Psychosocial and psychological interventions for treating antenatal depression

Not enough evidence to say if non-drug interventions are effective in treating antenatal depression.

Although for many women pregnancy was once thought of as a time of emotional wellbeing, approximately 12% of women will suffer from antenatal depression. Research suggests that women who are on low-income, lack social support, experience significant stress or negative life events, and have poor relationships may be at higher risk of developing antenatal depression.
Unfortunately, depression during the pregnancy is related to poor maternal self-care behaviours, which may influence the baby's health, and it places a woman at significant risk of developing postpartum depression. Many women are unwilling to take medication during their pregnancy and are often interested in psychosocial and psychological interventions as a form of treatment. The review found only one trial involving 50 US women evaluating interpersonal psychotherapy for the treatment of antenatal depression. This trial provided insufficient evidence to determine if psychological therapies are effective treatment for antenatal depression. Further research is needed.

Authors' conclusions: 

The evidence is inconclusive to allow us to make any recommendations for interpersonal psychotherapy for the treatment of antenatal depression. The one trial included was too small, with a non-generalisable sample, to make any recommendations.

[Note: The 12 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

Read the full abstract...

Although pregnancy was once thought of as a time of emotional wellbeing for many women, conferring 'protection' against psychiatric disorders, a recent meta-analysis of 21 studies suggests the mean prevalence rate for depression across the antenatal period is 10.7%, ranging from 7.4% in the first trimester to a high of 12.8% in the second trimester. Due to maternal treatment preferences and potential concerns about fetal and infant health outcomes, non-pharmacological treatment options are needed.


The primary objective of this review is to assess the effects, on mothers and their families, of psychosocial and psychological interventions compared with usual antepartum care in the treatment of antenatal depression.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2006), the Cochrane Collaboration Depression Anxiety and Neurosis Group's Trials Registers (CCDANCTR-Studies and CCDANCTR-References) (July 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 3), MEDLINE (1966 to July 2006), EMBASE (1980 to July 2006) and CINAHL (1982 to July 2006). We also scanned secondary references and contacted experts in the field to identify other published or unpublished trials.

We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 31 March 2010 and added the results to the awaiting classification section.

Selection criteria: 

All published, unpublished and ongoing randomised controlled trials of preventive psychosocial or psychological interventions in which the primary or secondary aim is to treat antenatal depression. We excluded quasi-randomised trials (for example, those randomised by delivery date, or odd versus even medical record numbers) from the analysis.

Data collection and analysis: 

All review authors participated in the evaluation of methodological quality and data extraction. Results are presented using relative risk for categorical data and weighted mean difference for continuous data.

Main results: 

One US trial was included in this review, incorporating 38 outpatient antenatal women who met Diagnostic and Statistical Manual for Mental Disorders-IV criteria for major depression. Interpersonal psychotherapy, compared to a parenting education program, was associated with a reduction in the risk of depressive symptomatology immediately post-treatment using the Clinical Global Impression Scale (one trial, n = 38; relative risk (RR) 0.46, 95% confidence interval (CI) 0.26 to 0.83) and the Hamilton Rating Scale for Depression (one trial, n = 38; RR 0.82, 95% CI 0.65 to 1.03).