Effects of stepped care on depression outcomes in perinatal women: a systematic review and meta-analysis

OBJECTIVE: To evaluate the effects of stepped care (SC) on perinatal depression and to provide the first systematic description of the core components and delivery models. METHODS: Six electronic databases, including PubMed, Web of Science, Embase, Cochrane, Scopus, and Ovid were searched from inception to July 2025. Randomized controlled trials (RCTs), quasi-experimental studies, and pilot studies of SC interventions on depression outcomes in perinatal women were included. Risk of Bias 2 and the Risk of Bias in Non-randomized Studies tools were used to rate the risk of bias in RCT and non-RCT studies, respectively. Meta-analysis and narrative synthesis were conducted based on data availability. Within-group standardized mean differences (SMDs) in depression scores were the primary outcomes, with positive SMDs indicating reductions in depressive symptoms. RESULTS: Seven studies composed of five RCTs and two pre-post studies were included. The duration of SC ranged from pregnancy to postpartum, involving continuous depression monitoring, psychotherapy, and antidepressant treatment. Interventions were delivered individually (n = 5) or in groups (n = 2), all delivered face-to-face (n = 7), with three studies also incorporating telephone formats (n = 3). All interventions were delivered by multidisciplinary teams (n = 7). The pooled analysis of pre-post changes within the intervention groups suggested that SC had large effects on reducing depression during pregnancy (SMD = 1.17, 95% CI:0.85 to 1.49; 2 studies; 91 participants), within the first 3 months postpartum (SMD = 1.71, 95% CI:1.26 to 2.15; 4 studies; 822 participants), at 6–9 months postpartum(SMD = 1.46, 95% CI:0.75 to 2.16; 6 studies; 861 participants), and during long-term follow-up (≥ 12 months postpartum) (SMD = 1.80, 95% CI:1.51 to 2.09; 2 studies; 274 participants). Narrative synthesis of the evidence suggested a potential beneficial effect on treatment engagement. CONCLUSIONS: The findings of this systematic review and meta-analysis suggest that SC has potential to reduce perinatal depression. However, the included studies exhibited considerable heterogeneity, suggesting the need for future research using high-quality RCTs.