Non-Pharmacological Strategies for Postpartum Depression: A Network Meta-Analysis of Randomized Controlled Trials

Hilmi Amirul  Haq; Zainab Khalisah  Nurulhaq; Bryan Naufal  Abdullah; Siti  Wahyuni; Farida  Murtiani; Rahmat  Saputra

doi:10.18502/ijps.v21i1.20569

Hilmi Amirul Haq Faculty of Medicine, Sebelas Maret University, Surakarta, Central Java, Indonesia
Zainab Khalisah Nurulhaq Faculty of Medicine, Sebelas Maret University, Surakarta, Central Java, Indonesia
Bryan Naufal Abdullah Faculty of Medicine, Sebelas Maret University, Surakarta, Central Java, Indonesia
Siti Wahyuni Faculty of Medicine, Sebelas Maret University, Surakarta, Central Java, Indonesia
Farida Murtiani Department of Research, Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia
Rahmat Saputra Department of Public Health, Institut Health Payung Negeri, Pekanbaru, Indonesia

DOI: https://doi.org/10.18502/ijps.v21i1.20569

Keywords: Depression; Edinburgh Postnatal Depression Scale (EPDS); Network Meta-Analysis; Postpartum; Psychotherapy

Abstract

Objective: Postpartum depression (PPD) has a significant impact on the mother, child and family. Pharmacologic therapy in breastfeeding mothers often causes side effects, so non-pharmacologic alternatives are needed. This study aims to systematically review and synthesize evidence from randomized controlled trials (RCTs) on the effectiveness of non-pharmacological interventions for PPD through a network meta-analysis.

Method: This network meta-analysis synthesizes evidence from RCTs evaluating non-pharmacological interventions for PPD. We reviewed 13 articles from PubMed, Science Direct, Scopus, and Cochrane Library. Network Meta-Analysis was performed using RStudio with a random effects model, while Rob 2.0, RoB-ME, and CINeMA were used to assess the risk of bias.

Results: The analysis showed that Therapy-Assisted Internet Cognitive Behavioral Therapy (TA-iCBT) had the highest benefit with a Mean Difference (MD) of 6.90 [95% CI 5.35 to 8.45], p = 0.005, as well as the highest effectiveness (P-score 0.891) and very low heterogeneity (I² = 0%). Qualitatively, other alternative therapies are also safe for the mother, but need to be tailored to the patient's needs.

Conclusion: In conclusion, TA-iCBT is the most effective non-pharmacological therapy for PPD and can be the main choice in the psychiatric treatment of PPD patients.