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

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.

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).

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.

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.