Comparative effectiveness of interventions for the prevention and treatment of perinatal depression: A systematic review and network meta-analysis

Robert David Smith; Wen Dang; Shuyuan Shen; Sze Chai Hung; Ip Hoi Lam; Jojo Y.Y. Kwok; Edmond P.H. Choi; Daniel Y.T. Fong; Shehzad Ali; Claire A. Wilson; Kris Y.W. Lok

doi:10.1016/j.ajp.2024.104316

Comparative effectiveness of interventions for the prevention and treatment of perinatal depression: A systematic review and network meta-analysis

Robert David Smith, Wen Dang, Shuyuan Shen, Sze Chai Hung, Ip Hoi Lam, Jojo Y.Y. Kwok, Edmond P.H. Choi, Daniel Y.T. Fong, Shehzad Ali, Claire A. Wilson, Kris Y.W. Lok^*

^*Corresponding author for this work

Psychological Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Several interventions have been investigated addressing perinatal depression; however, interventions have not been compared using both direct and indirect evidence. This study compared the relative effectiveness of all interventions that prevent depression (objective 1) or treat depression symptoms (objective 2) in perinatal women. Methods: Eight databases searched from their inception to March 2024. Inclusion criteria were randomised controlled trials in perinatal women participants evaluating any interventions that addressed prevention or treatment of depression. Two random-effects Bayesian network meta-analyses were conducted using studies with perinatal women participants reporting frequency of depression or reporting depression severity. For objective 1 odds ratios (OR) and objective 2 standardised mean differences (SMD) were used. Results: A total of 177 articles were included (n = 76 objective 1, n = 101 objective 2). For objective 1; mindfulness was the highest-ranking intervention (SCURA=88), with significant OR compared to treatment as usual (TAU) (OR=0.21; 0.06, 0.71 95 %CrI). Other interventions with significant OR, compared to TAU included: pharmacological treatments, CBT, physical activities, education, and collaborative care. For objective 2; interpersonal therapy plus massage was the highest-ranking intervention (SCURA=89) with significant SMD compared to TAU (SMD=-1.38; −2.54, −0.21). Other interventions with significant SMD compared to TAU: IPT, alternative therapies, physical activities, mindfulness, CBT, collaborative care, education, and enhanced TAU. Pharmacological treatments were effective compared to sham/placebo. Conclusion: CBT, mindfulness, physical activity, collaborative care, education, and pharmacological interventions were effective in addressing prevention and treatment of perinatal depression symptoms compared to control arms. Healthcare providers may consider offering these interventions to perinatal women.

Original language	English
Article number	104316
Journal	Asian journal of psychiatry
Volume	103
DOIs	https://doi.org/10.1016/j.ajp.2024.104316
Publication status	Published - Jan 2025

Keywords

Network Meta-analysis
Perinatal depression
Prevention
Treatment

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10.1016/j.ajp.2024.104316

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Smith, R. D., Dang, W., Shen, S., Hung, S. C., Lam, I. H., Kwok, J. Y. Y., Choi, E. P. H., Fong, D. Y. T., Ali, S., Wilson, C. A., & Lok, K. Y. W. (2025). Comparative effectiveness of interventions for the prevention and treatment of perinatal depression: A systematic review and network meta-analysis. Asian journal of psychiatry, 103, Article 104316. https://doi.org/10.1016/j.ajp.2024.104316

@article{a7d4fa162ce64073a85fe7416b74ce0c,

title = "Comparative effectiveness of interventions for the prevention and treatment of perinatal depression: A systematic review and network meta-analysis",

abstract = "Background: Several interventions have been investigated addressing perinatal depression; however, interventions have not been compared using both direct and indirect evidence. This study compared the relative effectiveness of all interventions that prevent depression (objective 1) or treat depression symptoms (objective 2) in perinatal women. Methods: Eight databases searched from their inception to March 2024. Inclusion criteria were randomised controlled trials in perinatal women participants evaluating any interventions that addressed prevention or treatment of depression. Two random-effects Bayesian network meta-analyses were conducted using studies with perinatal women participants reporting frequency of depression or reporting depression severity. For objective 1 odds ratios (OR) and objective 2 standardised mean differences (SMD) were used. Results: A total of 177 articles were included (n = 76 objective 1, n = 101 objective 2). For objective 1; mindfulness was the highest-ranking intervention (SCURA=88), with significant OR compared to treatment as usual (TAU) (OR=0.21; 0.06, 0.71 95 %CrI). Other interventions with significant OR, compared to TAU included: pharmacological treatments, CBT, physical activities, education, and collaborative care. For objective 2; interpersonal therapy plus massage was the highest-ranking intervention (SCURA=89) with significant SMD compared to TAU (SMD=-1.38; −2.54, −0.21). Other interventions with significant SMD compared to TAU: IPT, alternative therapies, physical activities, mindfulness, CBT, collaborative care, education, and enhanced TAU. Pharmacological treatments were effective compared to sham/placebo. Conclusion: CBT, mindfulness, physical activity, collaborative care, education, and pharmacological interventions were effective in addressing prevention and treatment of perinatal depression symptoms compared to control arms. Healthcare providers may consider offering these interventions to perinatal women.",

