Approaches to the prevention of postnatal depression and anxiety – a review of the literature

Abstract

Introduction: Poor maternal mental health during the perinatal period has been shown to have potentially long-lasting effects for mother and child. In recognition of this, maternal mental health is receiving increased attention from political and healthcare organizations, with a growing focus on preventing the onset of common mental health disorders.

Objective: The objective for this review is to provide an update of randomized controlled trials examining the use of interventions targeted to prevent the onset of postnatal depression and anxiety in nondiagnostic populations with universal or selected samples.

Methods: A total of four databases, EBSCO Host, Science Direct, Scopus, and Web of Science, incorporating PsychINFO were searched and papers selected according to clearly specified inclusion criteria. A large Health Technology review was published in 2016, for which the final search was conducted in December 2012. Therefore inclusion criteria were studies published from January 2013 onwards, available in English language, had a focus on prevention of postnatal maternal depression and anxiety, and used psychological interventions. Drug intervention trials were excluded.

Findings: 12 studies were identified as examining antenatal or postnatal intervention trials with an aim of preventing maternal postnatal depression and/or anxiety. There continues to be limited evidence to recommend specific prevention strategies for universal samples without further testing. There is evidence to suggest the use of rational-emotive behavioral therapy in an antenatal sample may have some utility, and the use of psychotherapy-based interventions in a postnatal setting is also supported although both require further investigation. Additionally, there is a need to gather information on acceptability, as many trials were hindered by poor adherence to interventions and high attrition that were otherwise unexplained.

KEYWORDS:

• Prevention
• postnatal depression
• RCT
• psychological
• intervention

Disclosure statement

No potential conflict of interest was reported by the authors.

Current knowledge on this subject

• Perinatal maternal mental health is important for women and the developing fetus.

• The importance of maternal mental health is increasing on both health and political agendas worldwide.

• There is some evidence of the efficacy of psychosocial/psychological interventions for the prevention of postnatal depression and anxiety.

What this study adds

• Recent additions to the literature do not add robust evidence of effectiveness of universal antenatal or postnatal prevention of postnatal distress.

• There is evidence to support the use of Rational Emotive Behavioral Therapy in samples of women during the antenatal period. There is also evidence to support the use of psychotherapy-based interventions in the postnatal setting, but both require additional investigation.

• There is a need for more detailed qualitative feedback on acceptability of interventions for women.

Additional information

Funding

This research was part funded by The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC). The views expressed here are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.