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


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.


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


  1. Helpguide, Depression in women [Internet], California: Helpguide, 2016, Available From:, (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:
  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:
  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:
  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:
  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.
  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:
  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:
  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:
  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:
  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:
  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:, (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:, (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:
  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:
  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:
  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:
  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:
  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.
  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:
  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:
  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:
  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: