Interpersonal psychotherapy’s effectiveness in alleviating depression symptoms in women with postpartum depression: a literature review
Abstract
Postpartum depression is a crucial public health issue with pervasive effects on mothers, infants, and families. The study used randomized control trials and the appraisal tool to source the material was critical appraisal skill program (CASP). The primary outcomes from the article reviews were depression, quality of life, improved psychological well-being, and social support. This review aims to show that interpersonal psychotherapy is beneficial in lowering depressed symptoms in women who have been diagnosed with postpartum depression. Articles, IPT guides modified to PPD, and empirical literature are used as sources of information. According to the findings, women diagnosed with postpartum depression had depressed symptoms. IPT is significantly important in reducing the symptoms. The review also indicated that postpartum depression is a component of other factors such as anxiety and family relationship, and the use of IPT can intervene in all these factors.
Postpartum depression is a significant public health problem, and effective treatment of women suffering from PPD can help address many interpersonal stressors. The primary best intervention to address these stressors is through IPT, which is specific, highly effective, specific, pragmatic, and problem-focused. In conclusion, the review indicates that the best and most effective intervention for women diagnosed with postpartum depression is using IPT. The consequence is that IPT effectively reduces depressive symptoms while also enhancing relationships, adjustment, and social support.
Introduction
PPD is a non-psychotic depressive episode classified as a moderate to severe mood illness equivalent to significant depression. Various disorders manifest in the postpartum period, but one unique disorder that manifests is mood disorders. Women experience anxiety, emotional lability, rage, crying spells, loneliness, and sadness during or after the delivery of their child (Phipps et al., 2020). Interpersonal psychotherapy (IPT) is a treatment method for depression. It is a type of psychotherapy that focuses on clients and their interpersonal interactions. For this review, IPT will be defined as acute treatment conducted in three aspects first, assessment through social history, two specific strategies, and three, identifying the effect of counter depressive symptoms that could arise. This method is founded on the assumption that personal feelings are at the root of psychiatric issues. Interpersonal therapy improves interpersonal functioning to alleviate symptoms (Sockol 2018). The core principle of this therapy is that psychiatric symptoms can be seen as a reaction to existing challenges in interpersonal relationships. Because few previous reviews and meta-analyses have analyzed the effectiveness of all psychological treatments on postpartum depression, the topic is worth investigating. There were only a few IPT trials on PPD in their study.
Depression is not the most prominent symptom of postpartum depression in moms, as there are others such as agitation, sleeplessness, anxiety, bewilderment, and irritability (Mennen et al.,2021). Therefore, there was no conclusion regarding the effectiveness of IPT on PPD was reported. The present literature review focuses on both primary and secondary outcomes of IPT to aid in finding a concrete conclusion on its effectiveness. IPT is effective in treating anxiety disorders, post-traumatic disorders, eating disorders, and affective disorders, and it can be utilized or offered in a variety of settings, including hospitals and community settings. The primary outcomes of IPT on women with postpartum depression are well-known. However, the secondary outcomes are still unclear, making it difficult to validate the study’s topic. As a result, the literature review for the study will focus on both primary and secondary outcomes to confirm if the intervention reduces depressive symptoms in women. Policymakers could utilize the evidence review findings to assess whether IPT effectively treats postpartum women with postpartum depression.
Methods
The literature review will use existing studies on postpartum depression, interpersonal psychotherapy, and the depressive symptoms of pregnant women. The study used randomized control trials articles within the period of five years from 2018 to 2021. Any article related to these aspects but not directed to its effect on women was excluded from the study. The appraisal tool used to source the material is critical appraisal skill program (CASP, 2018). The study retrieved the definition of keywords for the study from RCTs articles which search included the study of IPP in reducing the depressive symptoms to women diagnosed with PPD. Literature was reviewed from both primary and secondary analysis articles which aided in getting the secondary outcomes of IPT. The study narrowed down these articles into only those that specifically studied the population of women six months before and after childbirth.
Bright et al., (2019) used a sample size of 160 women aged 18 years and above, qualitative interviews were performed. The women were also asked about the barrier they encountered during IPT. The participants had to complete all the measures during pregnancy and three months of postpartum. Another study had a population of 49 mothers who were randomized by site who represented the intervention group and another 70 who represented the control group (Mennen et al.,2021). In another study by Sockol (2018) on perinatal women a review used 28 studies on the efficacy of IPT during pregnancy, the study evaluated sample characteristics as the potential moderators, the preventive studies indicated that IPT was essential in reducing the prevalence of depressive episodes and depressive symptoms. A study by Martín-Gómez 2021 used 17 RCTs which represented 4958 participants in four continents and used meta regression model for the analysis and a few of RCTs had a low risk of bias. A study by Phipps et al 2020 on postpartum depression used a sample of 250 pregnant adolescents who were 18 years or younger at the conception. The participants were randomized to interventions and each group received five prenatal sessions and postpartum booster session.
Report
Interpersonal therapy is an appropriate and effective treatment for women anguishing from this condition since it helps solve several stressors that arise during a postpartum period. The expected secondary outcomes were self-mastery, stress and anxiety symptoms, self-efficacy among others (Bright et al., 2019). Bright et al. comprehensive review, IPT is a beneficial intervention in treating and preventing psychological discomfort in women, particularly during pregnancy and postpartum. According to the findings of Bright et al., IPT was more valuable than active interventions, therapy, and no intervention. The findings showed that IPT was beneficial in lowering depressive illnesses and reducing anxiety and that it resulted in increased relationship satisfaction, improved adjustment, and social support.
