Clinical Question

Can psychosocial or psychological interventions prevent postpartum depression?

Evidence-Based Answer

A range of prevention strategies can reduce the risk of postpartum depression, but more study is needed to determine which interventions are most effective. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Among women of childbearing age in the United States, depression is the leading cause of nonobstetric hospitalization.¹ Postpartum depression is associated with morbidity for mother and infant, because affected women are less able to effectively parent and bond with their infants.² The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., defines depression with peripartum onset as that which occurs during pregnancy or within four weeks of delivery.³ However, depressive symptoms most often start within the first 12 weeks postpartum, and many studies define postpartum depression as that which occurs within the first year after delivery. A systematic review found a period prevalence of 19.2% for all depression in the first 12 weeks postpartum and 7.1% for major depression.⁴

Although postpartum depression can be treated effectively, preventive strategies are needed. The authors of this Cochrane review evaluated whether psychological or psychosocial interventions could reduce the risk of developing postpartum depression in the general population and among women at increased risk. They identified 28 randomized controlled trials conducted in seven countries that enrolled almost 17,000 pregnant women and new mothers within six weeks of delivery. Included trials compared a nonpharmacologic intervention (such as psychological therapy, counseling, or debriefing; or supportive psychosocial interactions such as pre- or postpartum home or clinic visits or telephone calls) with usual care. The interventions were provided to groups or individuals by health care professionals or laypersons.

The primary outcome was the risk of developing postpartum depression. Most of the studies used the Edinburgh Postnatal Depression Scale to measure post-partum symptoms. Overall, women who received a psychological or psychosocial intervention were significantly less likely to develop symptoms of postpartum depression than women receiving usual care (relative risk = 0.78; 95% confidence interval, 0.66 to 0.93). When interventions were broken down by type, the most promising were interpersonal psychotherapy, postpartum home visits by nurses or midwives, postpartum peer-based telephone support, and flexible postpartum care by midwives. No strong evidence supported antenatal or postnatal classes that provided education about depression, postpartum home visits by peers or laypersons, early postpartum follow-up, continuity-of-care models, in-hospital psychological debriefing, or cognitive behavior therapy.

The American College of Obstetricians and Gynecologists states the importance of screening for postpartum depression, but cites insufficient evidence to recommend universal screening of all women who are pregnant or in the postpartum period.⁵ Although the authors caution that the diversity of the study interventions and end points contributed to significant statistical heterogeneity that could limit the reliability of their findings, this review can help guide future research.