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Cognitive Behavioral Therapy for Insomnia in Postpartum Depression: A Meta-Analysis of Therapeutic Outcomes and
Zeeshan Ali1, Osama Akhtar1, Zekra Ehsaan2
1Psychiatry and Behavioral Sciences, Hayatabad Medical Complex Peshawar, Peshawar, PAK.
Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia in the general population and pregnant women. However, its effects on postpartum depression remain underexplored. Objectives of this meta-analytic review were to evaluate the effects of CBT-I on postpartum depression, insomnia severity, and total sleep time in perinatal women. PubMed, ScienceDirect, and Google Scholar databases were searched. Randomized controlled trials with perinatal women, CBT-I as intervention, and comparison with any other intervention were included. Bias was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool. Four studies were deemed eligible, with a combined sample size of 381 participants. Insomnia severity, postpartum depression, and total sleep time were selected as outcomes. Mean differences were calculated with 95% confidence interval (CI), and heterogeneity was assessed using I 2 statistics. For insomnia severity, a mean difference of -2.30 (95% CI: -4.10 to -0.49, P = 0.0126) was obtained, favoring the CBT-I group. For postpartum depression, a standardized mean difference of -0.20 (95% CI: -0.40 to 0.00; P = 0.0502) showed borderline statistical significance, also favoring the CBT-I group. However, for total sleep time, a mean difference of 0.44 (95% CI: -0.04 to 0.92; P = 0.075) with 66% heterogeneity showed nonsignificant results, mainly due to an outlier study. With this outlier study, the heterogeneity dropped to 0%, the mean difference increased to 0.68 (95% CI: 0.37-0.99), reaching statistical significance (P < 0.0001). This meta-analysis demonstrates that CBT-I significantly reduces insomnia severity and improves total sleep time in perinatal women, with a borderline significant reduction in postpartum depression scores. Despite its growing evidence, it remains an underutilized treatment option. By incorporating it, the overall quality of maternal healthcare services can be improved.
Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia in the general population and pregnant women. However, its effects on postpartum depression remain underexplored. Objectives of this meta-analytic review were to evaluate the effects of CBT-I on postpartum depression, insomnia severity, and total sleep time in perinatal women. PubMed, ScienceDirect, and Google Scholar databases were searched. Randomized controlled trials with perinatal women, CBT-I as intervention, and comparison with any other intervention were included. Bias was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool. Four studies were deemed eligible, with a combined sample size of 381 participants. Insomnia severity, postpartum depression, and total sleep time were selected as outcomes. Mean differences were calculated with 95% confidence interval (CI), and heterogeneity was assessed using I 2 statistics. For insomnia severity, a mean difference of -2.30 (95% CI: -4.10 to -0.49, P = 0.0126) was obtained, favoring the CBT-I group. For postpartum depression, a standardized mean difference of -0.20 (95% CI: -0.40 to 0.00; P = 0.0502) showed borderline statistical significance, also favoring the CBT-I group. However, for total sleep time, a mean difference of 0.44 (95% CI: -0.04 to 0.92; P = 0.075) with 66% heterogeneity showed nonsignificant results, mainly due to an outlier study. With this outlier study, the heterogeneity dropped to 0%, the mean difference increased to 0.68 (95% CI: 0.37-0.99), reaching statistical significance (P < 0.0001). This meta-analysis demonstrates that CBT-I significantly reduces insomnia severity and improves total sleep time in perinatal women, with a borderline significant reduction in postpartum depression scores. Despite its growing evidence, it remains an underutilized treatment option. By incorporating it, the overall quality of maternal healthcare services can be improved.
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