Long term effectiveness of cognitive behavior therapy for treatment of postpartum depression: A systematic review and meta-analysis

Background: The existing trials on the long term effectiveness of cognitive behavior therapy (CBT) for the treatment of postpartum depression have conflicting results. Therefore, we performed a systematic review to summarize the current evidence.Methodology: Literature search was performed using electronic databases Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsychINFO were explored from January 2000 to March 2013.All peer-reviewed English-published randomized controlled trials were eligible if they assessed the long term (at least at 24 weeks post partum) effectiveness of CBT versus standard postpartum care for prevention of postpartum depression. Data from eligible studies were abstracted by using structured data extraction form and pooled for calculation of relative risk ratio.Results: Five randomized controlled trials fulfilled eligibility criteria. In the included studies, the total number of women was 1087 with age ranged from 17 years to 42 years. Assessment carried on the ‘Cochrane Risk of Bias Tool’ showed the trials included in this review had low risk of bias. Two trials had sample size less than 50. Two out of five trials reported beneficial effect of CBT whereas three trials found no difference. Meta-analysis [random effect model] revealed 30% reduction in the prevalence of depression in the intervention group as compared with the control group [RR: 0.70 (95% C.I: 0.55 to 0.90)]. However, these results showed effectiveness of intervention because of one large trial and excluding this trial, there was no significant difference.Conclusion: In this systematic review, we found a beneficial effect of CBT in the prevention of postpartum depression at 24 weeks of postpartum period. However, the evidence is limited by a small number of trials with results being dominated by a single large trial. Robust research with larger sample size is needed to determine the long-term effectiveness of CBT for treatment of postpartum depression