keywords = "Network Meta-analysis, Perinatal depression, Prevention, Treatment",

author = "Smith, {Robert David} and Wen Dang and Shuyuan Shen and Hung, {Sze Chai} and Lam, {Ip Hoi} and Kwok, {Jojo Y.Y.} and Choi, {Edmond P.H.} and Fong, {Daniel Y.T.} and Shehzad Ali and Wilson, {Claire A.} and Lok, {Kris Y.W.}",

note = "Publisher Copyright: {\textcopyright} 2024 Elsevier B.V.",

year = "2025",

month = jan,

doi = "10.1016/j.ajp.2024.104316",

language = "English",

volume = "103",

journal = "Asian journal of psychiatry",

issn = "1876-2018",

publisher = "Elsevier",

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T1 - Comparative effectiveness of interventions for the prevention and treatment of perinatal depression

T2 - A systematic review and network meta-analysis

AU - Smith, Robert David

AU - Dang, Wen

AU - Shen, Shuyuan

AU - Hung, Sze Chai

AU - Lam, Ip Hoi

AU - Kwok, Jojo Y.Y.

AU - Choi, Edmond P.H.

AU - Fong, Daniel Y.T.

AU - Ali, Shehzad

AU - Wilson, Claire A.

AU - Lok, Kris Y.W.

PY - 2025/1

Y1 - 2025/1

N2 - Background: Several interventions have been investigated addressing perinatal depression; however, interventions have not been compared using both direct and indirect evidence. This study compared the relative effectiveness of all interventions that prevent depression (objective 1) or treat depression symptoms (objective 2) in perinatal women. Methods: Eight databases searched from their inception to March 2024. Inclusion criteria were randomised controlled trials in perinatal women participants evaluating any interventions that addressed prevention or treatment of depression. Two random-effects Bayesian network meta-analyses were conducted using studies with perinatal women participants reporting frequency of depression or reporting depression severity. For objective 1 odds ratios (OR) and objective 2 standardised mean differences (SMD) were used. Results: A total of 177 articles were included (n = 76 objective 1, n = 101 objective 2). For objective 1; mindfulness was the highest-ranking intervention (SCURA=88), with significant OR compared to treatment as usual (TAU) (OR=0.21; 0.06, 0.71 95 %CrI). Other interventions with significant OR, compared to TAU included: pharmacological treatments, CBT, physical activities, education, and collaborative care. For objective 2; interpersonal therapy plus massage was the highest-ranking intervention (SCURA=89) with significant SMD compared to TAU (SMD=-1.38; −2.54, −0.21). Other interventions with significant SMD compared to TAU: IPT, alternative therapies, physical activities, mindfulness, CBT, collaborative care, education, and enhanced TAU. Pharmacological treatments were effective compared to sham/placebo. Conclusion: CBT, mindfulness, physical activity, collaborative care, education, and pharmacological interventions were effective in addressing prevention and treatment of perinatal depression symptoms compared to control arms. Healthcare providers may consider offering these interventions to perinatal women.

AB - Background: Several interventions have been investigated addressing perinatal depression; however, interventions have not been compared using both direct and indirect evidence. This study compared the relative effectiveness of all interventions that prevent depression (objective 1) or treat depression symptoms (objective 2) in perinatal women. Methods: Eight databases searched from their inception to March 2024. Inclusion criteria were randomised controlled trials in perinatal women participants evaluating any interventions that addressed prevention or treatment of depression. Two random-effects Bayesian network meta-analyses were conducted using studies with perinatal women participants reporting frequency of depression or reporting depression severity. For objective 1 odds ratios (OR) and objective 2 standardised mean differences (SMD) were used. Results: A total of 177 articles were included (n = 76 objective 1, n = 101 objective 2). For objective 1; mindfulness was the highest-ranking intervention (SCURA=88), with significant OR compared to treatment as usual (TAU) (OR=0.21; 0.06, 0.71 95 %CrI). Other interventions with significant OR, compared to TAU included: pharmacological treatments, CBT, physical activities, education, and collaborative care. For objective 2; interpersonal therapy plus massage was the highest-ranking intervention (SCURA=89) with significant SMD compared to TAU (SMD=-1.38; −2.54, −0.21). Other interventions with significant SMD compared to TAU: IPT, alternative therapies, physical activities, mindfulness, CBT, collaborative care, education, and enhanced TAU. Pharmacological treatments were effective compared to sham/placebo. Conclusion: CBT, mindfulness, physical activity, collaborative care, education, and pharmacological interventions were effective in addressing prevention and treatment of perinatal depression symptoms compared to control arms. Healthcare providers may consider offering these interventions to perinatal women.

KW - Network Meta-analysis

KW - Perinatal depression

KW - Prevention

KW - Treatment

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U2 - 10.1016/j.ajp.2024.104316

DO - 10.1016/j.ajp.2024.104316

M3 - Article

AN - SCOPUS:85212336782

SN - 1876-2018

VL - 103

JO - Asian journal of psychiatry

JF - Asian journal of psychiatry

M1 - 104316

ER -

Comparative effectiveness of interventions for the prevention and treatment of perinatal depression: A systematic review and network meta-analysis

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