Statistically, in Mennen et al., (2021) article, it is predictable that approximately 10% to 15% of women and the pervasiveness arrays from 5% to more than 20%. The control group remained the same in terms of reduction in depressive disorders, but the intervention group not only improved in improving in the depressive disorders but also improved in the parenting styles ((Mennen et al.,2021). The results of Phipps et al., (2020) indicated that the rate of major depressive disorder was 7% in the control group and 7.6% in the intervention group. The difference between the two group was insignificant at a p value of 0.88. Another study by Sockol, (2018) indicated that IPT was effective in reducing the prevalence and the depressive symptoms in the perinatal women. Sockol results indicate that IPT further reduced anxiety symptoms, improved these women’s social adjustment, and improved their relationship quality. The study reported only a few significant moderators, and their results were inconsistent across the outcomes. The study identified only significant moderators and the results were inconsistent across the outcomes. The interventions on primiparous women were more effective (Martín-Gómez 2021).
Discussion
According to a review of the research, IPT is an effective strategy for lowering depression in postpartum women. For prenatal depression, the IPT is an effective prophylactic intervention. The usefulness of IPT in preventing depression in postpartum women has been well supported by the evidence presented in these studies (Bright et al., 2019; Mennen et al.,2021). The results show that IPT for PPD is typically directive, including direct advice to the patients or therapist intervention for practical issues. Postpartum depression is a crucial public health issue with pervasive effects on mothers, infants, and families. The primary outcomes from the article reviews were depression, quality of life, improved psychological well-being, and social support. It is an ordinary life-threatening and incapacitating condition affecting mothers. In this review, group prevention intervention by Bright et al., (2019) resulted in a more significant reduction in the risks symptoms of the depressive disorder compared to the individual administered interventions.
Policymakers can easily implement the interpersonal therapy principles into primary care surroundings as interpersonal therapy is practical, problem-focused, specific short term, and highly active. One should not terminate the treatment of IPT on these won; instead, it should be concluded after several sessions (Phipps, et al., 2020). Further research should focus on accessing the adaptations of IPT to enhance its efficacy. In particular, from this review, the primary outcomes of the interventions can be grouped into two; a primary outcome included depressive symptoms, social support, relationship quality, and psychological well-being. The secondary outcomes included mental health concerns of pregnant women and treatment efficacy. The studies also indicated that the individual administered IPT showed a reduction in anxiety disorders in favor of other therapies, including central-based therapy. A complete IPT manual is necessary to encourage adherence to future preventive and therapeutic actions. Individual preferences are crucial, and future IPT interventions should ensure that perinatal women finish the entire IPT intervention.
Conclusion
This research evaluation shows that IPT is an effective intervention for reducing anxiety in women during pregnancy and postpartum. Most of the studies supported the effectiveness of IPT is effective for population. The results of Phipps et al., (2020) indicated no difference between the two groups but since all other articles provided four articles report the effectiveness of IPT it is therefore sufficient to conclude that IPT is effective in the reduction of postpartum depression in women. Effective adoption of IPT reduces many interpersonal adjustment problems for women diagnosed with PDD because it focuses on others’ current relationships. Therefore, although IPT intervention requires considerable time between the patient and the doctor, the IPT techniques are most appealing because of their easier incorporation even when one has a busy schedule. Literature review had a limitation of literature search but the limitation was addressed by narrowing down to few articles which were specific to the problem under investigation. On the implementation, the intervention is essential in reducing postpartum depression and can also be used for all patients with interpersonal problems.
References
Bright, K.S., Mughal, M.K., Wajid, A., Lane-Smith, M., Murray, L., Roy, N., Van Zanten, S.V., Mcneil, D.A., Stuart, S. and Kingston, D., 2019. Internet-based interpersonal psychotherapy for stress, anxiety, and depression in prenatal women: study protocol for a pilot randomized controlled trial. Trials, 20(1), pp.1-11.
CASP. (2018). CASP – Critical Appraisal Skills Programme. https://casp-uk.net/wp-content/uploads/2018/03/CASP-Randomised-Controlled-Trial-Checklist-2018_fillable_form.pdf
Martín-Gómez, C., Moreno-Peral, P., Bellón, J.A., Conejo-Cerón, S., Campos-Paino, H., Gómez-Gómez, I., Rigabert, A., Benítez, I. and Motrico, E., 2022. Effectiveness of psychological interventions in preventing postpartum depression in non-depressed women: a systematic review and meta-analysis of randomized controlled trials. Psychological Medicine, pp.1-13.
Mennen, F.E., Molina, A.P., Monro, W.L., Duan, L., Stuart, S. and Sosna, T., 2021. Effectiveness of an Interpersonal Psychotherapy (IPT) Group Depression Treatment for Head Start Mothers: A Cluster-Randomized Controlled Trial. Journal of Affective Disorders, 280, pp.39-48.
Phipps, M.G., Ware, C.F., Stout, R.L., Raker, C.A. and Zlotnick, C., 2020. Reducing the risk for postpartum depression in adolescent mothers: a randomized controlled trial. Obstetrics & Gynecology, 136(3), pp.613-621.
Sockol, L.E., 2018. A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women. Journal of affective disorders, 232, pp.316-328.
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