Psychological intervention for postpartum depression: A systematic review and network meta-analysis.

BACKGROUND

Postpartum depression (PPD) is a common and serious psychiatric disorder occurring during the perinatal period, frequently accompanied by anxiety symptoms and associated with long-term adverse consequences for both maternal health and infant development. This study aimed to compare and rank the effectiveness of psychological interventions for PPD with respect to short-term anxiety, short-term depressive symptoms, and long-term depressive outcomes.

METHODS

PubMed, Embase, Cochrane Library, as well as Web of Science were thoroughly searched until May 6, 2025, for randomized controlled trials (RCTs) evaluating psychological treatments for PPD. A Bayesian network meta-analysis (NMA) was performed to assess the relative efficacy of different interventions. The protocol was prospectively registered in PROSPERO (Registration No.: CRD420251046914).

RESULTS

35 RCTs were encompassed, including seven psychological interventions and two control conditions. Online cognitive behavioral therapy (OCBT) demonstrated the most consistent benefit in reducing short-term anxiety and ranked highest in the primary analysis (SUCRA: 91.98%). For short-term depressive symptoms, interpersonal psychotherapy (IPT) ranked highest in the primary analysis (SUCRA: 94.72%) and was associated with the most favorable effect compared with treatment as usual (TAU). Nevertheless, the treatment rankings for short-term depression were sensitive to the exclusion of studies at high risk of bias and therefore warrant cautious interpretation. Regarding long-term depressive outcomes, no intervention showed a statistically significant advantage over TAU, and the corresponding rankings remained uncertain. Cognitive behavioral group therapy (CBGT) and mindfulness-based cognitive therapy (MBCT) generally exhibited intermediate rankings for short-term outcomes, whereas individual cognitive behavioral therapy (ICBT) ranked lower for short-term depression in the primary analysis.

CONCLUSION

OCBT may be a promising option for short-term anxiety management in women with PPD. IPT demonstrated favorable effects on short-term depressive symptoms in the primary analysis, but the relative ranking of interventions for short-term depression was less robust in sensitivity analyses. Evidence regarding long-term efficacy remains limited, highlighting the need for further high-quality randomized trials with longer follow-up.