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Review
. 2023 May-Jun:82:47-61.
doi: 10.1016/j.genhosppsych.2023.03.007. Epub 2023 Mar 15.

Effectiveness of interventions to prevent perinatal depression: An umbrella review of systematic reviews and meta-analysis

Emma Motrico  1 , Rena Bina  2 , Angelos P Kassianos  3 , Huynh-Nhu Le  4 , Vera Mateus  5 , Deniz Oztekin  6 , Maria F Rodriguez-Muñoz  7 , Patricia Moreno-Peral  8 , Sonia Conejo-Cerón  9
Affiliations
Review

Effectiveness of interventions to prevent perinatal depression: An umbrella review of systematic reviews and meta-analysis

Emma Motrico et al. Gen Hosp Psychiatry. 2023 May-Jun.

Abstract

Background: To date, dozens of systematic reviews (SRs) and meta-analyses (MAs) summarize the effectiveness of preventive interventions for perinatal depression. However, the results are inconclusive, making an urgent need to step up to higher levels of evidence synthesis.

Aims: To summarize and compare the evidence from the SR&MA examining the effectiveness of all types of interventions for preventing perinatal depression.

Method: PubMed, PsycINFO, Cochrane Database of Systematic Reviews and OpenGrey were searched from inception to December 2022. We selected SR&MA of randomized controlled trials (RCTs) that compared all types of preventive interventions for perinatal depression with control groups whose outcome was the reduction of depressive symptoms and/or incidence of new cases of perinatal depression (PROSPERO: CRD42020173125).

Results: A total of 19 SRs and MAs evaluated 152 unique RCTs that included 83,408 women from 26 countries and five continents. The median effect size for any intervention was SMD = 0.29 (95% CI: 0.20 to 0.38). Exercise/physical activity-based, psychological, and any type of intervention showed median effect sizes of 0.43, 0.28 and 0.36, respectively. The degree of overlap among RCTs was slight. According to AMSTAR-2, 79% of them were rated as low or critically low-quality. The strength of evidence, according to GRADE, was poorly reported and, in most cases, was low.

Conclusions: Exercise/physical activity-based and psychological interventions have a small-to-medium effect on reducing perinatal depressive symptoms. There is insufficient evidence to conclude that dietary supplements and pharmacological interventions are effective in preventing perinatal depression. There is a need for high-quality SR&MA of RCTs, mainly focusing on universal preventive interventions.

Keywords: Perinatal; Prevention; Randomized control trial; depression; meta-analysis; systematic review.

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Conflict of interest statement

Declaration of Competing Interest None.

Figures

Fig. 1
Fig. 1
Flow-chart of excluded and included systematic reviews and meta-analyses.
Fig. 2
Fig. 2
Overlap between the systematic review and/or meta-analysis included in the umbrella review. Note. *: The total number of primary studies (RCTs) included in the systematic review and/or meta-analysis. White = 0 RCTs duplicate; Very light green: 1 RCT duplicate; Light green: 2 RCTs duplicate; Very light blue: 3 RCTs duplicate; Light blue: 4 RCTs duplicate; Blue: 5 RCTs duplicate; Dark blue: 6 RCTs duplicate; Very dark blue: 9 RCTs duplicate. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).
Fig. 3
Fig. 3
Forest-plot of SR&MA of all types of preventive interventions for perinatal depression. Note. Weights are from random effects analysis. (a) Universal interventions; (b) targeted interventions; (c) Indicated interventions; (d) antenatal depression; (e) postnatal depression.
See this image and copyright information in PMC

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