DOI QR코드

DOI QR Code

Effect of Cognitive Behavioral Therapy (CBT) for Perinatal Depression: A Systematic Review and Meta-Analysis

산전우울 임부를 위한 인지행동치료 프로그램의 효과: 체계적 문헌고찰 및 메타분석

  • 신현희 (계명대학교 대학원 간호학과) ;
  • 신영희 (계명대학교 간호대학) ;
  • 김가은 (계명대학교 간호대학)
  • Received : 2016.08.08
  • Accepted : 2016.11.10
  • Published : 2016.11.30

Abstract

This study was carried out to evaluate the efficacy of CBT for perinatal depression through systematic literature review and meta-analysis. The following databases were used to search the literature: CINAHL, PubMed, EMBASE, Koreamed, Library of Korean Congress, KISS, and Korean Academic Publication Database. Keywords included 'perinatal depression,' 'pregnant women,' and 'cognitive behavioral therapy,' and the evaluated articles were published up to May 2016. Using the R program, the effect size of perinatal depression and anxiety were calculated by random-effects model. The heterogeneity of the effect size was analyzed by data moderator analysis using the meta-ANOVA. Furthermore, the funnel plot, Egger's regression test, fail-safe N, trim-and-fill test, and publication bias analysis were conducted and used to verify the results. Out of the 180 selected articles, 16 clinical trial studies were meta-analyzed. Each articles were evaluated for the risk of bias by the checklist of SIGN; the overall risk of bias was low. The effect size of CBT for perinatal depression was Hedges' g=-0.55 (95% CI: -0.76~-0.33), which was a moderate level, while for anxiety reduction, Hedges' g=-0.20 (95% CI: -0.48~-0.08) and it was not statistically significant. Heterogeneity or risk of publication bias were low. This meta-analytic study found that CBT is moderately effective in reducing perinatal depression in pregnant women.

Keywords

Cognitive behavioral therapy;Depression;Intervention;Meta-analysis;Pregnant women

