Friday, 14 January 2005 - 12:00 PM

This presentation is part of: Poster Session I

Treating Depression During Pregnancy and in the Postpartum: A Meta-Analysis

Background

Non-psychotic major depression is common during pregnancy and in the postpartum, affecting from 10-25% of pregnant and postpartum women, and has harmful effects across the family unit. Various pharmacological, therapeutic, group, and educational interventions exist for the treatment of major depression during pregnancy and in the postpartum. Meta-analysis is used to examine the various treatments currently available to combat the harmful effects of depression during pregnancy and in the postpartum in an effort to suggest best practices based on evidence.

Objectives

The main objective of this meta-analysis was to evaluate the efficacy of current treatments for non-psychotic major depression during pregnancy and in the postpartum and to compare the interventions based on the type of treatment used and the timing of the implementation of the intervention.

Search Strategy

Database searches of the Cochrane Central Register for Controlled Trials, MEDLINE, PSYLIT, and Social Work Abstracts were conducted. Citation list searches and personal approaches were also used.

Selection Criteria

All studies that have tested an intervention directed at decreasing depressive symptomatology in women during pregnancy and in the postpartum that have applied a treatment trial using standardized outcome measures were sought for the purpose of this review.

Data Collection and Analysis

Data were analyzed using the Comprehensive Meta-Analysis software package (Bornstein & Rothstein, 1999). Standardized mean differences were calculated for continuous variable outcome data. Quality of studies was assessed using a relatively simplistic model due to the time limitations of this analysis.

Main Results

The review reported the efficacy of current treatment interventions for non-psychotic depression during pregnancy and in the postpartum. Of the 16 treatment interventions analyzed 13 reported positive effect sizes. 1 treatment intervention reported a marginally positive effect size, one intervention reported no effect, and the remaining intervention reported a marginally negative effect size.

When grouped by category of treatment intervention and ranked by combined effect size, medication in combination with cognitive behavioral therapy and medication alone reported the largest effect sizes (3.871, P < .001 and 3.048, P < .001 respectively) and counseling and educational interventions reported the lowest effect sizes ( .418, P = .014 and .100, P = .457).

While those interventions implemented in the postpartum had a slightly larger effect size (.837, P < .001) than those implemented during pregnancy (.337, P = .002), this may be due to alternative explanations.

Conclusions

While further research and analyses are needed to validate the findings of this review, preliminary finding suggest that medication, alone and in combination with cognitive behavioral therapy, group therapy, interpersonal therapy and cognitive behavioral therapy produce the largest effect sizes in this population among the interventions tested in this review. Future research should focus on further testing and developing these interventions as well as culturally competent interventions and engagement strategies targeting women diagnosed with major depression during pregnancy and in the postpartum.

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