Abstract
The objective of this meta-analysis was to examine the efficacy of systemically oriented psychotherapy treatments for depression in pregnancy and the postpartum. Specifically, this synthesis examined standardized mean differences between pre- and posttest and treatment-control conditions in depression symptom reduction among 24 individual interpersonal psychotherapy or relational psychotherapy studies completed between 1997 and 2013. Analyses assessed heterogeneity, potential moderators, and publication bias. Random-effects analyses revealed a large, positive average effect size \( \left(\overline{d}=1.14\right) \) for psychotherapy treatments among one-group, pre–post-studies and a medium, positive average effect \( \left(\overline{d}=0.40\right) \) when treatments were compared with control groups. Mixed-effects meta-ANOVAs indicated that treatment type, participant depression severity, and method of depression assessment were significant moderators such that effect sizes were larger among individual interpersonal psychotherapy studies, clinical samples, and studies that included an independent evaluation of depression. However, relational treatments and studies with nonclinical samples were less represented in the literature, and still demonstrated small to medium positive effects. Meta-regressions revealed that effects were largest when treatments were delivered with adherence fidelity checks and over more sessions. Based on funnel plots and Egger tests, there was evidence of publication bias in this analysis; however, the effects were distributed fairly symmetrically about the mean given the relatively small number of available studies. Findings have implications for continued examination of systemically oriented psychotherapy treatments for depression in pregnancy and the postpartum.
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References
*Studies included in meta-analysis
Allen JP, Manning N, Meyer J (2010) Tightly linked systems: reciprocal relations between maternal depressive symptoms and maternal reports of adolescent externalizing behavior. J Abnorm Psychol 119:825–835. doi:10.1037/a0021081
Austin MP, Priest SR (2005) Clinical issues in perinatal mental health: new developments in the detection and treatment of perinatal mood and anxiety disorders. Acta Psychiatr Scand 112:97–104. doi:10.1111/j.1600-0447.2005.00549.x
Baldwin SA, Christian S, Berkeljon A, Shadish WR, Bean R (2012) The effects of family therapies for adolescent delinquency and substance abuse: a meta-analysis. J Marital Fam Ther 38:281–304. doi:10.1111/j.1752-0606.2011.00248.x
Beach SRH, Katz J, Kim S, Brody GH (2003) Prospective effects of marital satisfaction on depressive symptoms in established marriages: a dyadic model. J Soc Pers Relat 20:355–371. doi:10.1177/0265407503020003005
Beach SRH, Whisman MA (2012) Affective disorders. J Marital Fam Ther 38:201–219. doi:10.1111/j.1752-0606.2011.00243.x
Becker BJ (2000) Multivariate meta-analysis. In: Tinsley HA, Brown S (eds) Handbook of applied multivariate statistics and mathematical modeling. Academic, San Diego
Berkeljon A, Baldwin SA (2009) An introduction to meta-analysis for psychotherapy outcome research. Psychother Res 19:511–518
Bielawska-Batorowicz E, Koosakowska-Petrycka K (2006) Depressive mood in men after the birth of their offspring in relation to a partner's depression, social support, fathers' personality and prenatal expectations. J Reprod Infant Psychol 24:21–29. doi:10.1080/02646830500475179
Birge RT (1932) The calculation of errors by the method of least squares. Phys Rev 40:207–227
Bledsoe SE, Grote NK (2006) Treating depression during pregnancy and the postpartum: a preliminary meta-analysis. Res Soc Work Pract 16:109–120. doi:10.1177/1049731505282202
Borenstein M, Hedges LV, Higgins JPT, Rothstein HR (2009) Introduction to meta-analysis. Wiley, West Sussex, UK
Boyd RC, Mogul M, Newman D, Coyne JC (2011) Screening and referral for postpartum depression among low-income women: a qualitative perspective from community health workers. Depression Res Treat 2011:1–7. doi:10.1155/2011/320605
*Brandon AR, Ceccotti N, Hynan LS, Shivakumar G, Johnson N, Jarrett RB (2012) Proof of concept: partner-assisted interpersonal psychotherapy or perinatal depression. Arch Women's Mental Health 15: 469-480. doi:10.1007/s00737-012-0311-1
