A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression

• Published in: Health technology assessment (Winchester, England) England), 2016-05, Vol.20 (37), p.1-414
• Main Authors: Morrell, C Jane, Sutcliffe, Paul, Booth, Andrew, Stevens, John, Scope, Alison, Stevenson, Matt, Harvey, Rebecca, Bessey, Alice, Cantrell, Anna, Dennis, Cindy-Lee, Ren, Shijie, Ragonesi, Margherita, Barkham, Michael, Churchill, Dick, Henshaw, Carol, Newstead, Jo, Slade, Pauline, Spiby, Helen, Stewart-Brown, Sarah
• Format: Article
• Language: English
• Subjects: Adult; Antidepressive Agents - therapeutic use; Cognitive Behavioral Therapy - methods; Complementary Therapies - methods; Cost-Benefit Analysis; cost-effectiveness; Depression, Postpartum - prevention & control; Female; Humans; meta-analysis; Midwifery - organization & administration; Mothers - psychology; Patient Education as Topic - organization & administration; Postnatal Care - organization & administration; postnatal depression; postnatal women; Pregnancy; pregnant women; Prenatal Care - organization & administration; prevention; Qualitative Research; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; realist synthesis; Risk Factors; Social Support; systematic review; United Kingdom
• ISSN: 1366-5278; 2046-4924
• DOI: 10.3310/hta20370

Postnatal depression (PND) is a major depressive disorder in the year following childbirth, which impacts on women, their infants and their families. A range of interventions has been developed to prevent PND. To (1) evaluate the clinical effectiveness, cost-effectiveness, acceptability and safety of antenatal and postnatal interventions for pregnant and postnatal women to prevent PND; (2) apply rigorous methods of systematic reviewing of quantitative and qualitative studies, evidence synthesis and decision-analytic modelling to evaluate the preventive impact on women, their infants and their families; and (3) estimate cost-effectiveness. We searched MEDLINE, EMBASE, Science Citation Index and other databases (from inception to July 2013) in December 2012, and we were updated by electronic alerts until July 2013. Two reviewers independently screened titles and abstracts with consensus agreement. We undertook quality assessment. All universal, selective and indicated preventive interventions for pregnant women and women in the first 6 postnatal weeks were included. All outcomes were included, focusing on the Edinburgh Postnatal Depression Scale (EPDS), diagnostic instruments and infant outcomes. The quantitative evidence was synthesised using network meta-analyses (NMAs). A mathematical model was constructed to explore the cost-effectiveness of interventions contained within the NMA for EPDS values. From 3072 records identified, 122 papers (86 trials) were included in the quantitative review. From 2152 records, 56 papers (44 studies) were included in the qualitative review. The results were inconclusive. The most beneficial interventions appeared to be midwifery redesigned postnatal care [as shown by the mean 12-month EPDS score difference of -1.43 (95% credible interval -4.00 to 1.36)], person-centred approach (PCA)-based and cognitive-behavioural therapy (CBT)-based intervention (universal), interpersonal psychotherapy (IPT)-based intervention and education on preparing for parenting (selective), promoting parent-infant interaction, peer support, IPT-based intervention and PCA-based and CBT-based intervention (indicated). Women valued seeing the same health worker, the involvement of partners and access to several visits from a midwife or health visitor trained in person-centred or cognitive-behavioural approaches. The most cost-effective interventions were estimated to be midwifery redesigned postnatal care (universal), PCA-based intervention (indicated)