Effectiveness of psychological interventions for reducing depressive symptoms among women experiencing perinatal depression: a systematic review

Abstract

Background

Psychological interventions are well established as effective treatments for perinatal depression, with strong evidence supported by randomized controlled trials carried out in diverse cultural contexts and in settings with limited resources. Approaches such as cognitive behavioral therapy, problem-solving therapy, interpersonal therapy, and community based models that rely on task-sharing have repeatedly shown meaningful reductions in depressive symptoms and notable improvements in maternal functioning and overall well-being. These interventions are especially important in low- and middle- income countries (LMICs) where access to specialist mental health professionals is seriously limited. Evidence demonstrating that appropriately trained non-specialist including community health workers (CHW), Peers, and lay counselors can successfully deliver this intervention within primary health care and community platforms highlighting their practicality and effectiveness. Consequently, task-sharing strategies are therefore considered a promising and sustainable approach for reducing the treatment gap for perinatal depression in resource-constrained contexts.

Objective

This systematic review aimed to evaluate the effectiveness of psychological interventions in reducing depressive symptoms among women experiencing perinatal depression in low and middle income countries.

Study Design

Studies were eligible if they evaluated task-shared or lay-delivered psychological interventions for perinatal depression among pregnant or postpartum women aged 18 years and older in LMICs. Only randomized controlled trials or cluster randomized controlled trials were included. Participants were required to have screened positive for depressive symptoms or to have been diagnosed with major depressive disorder using validated screening or diagnostic instruments. Studies that solely addressed severe mental illness necessitating inpatient psychiatric treatment lacked a comparison group or did not report outcomes related to depression were excluded.

Methods and information sources

Major electronic databases commonly utilized in health research were thoroughly and systematically searched, with the most recent search conducted in Month/Year. Only studies published in English were considered. The study selection was carried out in staged manner according to predetermined eligibility criteria, with independent review of titles, abstracts, and full-text articles. The methodological quality and risk of bias of included studies were evaluated using standardized appraisal tools and relevant data were collected using a structured and piloted data extraction form. Due to substantial heterogeneity in intervention content, delivery modes, settings, and outcome measures, a narrative synthesis was undertaken rather than a meta-analysis. The level of confidence in the evidence for the main outcomes was evaluated, and no substantial deviations from the predetermined methodological plan were observed.

Results

Eleven studies met the inclusion criteria, comprising ten randomized controlled trials and one formative mixed-methods study, with a total sample of 4809 perinatal women from Pakistan, South Africa, and Tanzania. Interventions primarily involved task-shared psychological therapies delivered by peers, community health workers, or lay counsellors, often based on cognitive behavioral or problem-solving principles. Study quality was mixed, with generally low risk of bias in well-conducted trials but important limitations related to heterogeneity of outcome measures, limited reporting on cost-effectiveness, and incomplete effectiveness data in formative and protocol-based studies. Technology-assisted, peer-delivered interventions demonstrated similar or greater reductions in depressive symptoms and higher remission rates compared with standard care. Conversely, certain task-shared interventions did not demonstrate a statistically meaningful advantage when compared with enhanced usual care. Overall, the certainty of evidence ranged from low to moderate across outcomes.

Conclusion

Task-shared psychological interventions for perinatal depression appear feasible and acceptable in low-resource settings. From the review findings the availability of technology assisted interventions that delivered by peers can achieve similar clinical outcomes that comparable to interventions delivered by mental health professionals. Nevertheless, both effectiveness and cost-efficiency differ depending on context, level and intervention intensity, as well as the capacity of health system in which they are implemented. Additional rigorously designed studies, incorporating standardized outcome measures, extended follow-up durations, and comprehensive economic evaluations are needed to reinforce the existing evidence and to inform policy decisions and large-scale implementation strategies.

Systematic review registration

PROSPERO, CRD420261285318.