Department of Medicine, Fatima Jinnah Medical University, Queen's Road, Mozang Chungi, Lahore, 54000, Punjab, Pakistan.
Department of Pediatrics, The Aga Khan University, Karachi, Pakistan.
Arch Womens Ment Health. 2024 Jun;27(3):459-475. doi: 10.1007/s00737-024-01428-2. Epub 2024 Jan 31.
Postnatal depression (PND) impacts numerous women after childbirth, leading to various impairments in their lives. Mental health interventions, such as cognitive behavioral therapy (CBT), need further evaluation in low- and middle-income countries (LMICs) where resources may be scarce. This study aimed to assess the effectiveness of CBT in treating PND in women from LMICs, comparing it to standard care.
A systematic review and meta-analysis were conducted following the PRISMA Statement 2020 guidelines. Databases such as PubMed, CINAHL Plus, Cochrane Library, and PsycINFO were searched until September 2022. A modified Delphi process was employed to identify relevant studies. The primary outcome was mean depression scores, measured by the Edinburgh postnatal depression scale at baseline and post-intervention.
Out of 487 studies identified, five trials were included, totaling 1056 participants (520 in the intervention group and 536 in the comparator group). At baseline, a minor, insignificant positive effect size was found (Cohen's d = 0.1, 95% CI = - 0.15, 0.35). Post-CBT, the intervention group showed significant improvements in depression scores (Cohen's d = - 1.9, 95% CI = - 3.8, 0). When accounting for the influence of one study, (Ngai et al., Psychother Psychosom 84:294-303, 2015), which held substantial weight in the initial analysis, the effect size was adjusted to d = 0.5, highlighting a lesser but still significant difference.
CBT appears to be effective in improving PND symptoms among women in LMICs and may be considered a first-line treatment for at-risk mothers, including those who are displaced. However, the significant impact of one study on the results emphasizes the need for more rigorous research. The study also highlights the challenges and limitations of providing psychotherapies across LMICs, emphasizing the need for culturally adapted and contextually appropriate interventions to ensure successful implementation and sustainability of mental health care for postnatal women in these settings.
产后抑郁症（PND）在分娩后影响着许多女性，导致她们的生活出现各种障碍。认知行为疗法（CBT）等心理健康干预措施在资源可能匮乏的中低收入国家（LMICs）需要进一步评估。本研究旨在评估 CBT 在治疗来自 LMICs 的患有 PND 的女性方面的有效性，并将其与标准护理进行比较。
本研究遵循 PRISMA 声明 2020 指南进行系统评价和荟萃分析。直到 2022 年 9 月，我们检索了 PubMed、CINAHL Plus、Cochrane 图书馆和 PsycINFO 等数据库。采用改良 Delphi 流程来确定相关研究。主要结局指标是基线和干预后使用爱丁堡产后抑郁量表测量的平均抑郁评分。
在确定的 487 项研究中，纳入了五项试验，共 1056 名参与者（干预组 520 名，对照组 536 名）。在基线时，发现了一个较小的、不显著的正效应量（Cohen's d = 0.1，95%CI = -0.15，0.35）。在接受 CBT 后，干预组的抑郁评分显著改善（Cohen's d = -1.9，95%CI = -3.8，0）。在考虑到一项研究（Ngai 等人，Psychother Psychosom 84：294-303，2015）的影响后，该研究在初始分析中具有较大权重，调整后的效应量为 d = 0.5，突出了虽然较小但仍然显著的差异。
CBT 似乎可以有效改善来自 LMICs 的患有 PND 的女性的症状，并且可以被认为是高危母亲的一线治疗方法，包括流离失所的母亲。然而，一项研究对结果的显著影响强调了需要进行更严格的研究。该研究还突出了在 LMICs 提供心理治疗的挑战和限制，强调需要进行文化适应和情境适当的干预，以确保在这些环境中为产后妇女提供成功实施和可持续的精神卫生保健。