Brennan PA, Hammen C, Katz AR, Le Brocque RM (2002) Maternal depression, paternal psychopathology, and adolescent diagnostic outcomes. J Consult Clin Psychol 70:1075–1085. doi:10.1037//0022-006X.70.5.1075
Burke L (2003) The impact of maternal depression on familial relationships. Int Rev Psychiatry 15:243–255. doi:10.1080/0954026031000136866
*Calvert CA (2008) Structural family therapy as a treatment modality to decrease depressive symptoms for women suffering from postpartum depression and improve family functioning. Retrieved from ProQuest Dissertations and Theses (89236832)
Carter W, Grigoriadis S, Ravitz P, Ross LE (2010) Conjoint IPT for postpartum depression: literature review and overview of a treatment manual. Am J Psychother 64:373–392
Centers for Disease Control and Prevention (2013) Current depression in U.S. adults. Retrieved from http://www.cdc.gov/features/dsdepression/
Choate LH, Gintner GG (2011) Prenatal depression: best practice guidelines for diagnosis and treatment. J Couns Dev 89:373–381. doi:10.1002/j.1556-6678.2011.tb00102.x
*Clark R, Tluczek A, Wenzel A (2003) Psychotherapy for postpartum depression: a preliminary report. Am J Orthopsychiatr 73: 441-454. doi:10.1037/0002-9432.73.4.441
*Clulow C, Donaghy M (2010) Developing the couple perspective in parenting support: evaluation of a service initiative for vulnerable families. J Family Ther 32: 142-168. doi:10.1111/j.1467-6427.2010.00491.x
Cooper PJ, Murray L (1995) Course and recurrence of postnatal depression. Evidence for the specific city of the diagnostic concept. Brit J Psychiatry J Mental Sci 166:191–195
Cuijpers P, van Straten A, Andersson G, van Oppen P (2008) Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol 76:909–922. doi:10.1037/a0013075
Davey SJ, Dziurawiec S, O'Brien-Malone A (2006) Men's voices: postnatal depression from the perspective of male partners. Qual Health Res 2:206–220. doi:10.1177/1049732305281950
Davila J, Bradbury TN, Cohan CL, Tochluk S (1997) Marital functioning and depressive symptoms: evidence for a stress generation model. J Pers Soc Psychol 73:849–861. doi:10.1037/0022-3514.73.4.849
Davila J, Karney BR, Hall TW, Bradbury TN (2003) Depressive symptoms and marital satisfaction: within-subject associations and the moderating effects of gender and neuroticism. J Fam Psychol 17:557–570. doi:10.1037/0893-3200.17.4.557
Dennis CL, Chung-Lee L (2006) Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth 33:323–331. doi:10.1111/j.1523-536X.2006.00130.x
Eberhard-Gran M, Tambs K, Opjordsmoen S, Skrondal A, Eskild A (2004) Depression during pregnancy and after delivery: a repeated measurement study. J Psychosom Obstet Gynecol 25:15–21. doi:10.1080/01674820410001737405
Egger M, Juni P, Bartlett C, Holenstein F, Sterne J (2003) How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Health Technol Assess 7:1–76
Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. Br Med J 315:629–634
Epperson CN, Jatlow PI, Czarkowski K, Anderson GM (2003) Maternal fluoxetine treatment in the postpartum period: effects on platelet serotonin and plasma drug levels in breastfeeding mother–infant pairs. Pediatrics 112:e425–e429. doi:10.1542/peds.112.5.e425
*Gao L, Chan SW, Li X, Chen S, Hao Y (2010) Evaluation of an interpersonal-psychotherapy-oriented childbirth education programme for Chinese first-time childbearing women: a randomised controlled trial. Int J Nurs Stud 47: 1208-1216. doi:10.1016/j.ijnurstu.2010.03.002
Greenland S (1994) Invited commentary: a critical look at some popular metaanalytic methods. Am J Epidemiol 140:290–296
*Grote NK, Swartz HA, Geibel SL, Zuckoff A, Houck PR, Frank E (2009) A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatr Serv 60: 313-321. doi:10.1176/appi.ps.60.3.313
Habib C (2012) Paternal perinatal depression: an overview and suggestions toward an intervention model. J Fam Stud 18:4–16
Hammen CL (2006) Stress generation in depression: reflections on origins, research, and future directions. J Clin Psychol 62:69–82. doi:10.1002/jclp.20293
Hedges LV (1981) Distribution theory for glass's estimator of effect size and related estimators. J Educ Behav Stat 6:107–128. doi:10.3102/10769986006002107
Hedges LV, Vevea JL (1998) Fixed- and random-effects models in meta-analysis. Psychol Methods 3:486–504
*Heinicke CM, Fineman NR, Ruth G, Recchia SL, Guthrie D, Rodning C (1999) Relationship-based intervention with at-risk mothers: outcomes in the first year of life. Infant Mental Health J 20: 349-374. doi:10.1002/(SICI)1097-0355(199924)20:4<349::AID-IMHJ1>3.0.CO;2-X
