Preventing postpartum depression part II: A critical review of nonbiological interventions.

OBJECTIVE To critically review the literature to determine the current state of scientific knowledge concerning the prevention of postpartum depression (PPD) from a nonbiological perspective. METHODS Databases searched for this review include Medline, PubMed, Cinahl, PsycINFO, Embase, ProQuest, the Cochrane Library, and the World Health Organization Reproductive Health Library. Studies selected were peer-reviewed English-language articles published between January 1, 1966, and December 31, 2003. Criteria used to evaluate the interventions were derived from the standardized methodology developed by the Canadian Task Force on Preventive Health Care. RESULTS Twenty-nine studies that met criteria were examined. These included studies evaluating interpersonal psychotherapy, cognitive-behavioural therapy, psychological debriefing, antenatal classes, intrapartum support, supportive interactions, continuity of care, antenatal identification and notification, early postpartum follow-up, flexible postpartum care, educational strategies, and relaxation with guided imagery. CONCLUSIONS While this review demonstrates that no specific approach can be strongly recommended for clinical practice, many explicit research implications have been highlighted. To further address PPD as a public health problem, it is critical to include ethnically and socioeconomically diverse women in research efforts examining the differences among depression symptoms, intervention response rates, and health service use.