A Systematic Review of Factors Associated With Treatment Engagement and Outcome for Women in the Perinatal Period Receiving Individual Cognitive Behavioral Therapy (CBT) for Depression, Anxiety, and Trauma-Related Disorders

Abstract

Depression, anxiety, and trauma-related disorders commonly occur in the perinatal period, with high rates of comorbidity, and potentially adverse outcomes for women and children. Cognitive behavioral therapy (CBT) is an effective treatment, however less than half of new mothers experiencing symptoms seek treatment. This review was focused on factors affecting treatment engagement and outcome in a clinical perinatal population. A mixed-methods systematic review was conducted according to Cochrane Collaboration Guidelines. We included randomized controlled trials (RCTs) of individual CBT where at least 70% of women met diagnostic criteria for depression, anxiety, or trauma-related disorders during the perinatal period. Information on, and factors associated with treatment engagement, satisfaction, therapeutic alliance were examined as risk ratios (RRs). Twenty-eight studies relating to 19 RCTs, with 2557 participants were reviewed. Most studies examined CBT adapted to the perinatal context. Engagement was good overall, and high levels of satisfaction and therapeutic alliance were reported. A relationship was demonstrated between engagement and outcome in three studies. Dropout did not differ for studies of CBT compared to treatment as usual (TAU), but there was greater dropout for CBT across four studies where the guiding therapist/coach had a minimal level of psychological therapy training and qualifications (k = 4; n = 675; RR 2.38; CI 1.17–4.83). Findings indicate the importance of engagement, which may be optimized by adapting CBT to be relevant to the unique challenges faced by women in the perinatal period, and through therapeutic provision from therapists with at least a moderate amount of psychological therapy training and qualifications.