Heron J, O'Connor TG, Evans J, Golding J, Glover V, ALSPAC Study Team U.S (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80:65–73. doi:10.1016/j.jad.2003.08.004
Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. Br Med J 327:557–560
Joiner TE (2000) Depression's vicious scree: self-propagating and erosive processes in depression chronicity. Clin Psychol Sci Pract 72:203–218. doi:10.1093/clipsy/7.2.203
Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Wang PS (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). J Am Med Assoc 289:3095–3105. doi:10.1001/jama.289.23.3095
Kim DR, O' Reardon JP, Epperson CN (2010) Guidelines for the management of depression during pregnancy. Curr Psychiatr Rep 12:279–281. doi:10.1007/s11920-010-0114-x
Kingston D, Tough S, Whitfield H (2012) Prenatal and postpartum maternal psychological distress and infant development: a systematic review. Child Psychiatry Hum Dev 43:683–714. doi:10.1007/s10578-012-0291-4
Klerman TB, Weissman MM (1993) New applications of interpersonal psychotherapy. American Psychiatric Press, Washington, DC
*Klier CM, Muzik M, Rosenblum CL, Lenz G (2001) Interpersonal psychotherapy adapted for the group setting in the treatment of postpartum depression. J Psychother Pract Res 10: 124-131
Ko JY, Farr SL, Dietz PM, Robbins CL (2012) Depression and treatment among U.S. pregnant and nonpregnant women of reproductive age, 2005–2009. J Women's Health 21:830–836. doi:10.1089/jwh.2011.3466
Korhonen M, Luoma I, Salmelin R, Tamminen T (2012) A longitudinal study of maternal prenatal, postnatal and concurrent depressive symptoms and adolescent well-being. J Affect Disord 136:680–692. doi:10.1016/j.jad.2011.10.007
Le Strat Y, Dubertret C, Le Foll B (2011) Prevalence and correlates of major depressive episode in pregnant and postpartum women in the United States. J Affect Disord 135:128–138. doi:10.1016/j.jad.2011.07.004
*Leung SS K, Lam TH (2012) Group antenatal intervention to reduce perinatal stress and depressive symptoms related to intergenerational conflicts: a randomized controlled trial. Int J Nurs Stud 49: 1391-1402. doi:10.1016/j.ijnurstu.2012.06.014
Lizardi H, Klein DN, Shankman SA (2004) Psychopathology in the adolescent and young adult offspring of parents with dysthymic disorder and major depressive disorder. J Nerv Ment Dis 192:193–199. doi:10.1097/01.nmd.0000116462.18406.8f
*Matthey S, Kavanagh DJ, Howie P, Barnett B, Charles M (2004) Prevention of postnatal distress or depression: an evaluation of an intervention at preparation for parenthood classes. J Affect Disord 79: 113-126. doi:10.1016/S0165-0327(02)00362-2
McQueen K, Montgomery P, Lappan-Gracon S, Evans M, Hunter J (2008) Evidence-based recommendations for depressive symptoms in postpartum women. J Obstet Gynecol Neonatal Nurs 37:127–136. doi:10.1111/j.1552-6909.2008.00215.x
*Miller L, Gur M, Shanok A, Weissman M (2008) Interpersonal psychotherapy with pregnant adolescents: Two pilot studies. J Child Psychol Psychiatry 49: 733-742. doi:10.1111/j.1469-7610.2008.01890
*Misri S, Kostaras X, Fox D, Kostaras D (2000) The impact of partner support in the treatment of postpartum depression. Can J Psychiatry 45: 554-558
Moehler E, Brunner R, Wiebel A, Reck C, Resch F (2006) Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother–child bonding. Arch Women's Mental Health 9:273–278. doi:10.1007/s00737-006-0149-5
*Mulcahy R, Reay RE, Wilkinson RB, Owen C (2010) A randomised control trial for the effectiveness of group interpersonal psychotherapy for postnatal depression. Arch Women's Mental Health 13: 125-139. doi:10.1007/s00737-009-0101-6
Munson JA, McMahon RJ, Spieker SJ (2001) Structure and variability in the developmental trajectory of children's externalizing problems: impact of infant attachment, maternal depressive symptomatology, and child sex. Dev Psychopathol 13:277–296. doi:10.1017/S095457940100205X
O'Hara MW, Swain AM (1996) Rates and risk of postpartum depression: a meta-analysis. Int Rev Psychiatry 8:37–54. doi:10.3109/09540269609037816
*O'Hara MW, Stuart S Gorman LL, Wenzel A (2000) Efficacy of interpersonal psychotherapy for postpartum depression. Arch Gen Psychiatry 57: 1039-1045. doi:10.1001/archpsyc.57.11.1039
*Pearlstein TB, Zlotnick C, Battle CL, Stuart S, O'Hara MW, Price, AB.,…, Howard M (2006) Patient choice of treatment for postpartum depression: a pilot study. Arch Women's Mental Health 9: 303-308. doi:10.1007/s00737-006-0145-9
