Table 1 Characteristics of included articles
Author (year) | Study design (sample size) | Country | Participant characteristics | Postpartum depression | Treatment | ||||
|---|---|---|---|---|---|---|---|---|---|
Race/ethnicity distribution | Mean age | Measure | Definition | Assessment | Type | Treatment outcome | |||
Abrams et al. (2009) [28] | Cohort (14) | USA | B—43%, L—57% | 27 | Self-report | Self-report of PPD symptoms | Self-assessment through focus groups, individual interviews | No women in this study sought treatment | No women in this study sought treatment |
Beeber et al. (2004) [15] | RCT (16) | USA | W—38%, B—62% | 26.6 | CES-D | 16 or higher on CES-D | Intervention group | Therapeutic relationship with master-prepared psychiatric mental health nurse home visitor —8 face-to-face contacts over 8–10 weeks, then about 5 phone calls per week for 8 weeks | 50% randomized to treatment intervention, no one in control group (n = 8) sought treatment during study period |
Bobo et al. (2014) [34] | RCT (2343) | USA | W—65%, B—15%, A—1%, U—19% | 26.4 | EPDS, PHQ-9 | 10 or more on EPDS or PHQ-9 | Intervention group | Nursing staff: follow-up telephone calls dealing with antidepressant drug therapy or counseling initiation, adherence, and adverse effects | Treatment selection at discretion of participant (not reported); of 1246 who completed supplemental survey, 9.2% were unable to access treatment |
Broom et al. (2015) [30] | Cohort (58) | USA | W—14%, B—83%, M—3% | NR | EPDS, BDI-II | 10 or more on EPDS | All study participants received treatment | Supportive 4 text messages/week for 6 months; CBT counseling—unlimited access to therapeutic services and telephone support | CBT use not reported; 1.9% of total texts sent requested a call back from researchers |
Callister et al. (2011) [35] | Cohort (20) | USA | L—100% | 24 | PDSS-Spanish | Cutoff score of 60 on PDSS for positive screen | Interview | Interview to assess PPD thoughts, treatments, and barriers | Women were not directly asked about their own treatment |
Chaundron et al. (2005) [27] | Cohort (218) | USA | L—100% | 26.5 | EPDS | Self-recognition: “yes” to question, “have you thought that you needed help with sadness or depression”; 10 or more on EPDS | Self-report | Referral to mental health specialist after self-report to physician | 28% of participants felt they needed help, 47.5% of those participants spoke to a provider, and 33% of those were referred to a mental health specialist |
Crockett et al. (2008) [32] | RCT (36) | USA | B—100% | 23.4 | CSQ, EPDS | 27 or more on CSQ, 10 or more on EPDS | Intervention group | Four 90-min weekly group sessions and a 50-min individual booster session 2 weeks after delivery | 52.7% participants randomized to treatment |
Geier et al. (2015) [36] | Retrospective cohort (6030) | USA | W—9%, B—3%, A—1%, L—85%, O—1%, U—1% | NR | ICD-9 code | Any ICD-9 code for depressive illness as primary or secondary diagnosis | ICD-9 codes for treatment | (1) Received antidepressant medication only, (2) received psychotherapy only, (3) received both antidepressant medication and therapy, and (4) received neither | 4.1% received antidepressants postpartum; 56% of depressed cohort received treatment vs 74% of control group |
Kozhimannil et al. (2011a) [40] | Cohort (30,955) | USA | W—42%, B—43%, O—15% | NR | New Jersey’s Medicaid data | No documented diagnosis to indicate treatment initiation | Medicaid data on filling a prescription for antidepressant medication or having had an outpatient mental health visit in 6 months after delivery | Antidepressants or outpatient mental health visit | 7% initiated mental health treatment, of which 90% used outpatient mental health services and antidepressants |
Kozhimannil et al. (2011b) [39] | Retrospective cohort (29,601) | USA | W—44%, B—45%, A—11% | NR | ICD-9 code | Any ICD-9 code for depressive illness as primary or secondary diagnosis | ICD-9 codes for treatment | Filling a prescription for antidepressant medication or having had an outpatient mental health visit in 6 months after delivery | 9% white women, 4% black women, and 5% Latina women initiated treatment |
Letourneau et al. (2007) [25] | Cohort (41) | Canada | W—81%, N—10%, O—9% | 31.27 | EPDS | 10 or more on EPDS | Interview | Support seeking, support needs, barriers to support, and preferences for support intervention | 43.9% were unable to locate support programs for PPD; those with treatment not reported |
Logsdon et al. (2009) [29] | Cohort (9) | USA | W—22%, B—44%, L—22%, N—11% | 16 | Self-report | Self-report of PPD symptoms | Semi-structured interview: What actions might you take if you had a lot of negative (sad/unhappy) feelings after having a baby? Probes: Is there anything you can do? What might you do first? What do you think is the best way to handle a situation like this? Who would be someone you could go to help you? Anyone else? Have you had any experience in getting help in a situation like this? If so, what were the challenges to getting help with negative feelings after having a baby? | No women in this study sought treatment | Participants were asked if they had received help for negative feelings, but outcome is not reported in paper |
McGarry et al. (2009) [26] | Retrospective cohort (213) | USA | W—85%, O—15% | NR | Primary Care Evaluation of Mental Disorders Patient Health Questionnaire | Response of “always” or “often” to the following: (1) Since your new baby was born, how often have you felt down, depressed, or hopeless? and (2) Since your new baby was born, how often have you had little interest or little pleasure in doing things? | Survey question: “Since your new baby was born, did you seek help for depression from a doctor, nurse, or other health care worker?” | Type of treatment not specified | 60.5% (unweighted) women who reported PPD did not seek help |
O’Mahoney et al. (2012) [37]; O’Mahoney et al. (2013) [38] | Cohort (30) | Canada | B—7%, A—50%, L—43% | NR | EPDS | 10 or more on EPDS | Self-report in interview | Type of treatment not specified | Patents were unfamiliar with or unaware of treatment options |
Price et al. (2009) [31] | Cohort (1086) | USA | W—70%, B—27%, L—2%, O—1% | 24.6 | PHQ | Published guidelines for PHQ | Self-report on questionnaire | Type of treatment not specified | Treatment specific to postpartum women not reported: 38% sample with depressive symptoms, 3.4% postpartum, 2.3% current psychiatric medication use, and 5.5% current counseling |
Song et al. (2004) [33] | Cohort (3841) | USA | W—17%, B—83% | 24.4 | Psychiatric diagnosis | DSM-III-R criteria for severe mental disorders, major depression, minor psychiatric disorders | Medical chard codes for using mental health services | Inpatient, outpatient mental health visits (psychiatrists, psychologists, psychiatric social workers, community psychiatric nurses) | 6.4% used mental health services in postpartum period |
Surkan et al. (2012) [24] | RCT (679) | USA | L—75%, UTD—25% | 26 | CES-D | Standard CES-D cut-off | Randomized to control (WIC benefits) or intervention | Five home visits, delivered by paraprofessionals, monthly phone calls from intervention staff | 49.6% patients randomized to intervention with treatment |