Peer-delivered CBT may reduce symptoms of postpartum depression, anxiety

Cognitive behavioral therapy for postpartum depression delivered by women who have experienced it improved symptoms of this disorder and anxiety, according to results of a randomized controlled trial published in Journal of Clinical Psychiatry.

It also appeared linked to improvements in the mother-infant relationship.

“Peer-administered interventions (PAIs), those delivered by former sufferers, are increasingly recognized as alternatives to traditional mental health services and can overcome some barriers to [postpartum depression (PPD)] treatment,” Bahar Amani, MA, of the Neuroscience Graduate Program at McMaster University in Canada, and colleagues wrote. “They capitalize on the number of women who have experienced PPD and the fact that levels of therapist training may not predict psychotherapy effectiveness. Studies examining the impact of PAIs for depression in general population samples suggest they have the biggest impact if they are structured and utilize evidence-based treatments (eg, CBT).”

The investigators sought to determine whether 9 weeks of group CBT intervention delivered by women who previously had PPD could reduce symptoms of PPD and anxiety, as well as bolster social support and the bond between mother and infant. They randomly assigned 73 mothers who lived in Canada to experimental or waitlist control groups between March 2018 and February 2020.

Participants were aged 18 years or older, had an infant younger than 12 months, had English fluency and scored 10 or higher on the Edinburgh Postnatal Depression Scale. Those in the experimental group received 9 weeks of the group CBT intervention immediately following study enrollment, whereas those in the control group received it following a 9-week waiting period. The researchers assessed all outcomes at enrollment (n = 54) and 9 weeks later (n = 38). They assessed outcomes among the experimental groups at 6 months to determine treatment stability.

Results showed peer-delivered group CBT for PPD correlated with clinically and statistically significant improvements in symptoms of depression and anxiety among the experimental group. At 6 months, these improvements remained stable. Further, the experimental group exhibited decreases in perceptions of impaired mother-infant bonding and rejection and pathological anger at 6 months.

“Peer-delivered group CBT may be an effective and scalable means of addressing the limitations of existing health care systems to address PPD and has the potential to reach women who would otherwise not receive treatment, significantly improving outcomes for them, their families and society,” Amani and colleagues wrote.