The efficacy of antenatal Cognitive Behavioural Therapy for antenatal and postnatal depression: A PRISMA based systematic review and meta-analysis

Dooley, R. L., & McAloon, J. (2025). The efficacy of antenatal cognitive Behavioural therapy for antenatal and postnatal depression: A PRISMA based systematic review and meta-analysis. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2025.02.008

Summary by: Ana Melissa Caballero Pasquini

This study emphasizes the potential risks and effective treatments of depression during the antenatal and postnatal period of pregnancy, considering it is a period of ongoing hormonal changes. Antenatal depression usually increases risk for mothers and children, including obstetrics and neonatal complications, difficulty in mother-infant attachment, and the development of depression after birth. However, its severity can vary during the perinatal period, raising the questions of whether antenatal depression and postnatal depression should be considered as two different conditions of affective illness. Considering that Cognitive Behavioral Therapy has been widely used to aid symptoms of depression, this study aimed to investigate the effectiveness of this therapy during the antenatal period and postnatal period. The study also aims to examine delivery format, treatment facilitator, location, outcome measures, age, gestation, parity, and symptom severity as factors that influence the effectiveness of CBT treatment.

By using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,  studies with pregnant female participants from 2000-2023 were chosen based on whether they experienced clinical levels of depression and were receiving CBT treatment for affective or depressive symptoms with control groups based on a non-clinical intervention. It included studies with psychometric assessments of depression before, during, or within 12 months of birth. While those studies that portrayed clinical comorbidities were excluded. The risk of bias was assessed with the help of the Cochrane Risk of Bias Tool Version 2. The data extracted from studies included: intervention type, sample size and mean participant age, mean gestation week, inclusion criteria, participant demographics, and outcome measures. The following statistical analyses were utilized:  Comprehensive Meta-Analysis Version 3, random effects models, meta-regressions and subgroup analyses.

The study found that CBT delivered during pregnancy significantly reduced symptoms of depression experienced in the antenatal period, and up to 12 months in the postnatal period in between and within group analyses. Nevertheless, the effectiveness of symptom reduction was higher for those in the antenatal period. The following variables were found to be moderators for treatment outcomes in both the antenatal and postnatal periods: maternal age, number of weeks of gestation, multiparity, marital status, and almost all psychometric assessment measures. The following variables were found to be less consistent when moderating treatment effectiveness: facilitator of treatment, treatment delivery mode, outcome measure, and symptom severity. Meanwhile, only the delivery of treatment by mental health professionals seems to moderate treatment outcomes in the postnatal period.

This study demonstrates that Cognitive Behavioral Therapy has benefits for treating depression in both the antenatal and postnatal periods. It serves as a guidance for future practitioners to utilize CBT especially during the antenatal period, considering its higher effectiveness compared to the postnatal period benefits. The study also suggests the identification of depression in the antenatal period to be distinct from the postnatal period. It also contributes to the specific moderators that influence treatment outcomes. However, more research utilizing larger samples and active control groups could be beneficial, as well as exploration of how specific moderators impact pregnancy.