As an LCSW in the State of Utah I care deeply about mood disorders and effective treatment interventions for them. With my doula business up and running and an active clientele that I support, I have started reading more about postpartum mood disorders and the best practices for achieving good mental health during such a crucial time. In August I wrote a blog that gave a brief overview of what postpartum depression is and how it differs from “baby blues.”
That blog can be found here
In that blog I mention that the predominant medication prescribed for the treatment of PPD is Prozac (fluoxetine) because it has shown the best medicinal results (Cooper & Murray, 1998). Today I found myself wondering what the research shows is the best non-medication based intervention for PPD, and that is when I came across this meta-analysis for psychosocial and psychological interventions for preventing the development of PPD.
Before I review the results of this meta-analysis I want to talk more about postpartum depression and why it is so important to know the best interventions and the best ways to help the women in our lives. Depression is one of the most common mental health struggles for men and women across the world, and lifetime rates of depression for women range from 10-25%. For women in their reproductive years (ages 15-44) depression is the leading cause of non-obstetric related hospitalizations. A recent systematic review of 59 studies of postpartum depression found that within the first 12 weeks following childbirth 19.2% of women experienced depression, and of those women 7.1% experienced major depression (Dennis, Brown, Morrell, 2016). Common risk factors for developing PPD are a history of anxiety or depression, depression during pregnancy, complications during delivery, and the occurrence of stressful life events (financial, marital conflict, and the absence of support, Cooper & Murray, 1998).
Women who struggle with PPD may experience some of the following:
insomnia or hypersomnia (sleeping a lot)
feelings of guilt or worthlessness
and in some extreme cases self-harm and thoughts of suicide.
In addition to how PPD impacts the mother, there are also noted impacts on child development compared to children raised by nondepressed mothers, the impacts include lower scores on measures of motor and intellectual development, more difficult temperaments, less secure attachments to their mothers, delayed development of self-regulatory strategies, lower self-esteem, and more social and behavioral problems (Dennis & Dowswell, 2013). As you can see concern for both the mother's health and the health of the baby is warranted.
The meta-analysis that I found was published in 2013 and reviewed 28 studies with almost 17,000 women in 7 countries (Australia, United Kingdom, USA, China, Canada, Germany, and India). The goal was to determine which psychosocial and psychological interventions provided to women antenatally and/or early in the postpartum period would significantly reduce the risk of developing PPD.
They found that professionally-based postpartum home visits by a doula, telephone-based peer support, and interpersonal psychotherapy show the most promising results.
These interventions are able to directly influence the development of postpartum depression by decreasing feelings of loneliness, deterring maladaptive coping responses, supporting positive motivation, and providing information about other local resources. Using these psychosocial and psychological interventions can buffer the impact of PPD in an number of ways, including: reduction of harm of a possible stressor, increasing positive coping skills and problem solving techniques, and normalizing reactions and behavior. Finally, the use of professionally based postpartum home visits, peer support, and interpersonal therapy can mediate the development of PPD by providing positive feedback on accomplishments, opportunities for vicarious learning and role-modeling, and guiding the way by using anticipatory guidance in the weeks following delivery (Dennis & Dowswell, 2013).
What does all of this mean?
It means that women who receive psychosocial and psychological support are 50% less likely to develop PPD compared to those receiving standard care (Dennis & Dowswell, 2013). These interventions are effective because they help combat feelings of worthlessness, guilt, low self-esteem, and loneliness. In visits with postpartum doulas, new moms are able to learn effective positive coping strategies, learn from others with more experience, hear praise when they are doing a great job, process through stressful life events, and normalize their feelings and behaviors.
To provide a brief summary of the meta-analyses findings the following interventions did not significantly impact the development of PPD: antenatal and postnatal classes, postpartum visits from non-professionals, in-hospital psychological debriefing, and cognitive behavioral therapy. What was significantly helpful in the reduction of PPD was professionally-based postpartum home visits by a midwife or doula, telephone-based peer support, and interpersonal psychotherapy (Dennis & Dowswell, 2013).
There are many options available in the support of women during this time including pharmacological, psychological, and psychosocial options. If you have questions talk to your primary care provider, your therapist, or reach out to me in the “contact me” section of my website.
No one needs to face postpartum depression alone.
Cooper, P. J., & Murray, L. (1998). Postnatal depression . BMJ : British Medical Journal, 316(7148), 1884–1886.
Dennis CL, Brown HK, Morrell J. Interventions (other than psychosocial, psychological and pharmacological) for preventing postpartum depression (Protocol). Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD012201. DOI: 10.1002/14651858.CD012201.
Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD001134. DOI: 10.1002/14651858.CD001134.pub3.