Pequegnat W, Boyce CA, Stover E (2011) How to write a successful research grant application: a guide for social and behavioral scientists, 2nd edn. Springer, New York
Pinquart M, Teubert D (2010) A meta-analytic study of couple intervention during the transition to parenthood. Fam Relat 59:221–231. doi:10.1111/j.1741-3729.2010.00597.x
Proulx CM, Helms HM, Buehler C (2007) Marital quality and personal well-being: a meta-analysis. J Marriage Fam 69:576–593. doi:10.1111/j.1741-3737.2007.00393.x
*Reay RE, Fisher Y, Robertson M, Adams E, Owen C (2006) Group interpersonal psychotherapy for postnatal depression: a pilot study. Arch Women's Mental Health 9: 31-39. doi:10.1007/s00737-005-0104-x
Rothstein HR (2008) Publication bias as a threat to the validity of meta-analytic results. J Exp Criminol 4:61–81
Ryan D, Mills L, Misri N (2005) Depression during pregnancy. Can Fam Physician 51:1087–1093
Scope A, Booth A, Sutcliffe P (2012) Women's perceptions and experiences of group cognitive behaviour therapy and other group interventions for postnatal depression: a qualitative synthesis. J Adv Nurs 68:1909–1919. doi:10.1111/j.1365-2648.2012.05954.x
Sleath B, West S, Tudor G, Perreira K, King V, Morrissey J (2005) Ethnicity and depression treatment preferences of pregnant women. J Psychosom Obstet Gynecol 26:135–140. doi:10.1080/01443610400023130
Sockol LE, Epperson CN, Barber JP (2011) A meta-analysis of treatments for perinatal depression. Clin Psychol Rev 31:839–849. doi:10.1016/j.cpr.2011.03.009
*Spinelli MG (1997) Interpersonal psychotherapy for depressed antepartum women: a pilot study. Am J Psychiatry 154: 1028-1030
*Spinelli MG, Endicott J (2003) Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. Am J Psychiatry 160: 555-562. doi:10.1176/appi.ajp.160.3.555
*Spinelli MG, Endicott J, Leon AC, Goetz RR, Kalish, RB, Bristman LE, Schulick JL (2013) A controlled clinical treatment trial of interpersonal psychotherapy for depressed pregnant women at 3 New York City sites. J Clin Psychiatry 74: 393-399
*Stuart S, O'Hara MW (1995) Interpersonal psychotherapy for postpartum depression: a treatment program. J Psychother Pract Res 4: 18-29
Ventura SJ, Curtin SC, Abma JC, Henshaw SK (2012) Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990–2008. Natl Vital Stat Rep 60:1–22
Whisman MA, Bruce ML (1999) Marital distress and incidence of major depressive episode in a community sample. J Abnorm Psychol 108:674–678
Whisman MA, Uebelacker LA (2006) Impairment and distress associated with relationship discord in a national sample of married or cohabiting adults. J Fam Psychol 20:369–377. doi:10.1037/0893-3200.20.3.369
Witton SW, Stanley SM, Markman HJ, Baucom BR (2008) Women’s weekly romantic relationship functioning and depressive symptoms. Pers Relationship 15:533–550. doi:10.1111/j.1475-6811.2008.00214.x
Yancy AK, Ortega AN, Kumanyika SK (2006) Effective recruitment and retention of minority research participants. Ann Rev Public Health 27:1–28. doi:10.1146/annurev.publhealth.27.021405.102113
*Zlotnick C, Johnson SL, Miller IW, Pearlstein T, Howard M (2001) Postpartum depression in women receiving public assistance: pilot study of an interpersonal-therapy-oriented group intervention. Am J Psychiatry 158: 638-640. doi:10.1176/appi.ajp.158.4.638
*Zlotnick C, Miller IW, Pearlstein T, Howard M, Sweeney P (2006) A preventative intervention for pregnant women on public assistance at risk for postpartum depression. Am J Psychiatry 163: 1443-1445. doi:10.1176/appi.ajp.163.8.1443
*Zlotnick C, Capezza NM, Parker D (2011) An interpersonally based intervention for low-income pregnant women with intimate partner violence: a pilot study. Arch Women's Mental Health 14: 55-65. doi:10.1007/s00737-010-0195-x
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The author thanks R. Shaffer Claridge, Esquire and Stephanie Simms, B. A. for their diligent coding assistance and Drs. Betsy Becker and Lenore McWey for their comments on an earlier draft.
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Claridge, A.M. Efficacy of systemically oriented psychotherapies in the treatment of perinatal depression: a meta-analysis. Arch Womens Ment Health 17, 3–15 (2014). https://doi.org/10.1007/s00737-013-0391-6
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DOI: https://doi.org/10.1007/s00737-013-0391-6