There may be substantial research supporting cognitive-behavioral therapy (CBT) for depression while pregnant and the postpartum period. Systematic reviews and meta-analyses have identified CBT as effective for each the prevention and treatment of perinatal depression (e.g., Nillni et al. 2018; Sokol 2015). Nonetheless, CBT interventions can range in format (e.g., group or in-person), delivery mechanism (e.g., licensed mental health provider, digital delivery), variety of sessions, and content included. 

There may be a necessity to raised understand mechanisms of motion for cognitive behavioral therapies and to grasp what approaches work best for whom throughout the perinatal population.

Waqas and colleagues (2023) recently published a scientific review and meta-regression evaluation that addressed exactly these gaps in knowledge by:

1. Assessing the effectiveness of CBT interventions for the prevention and treatment of perinatal depression (PND),
2. Exploring the settings by which the interventions work best,
3. Exploring the person level and intervention level aspects driving PND’s prognosis amongst women undergoing CBT, and
4. Exploring the energetic ingredients of CBT interventions for PND.

A complete of 56 studies covering 59 interventions were included within the review, and interventions were delivered individually (n=24), in a gaggle format (n=25) and digitally (n=10). Overall, the included CBT-based interventions had a powerful effect size in improving perinatal depressive symptoms. Other key findings included:

Intervention-Level Moderators:

• Treatment interventions had significantly higher effect sizes than prevention interventions for perinatal depressive symptoms.
• Interventions offered as stand-alone programs performed higher than those integrated into healthcare settings.
• Effect sizes didn’t differ in keeping with delivery format (i.e., electronic delivery, face-to-face in groups, or face-to face individually).
• Delivery agents with various backgrounds and credentials were effective, although interventions delivered electronically and thru mental health specialists had barely higher, yet statistically not significant, effect sizes than others (i.e., non-specialists).

Participant-Level Moderators:

• Higher effect sizes were related to interventions recruiting perinatal women with older age.
• Smaller effect sizes were found amongst samples with a greater proportion of ladies belonging to racial minority groups, low-income levels, lower educational levels, and recurrent episodes of depression.
• Interventions delivered through the postpartum period had barely higher effect sizes than those delivered in while pregnant or each time periods, although this difference was not statistically significant.

Energetic Ingredient Moderators:

• The dose of the intervention was inversely related to effect size. In other words, briefer interventions were more practical than longer interventions.
• Using more behavioral ingredients (e.g., problem-solving, rest, emotional regulation and stress management, decision-making) in CBT interventions was related to greater effect sizes.
• Interventions utilizing the identification of affect and self-awareness strategies yielded larger effect sizes than interventions without these components included.

These findings might help guide intervention developers and practitioners in additional effectively addressing symptoms of depression in perinatal individuals. It’s encouraging to learn that interventions were effective across different delivery formats (individual, group, and electronic) and might be delivered effectively by specialists and non-specialists. Such findings indicate that a big selection of delivery options could also be effective and might be leveraged to expand access to effective treatments. Moreover, longer durations of CBT interventions may not necessarily be more practical than shorter ones; thus, transient CBT could also be an efficient and more scalable option. As well as, we learned that interventions should consider including multiple behavioral ingredients to maximise intervention advantages.

This review also points to areas where further work is required. For instance, the authors found that there have been smaller reductions in PND symptoms amongst younger perinatal women, those with lower educational or economic levels, and people belonging to minority ethnic groups. The authors note how these findings highlight the importance of considering contextual aspects affecting health and wellbeing of perinatal individuals in certain communities, and the way more research is required to optimize intervention effectiveness for these groups.

Margaret Gaw, BA

Rachel Vanderkruik, PhD, MSc

References

Nillni YI, Mehralizade A, Mayer L, Milanovic S. Treatment of depression, anxiety, and trauma-related disorders through the perinatal period: A scientific review. Clin Psychol Rev. 2018 Dec;66:136-148. doi: 10.1016/j.cpr.2018.06.004. Epub 2018 Jun 9. PMID: 29935979; PMCID: PMC6637409.

Sockol LE. A scientific review of the efficacy of cognitive behavioral therapy for treating and stopping perinatal depression. J Affect Disord. 2015 May 15;177:7-21. doi: 10.1016/j.jad.2015.01.052. Epub 2015 Feb 2. PMID: 25743368.

Waqas A, Zafar SW, Akhtar P, Naveed S, Rahman A (2023). Optimizing cognitive and behavioral approaches for perinatal depression: A scientific review and meta-regression evaluation. Cambridge Prisms: Global Mental Health, 10, e22, 1–14.