% previously received counseling) were randomly assigned to treatment as usual in the form of pharmacotherapy and/or psychotherapy plus participation in the workshop (n=202) or treatment as usual with 12-week delayed engagement in the workshop (n=201).
Women who participated in the workshop experienced significant reductions in EPDS scores (from 16.47 [4.41] to 11.65 [4.83]; B = -4.82; P <.001) and were found to be at higher odds of experiencing significant reductions in EPDS scores (odds ratio, 4.15; 95% CI, 2.66-6.46).
Following participation in the workshop, participants’ mean Generalized Anxiety Disorder Questionnaire (GAD-7) scores decreased from 12.41±5.12 to 7.97±5.54 (B=-4.44; 95% CI, -5.47 to -3.38; P <.001), and they were more likely to report significant improvement in GAD-7 scores (odds ratio, 3.09; 95% CI, 1.99-4.81).
Scores on the Postpartum Bonding Questionnaire-Impaired Bonding (B=-3.22; 95% CI, -4.72 to -1.71; P <.001), Postpartum Bonding Questionnaire-Infant Focused Anxiety (B = -1.64; 95% CI, -2.25 to 1.00; P <.001), Social Provisions Scale (B=3.31; 95% CI, 1.04-5.57; P <.001), and the Infant Behavior Questionnaire-Revised Very Short Form positive affectivity/surgency in infants (B=0.31; 95% CI, 0.05-0.56; P <.001) also improved following participation in the workshop.
“Because [postpartum depression] treatment guidelines recommend a stepped approach where the least expensive and intrusive interventions are offered first, these workshops could be an important early step in [postpartum depression] treatment pathways, treating some women while identifying those in need of more intensive treatment,” the investigators said. “Given that these workshops may be capable of treating as many as 30 women at a time from the comfort of their own homes, they could represent a significant component of the next successfully implemented, research-enabled public health strategy, an important goal given women’s treatment preferences and the importance of maternal mental health to children, families, and society.”
Van Lieshout RJ, Layton H, Savoy CD, et al. Effect of online 1-day cognitive behavioral therapy-based workshops plus usual care vs usual care alone for postpartum depression: a randomized clinical trial. JAMA Psych. 2021;78(11):1200-1207. doi:10.1001/jamapsychiatry.2021.2488