Psychosocial Interventions for Perinatal Depression in China: A Systematic Review and Meta-Analysis

Abstract

Background: The prevalence of perinatal depression is 16.3% in China and has shown a rising trend in the last decade. However, very few studies were found comparing and summarizing psychosocial interventions for perinatal depression. This study aimed at evaluating and characterizing psychosocial interventions for perinatal depression in Mainland China. Methods: In this systematic review and meta-analysis, ten major English and Chinese language electronic bibliographic databases were searched for randomized controlled trials examining the effect of psychosocial interventions for perinatal depressed women in Mainland China. Studies meeting eligibility criteria and published before 25th February 2019 were included, while those focusing on a very specific sub-population or reporting non-psychosocial interventions were excluded. Data was extracted from articles by a standard form. Meta-analysis was conducted to obtain a summary measure of the effectiveness of the interventions in reducing perinatal depressive symptoms. The theoretical underpinnings and implementation processes of the interventions were also characterised. Findings: A total of 6,857 articles were identified in the initial database searching, of which, 26 studies were eligible for data analysis, representing a sample size of 4,673. Meta-analysis indicated that psychosocial interventions in China significantly reduced perinatal depressive symptoms (standard difference in means 0·81, 95% confidence intervals -1·03 to -0·58, P<0·001). However, the overall evidence presented substantial heterogeneity (I 2 =91·12%). Most interventions were implemented in hospitals in urban areas by non-specialist health care providers. Few studies reported details of implementation procedures or scale-up strategies. Interpretation: Current psychosocial interventions in China are somewhat effective in reducing perinatal depressive symptoms. High quality randomized controlled trials on scale-up interventions are required, especially in rural areas. Funding Statement: This study was supported by the Chinese Nursing Association (ZHKY201809). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This review was registered with PROSPERO (CRD42018115934).