Talk therapy cuts risk of postpartum depression

The months before childbirth can prompt wide-ranging emotions, from joy and excitement to uncertainty and anxiety. Anxiety during pregnancy is common among women in resource-poor settings, where specialist mental health care can be scarce. Studies have found that prenatal anxiety strongly predicts anxiety, depression, and other mental health challenges after childbirth. Prenatal anxiety has also been linked to reduced growth and developmental outcomes for infants.

An NIH-supported research team led by Dr. Pamela J. Surkan at Johns Hopkins Bloomberg School of Public Health thought that an intervention to reduce anxiety during pregnancy might lessen mental health risks after childbirth. This could improve outcomes for both mothers and children.

The researchers first sought input from pregnant women in Pakistan to learn more about their sources of anxiety, coping strategies, and resources. The team then developed an anxiety-focused intervention based on cognitive behavior therapy (CBT). CBT is a type of psychotherapy that trains people to modify specific thoughts and behaviors.

They tested the resulting intervention, called Happy Mother-Healthy Baby, in a randomized controlled trial. Pregnant women with symptoms of mild or greater anxiety but no depression were randomly assigned to receive either the intervention (380 women) or routine medical care (375). The trial was conducted between April 2019 and January 2022 in the Punjab Province of Pakistan.

Women in the intervention group received at least six sessions of one-on-one counseling given mostly during early to mid-pregnancy. A final session occurred during the third trimester. Sessions were designed to teach participants to identify anxious thoughts and behaviors. They then practiced replacing them with helpful thoughts and behaviors. Non-specialists, with the equivalent of a bachelor’s degree in psychology but no clinical experience, were trained to do the counseling.

The participants were assessed for anxiety and depression six weeks after childbirth. Results appeared in Nature Medicine on February 26, 2024.

By six weeks after childbirth, 9% of women in the CBT group had moderate-to-severe anxiety, compared to 27% of those in the control group. In addition, 12% of women receiving CBT had a major depressive episode, compared to 41% in the control group.

Overall, the odds of women who received CBT having either depression or anxiety six weeks after childbirth were reduced by 81% compared to the control group. The findings suggest that this intervention could be an effective way to reduce the risks of developing postpartum mental health conditions.

“In low resource settings, it can be challenging for women to access mental health care due to a global shortage of trained mental health specialists,” says Dr. Joshua A. Gordon, director of NIH’s National Institute of Mental Health. “This study shows that non-specialists could help to fill this gap, providing care to more women during this critical period.”