Details of 42 studies were tabulated.
Universal antenatal: 5 studies were identified, including one cluster RCT that did not adjust the analysis for cluster randomisation and was excluded. The 4 included studies (one-to-one intervention and 3 midwifery care group interventions) showed no consistent benefit from the interventions.
Selective and indicated antenatal interventions: 8 studies were identified, but one had historical controls and was excluded. Only one study found the intervention (indicated antenatal) reduced major antenatal depression, but the drop-out rate was high, the participation rate was low, and the women lived in very adverse social situations. Other studies found no significant benefit from the intervention.
Interventions during labour: 4 studies of doula or support nurse care were identified. One study found a short-term benefit that was not sustained. The other 3 studies found no benefits from the interventions.
Universal postnatal interventions: 6 studies were found. The results were mixed. Two studies showed benefit: one found a large benefit from midwife-led listening and discussion after birth, but the control group had high anxiety levels and the results may not generalise; the other study found that embedding a relatively intensive intervention in existing community-based midwifery postnatal service had a large positive effect on the mental health score. Four studies showed no effect of interventions; these included one large study (n=1,745) that found no significant difference between debriefing after labour in comparison with usual care.
Selective postnatal interventions: 4 studies were found. The interventions were diverse. Three studies found some benefits from interventions: one study found large benefits 4 to 6 weeks after a postscreening psychological intervention; one found short-term benefits from intensive home-visiting that were not sustained at 4 months; and one found reduced depression with telephone-based peer support. One study found no benefit from debriefing.
Indicated postnatal interventions: 11 studies were identified. Six counselling interventions showed consistent and sustained reductions in measures of depression. One study found benefits with counselling plus fluoxetine versus counselling alone. Three group interventions found mixed results: 2 studies found some benefit from peer support, while the other found no sustained difference between massage and relaxation.
Interventions with mother and child: 4 studies were found. Two studies found no effect for interventions that focused on the mother-child interaction. One study showed some benefit from baby massage plus support group, but it had methodological limitations. The other study showed no consistent effect for an intervention aimed at improving infant sleep patterns.
Meta-analyses showed that only indicated postnatal interventions significantly reduced postnatal depression (7 studies; fixed-effect RR 0.53, 95% CI: 0.44, 0.64). No statistically significant heterogeneity was detected (P=0.20). The funnel plot suggested the possibility of publication bias.
Postnatal counselling interventions significantly reduced postnatal depression (5 studies; random-effects RR 0.46, 95% CI: 0.32, 0.67). Statistically significant heterogeneity was detected (P=0.068). The NNT with postnatal counselling in women diagnosed as depressed was 3 (95% CI: 2, 4).