References

  1. Helpguide, Depression in women [Internet], California: Helpguide, 2016, Available From: http://www.helpguide.org/mental/depression_women, (accessed June 3, 2016)
  2. W. A. N. Dorland, "Dorland's illustrated medical dictionary (32nd ed.)," Philadelphia: Elsevier Saunders, 2012.
  3. C. T. Beck, "Predictors of postpartum depression: An update," Nursing Research, 50(5), pp. 275-285, 2001. DOI: http://dx.doi.org/10.1097/00006199-200109000-00004 https://doi.org/10.1097/00006199-200109000-00004
  4. S. K. Choi, S. Y. Ahn, J. C. Shin, D. G. Jang, "A clinical study of depressive symptoms during pregnancy," Korean Journal of Obstetrics and Gynecology, 52(11), pp. 1102-1108, 2009.
  5. C. A. Lancaster, K. J. Gold, H. A. Flynn, H. Yoo, S. M. Marcus, M. M. Davis, "Risk factors for depressive symptoms during pregnancy: A systematic review," American Journal of Obstetrics and Gynecology, 202(1), pp. 5-14, 2010. DOI: http://dx.doi.org/10.1016/j.ajog.2009.09.007 https://doi.org/10.1016/j.ajog.2009.09.007
  6. C. L. Dennis, K. Allen, "Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression," Cochrane Database of Systematic Reviews, 8(4), 2008. DOI: http://dx.doi.org/10.1002/14651858.CD006795.pub2
  7. H. W. Kim, Y. Y. Jung, "Effects of antenatal depression and antenatal characteristics of pregnant women on birth outcomes: A prospective cohort study," Journal of Korean Academy of Nursing, 42(4), pp. 477-485, 2012. DOI: http://dx.doi.org/10.4040/jkan.2012.42.4.477 https://doi.org/10.4040/jkan.2012.42.4.477
  8. S. Misri, K. Kendrick, T. F. Oberlander, S. Norris, L. Tomfohr, H. Zhang, et al, "Antenatal depression and anxiety after postpartum parenting stress: A longitudinal, prospective study," Canadian Journal of Psychiatry, 55(4), pp. 222-228, 2010. https://doi.org/10.1177/070674371005500405
  9. S. N. Choi, "Mother's various psychological characteristics and infant temperament, nurturing behavior, effect on infant development: The mediating effects of nurturing behavior," Journal of the Korea Academia-Industrial cooperation Society, 16(8), pp. 5160-5171, 2015. DOI: http://dx.doi.org/10.5762/KAIS.2015.16.8.5160 https://doi.org/10.5762/KAIS.2015.16.8.5160
  10. H. L. Zhang, C. Y. Li, H. L. Kim, "Status and influencing factors of health behavior in pregnant women in Yanbian area," Journal of the Korea Academia-Industrial cooperation Society, vol. 16, no. 11, pp. 7863-7869, 2015. DOI: http://dx.doi.org/10.5762/KAIS.2015.16.11.7863 https://doi.org/10.5762/KAIS.2015.16.11.7863
  11. K. S. Bang, "Impact of maternal depression on their children: A literature review," Korean Parent Child Health Journal, 11(1), pp. 15-24, 2008.
  12. L. E. Sockol, "A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression," Journal Of Affective Disorders, 177, pp. 7-21, 2015. DOI: http://dx.doi.org/10.1016/j.jad.2015.01.052 https://doi.org/10.1016/j.jad.2015.01.052
  13. H. J. Cho, "Understanding and overcoming of postpartum depression: Efficacy of CBT for postpartum depression," The Korean journal of stress research, 12(3), pp. 39-49, 2004.
  14. A. Rahman, J. Fisher, P. Bower, S. Luchters, T. Tran, M. T. Yasamy, et al, "Interventions for common perinatal mental disorders in women in low and middle income countries: A systematic review and meta-analysis," Bulletin Of The World Health Organization, 91(8), pp. 593-601, 2013. DOI: http://dx.doi.org/10.2471/BLT.12.109819 https://doi.org/10.2471/BLT.12.109819
  15. R. T. Mercer, L. O. Walker, "A review of nursing interventions foster becoming a mother," Journal of Obstetric, Gynecologic and Neonatal Nursing, 35(5), pp. 568-582, 2006. DOI: http://dx.doi.org/10.1111/j.1552-6909.2006.00086.x https://doi.org/10.1111/j.1552-6909.2006.00080.x
  16. S. M. Kwon, "Relationship between depression and anxiety: Their commonness and difference in related life events and cognitions," Psychological Science, 5(1), pp. 13-38, 1996.
  17. S. D. Hwang, "Meta-analysis using R," Seoul: Hakjisa, 2015.
  18. Scottish Intercollegiate Guidelines Network, SIGN 50: A guideline developer's handbook [Internet], Edinburgh: Scottish Intercollegiate Guidelines Network, 2011, Available From: http://www.sign.ac.uk/guidelines/fulltext/50/index.html, (accessed June 3, 2016)
  19. J. P. T. Higgins, S. Green, Cochrane handbook for systematic reviews of interventions version 5.1.0 [Internet], London: The Cochrane Collaboration, 2011, Available From: http://handbook.cochrane.org/, (accessed June 3, 2016)
  20. M. Borenstein, L. V. Hedges, J. P. T. Higgins, H. R. Rothstein, "Introduction to meta-analysis," West Sussex: John Wiley & Sons, 2009. DOI: http://dx.doi.org/10.1002/9780470743386
  21. M. Egger, G. Davey Smith, M. Schneider, C. Minder, "Bias in meta-analysis detected by a simple, graphical test," British Medical Journal, 315(7109), pp. 629-634, 1997. DOI: http://dx.doi.org/10.1136/bmj.315.7109.629 https://doi.org/10.1136/bmj.315.7109.629
  22. S. Duval, R. Tweedie, "A nonparametric trim and fill method of accounting for publication bias in meta-analysis," Journal of the American Statistical Association, 95(449), pp. 89-98, 2000. DOI: http://dx.doi.org/10.2307/2669529
  23. H. S. Kim, E. J. Kim, "Meta-analysis of the effects of nonpharmacological interventions for anxiety disorder," Journal of the Korea Academia-Industrial cooperation Society, 16(11), pp. 7273-7284, 2015. DOI: http://dx.doi.org/10.5762/KAIS.2015.16.11.7273 https://doi.org/10.5762/KAIS.2015.16.11.7273
  24. A. C. Butler, J. E. Chapman, E. M. Forman, A. T. Beck, "The empirical status of cognitive behavioral therapy: A review of meta-analyses," Clinical Psychological Review, 26, pp. 17-31, 2006. DOI: http://dx.doi.org/10.1016/j.cpr.2005.07.003 https://doi.org/10.1016/j.cpr.2005.07.003
  25. P. Cuijpers, M. Berking, G. Andersson, L. Quigley, A. Kleiboer, K. S. Dobson, "A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments," Canadian Journal of Psychiatry, 58(7), pp. 376-385, 2013. https://doi.org/10.1177/070674371305800702
  26. R. Silva, K. Jansen, L. Souza, L. Quevedo, L. Barbosa, I. Moraes, et al, "Sociodemographic risk factors of perinatal depression: A cohort study in the public health care system," Revista Brasileira de Psiquiatria, 34(2), pp. 143-148, 2012. DOI: http://dx.doi.org/10.1016/S1516-4446(12)70031-4 https://doi.org/10.1590/S1516-44462012000200005
  27. J. R. Vittengl, L. A. Clark, T. W. Dunn, R. B. Jarrett, "Reducing relapse and recurrence in unipolar depression: A comparative meta-analysis of cognitive-behavioral therapy's effects," Journal of Consulting and Clinical Psychology, 75(3), pp. 475-488, 2007. DOI: http://dx.doi.org/10.1037/0022-006X.75.3.475 https://doi.org/10.1037/0022-006X.75.3.475
  28. E. Jane-Llopis, C. Hosman, R. Jenkins, P. Anderson, "Predictors of efficacy in depression prevention programmes. Meta-analysis," The British journal of psychiatry, 183, pp. 384-397, 2003. DOI: http://dx.doi.org/10.1192/bjp.183.5.384 https://doi.org/10.1192/bjp.183.5.384
  29. P. Cuijpers, M. Sijbrandij, S. Koole, M. Huibers, M. Berking, G. Andersson, "Psychological treatment of generalized anxiety disorder: A meta-analysis," Clinical Psychology Review, 34, pp. 130-140, 2014. DOI: http://dx.doi.org/10.1016/j.cpr.2014.01.002 https://doi.org/10.1016/j.cpr.2014.01.002