Different Psychological Interventions for Perinatal Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Different Psychological Interventions for Perinatal Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Different Psychological Interventions for Perinatal Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Guangshun Hua, Keling Yue, Yu Zhu, Fuchao Yang, Mijuan Zhou This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6134884/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Oct, 2025 Read the published version in BMC Psychiatry → Version 1 posted 13 You are reading this latest preprint version Abstract Background: Psychological interventions are the preferred treatment for women with perinatal depression, but there is a lack of comprehensive meta-analyses evaluating their effectiveness and the impact of related variables. Objective: We performed a systematic review and meta-analysis to assess the efficacy of psychological interventions for perinatal depression and to examine the influence of associated variables. Methods: We systematically searched the Ovid platform, covering the MEDLINE, EMBASE, PsycINFO, and Web of Science databases from their inception to March 11, 2024. Results: We screened 5,827 articles, and 33 were included in a random-effects meta-analysis. Compared to the control groups, psychological interventions showed a moderate pooled effect size (SMD: -0.65; 95% CI: -0.87 to -0.43, moderate certainty of evidence). Subgroup analyses revealed that individualized interventions were more effective than group-based approaches. Additionally, interventions delivered in non-clinical settings were more effective than those in clinical settings. It was also observed that non-specialist therapists, who were professionally trained, achieved outcomes comparable to those of specialist therapists in treating perinatal depression. The effectiveness of different psychological interventions varied, with IPT demonstrating a larger effect size compared to CBT. Limitations: The limited number of studies on MBI, BA and PST may affect the accuracy of the meta-analysis results. Conclusions: IPT, CBT, MBI, and BA have been shown to effectively alleviate perinatal depression, while PST did not demonstrate significant efficacy. Notably, IPT outperformed the other interventions. Additionally, personalized interventions in non-clinical settings proved more beneficial. Furthermore, trained non-mental health professionals also achieved positive outcomes when delivering psychological interventions. Perinatal depression Psychotherapy Meta-analysis Figures Figure 1 Figure 2 Introduction Perinatal depression (PPD) is identified as a significant manifestation of major depressive disorder, typically emerging during pregnancy or within a few weeks postpartum. In both clinical and research settings, this timeframe is often extended to encompass the entire first postpartum year(The Lancet, 2023a ). The global prevalence of perinatal depression is estimated to range between 13% and 30%, with higher incidence rates observed in middle- and low-income countries. Although the precise pathophysiology remains unclear, prevailing theories suggest that increased sensitivity to hormonal fluctuations during the perinatal period, dysregulation of the hypothalamic-pituitary-adrenal axis, and immune system alterations play crucial roles in its development. Identified risk factors include a history of psychiatric disorders, lack of social support, intimate partner violence, low socioeconomic status, and maternal and child health problems(Bränn et al., 2024a ). Contrary to the common misconception that perinatal depression may resolve spontaneously, many cases can persist for months or even longer, particularly in the absence of timely intervention. Beyond the hallmark symptoms of persistent depressive mood, fatigue, sadness, and feelings of guilt, women with perinatal depression are at heightened risk for adverse health outcomes during the perinatal period. The condition has been linked to pregnancy complications such as preeclampsia and gestational diabetes. Moreover, women clinically diagnosed with perinatal depression exhibit an elevated risk of mortality(Hagatulah et al., 2024 ), particularly from unnatural causes, including suicide, with the most pronounced risk occurring within the first year following diagnosis. Notably, this risk appears to be independent of any prior psychiatric history or familial predisposition. Currently, various screening tools for perinatal depression (e.g. Edinburgh Postnatal Depression Scale), have been widely incorporated into clinical settings to assess symptomatic women. However, the stigma associated with perinatal depression and the lack of cognitive symptoms may impact further evaluation. A range of interventions has been employed during the perinatal period to attempt to treat or prevent depression (including pharmacotherapy, dietary interventions, and psychotherapy). On August 4, 2023, the U.S. Food and Drug Administration (FDA) approved zuranolone(Deligiannidis et al., 2023 , 2021 ; Heo, 2023), the first oral medication for the treatment of postpartum depression. Zuranolone, a neuroactive steroid γ-aminobutyric acid receptor–positive allosteric modulator, is considered a novel and potentially rapid-acting oral treatment for postpartum depression (PPD). However, it seems unlikely that any single medication will substantially alleviate the overall burden of perinatal depression. For most mothers, pharmacotherapy is not recommended as a first-line treatment. The best approach appears to involve strategies that address the psychosocial factors associated with the development of perinatal depression(The Lancet, 2023b ). Additionally, dietary interventions for perinatal depression have shown limited efficacy(Tsai et al., 2023 ). Despite the widespread use of polyunsaturated fatty acids (PUFAs) and trace elements in the diets of perinatal women, they do not seem to significantly alleviate perinatal depression. However, daily intake of 1800–3500 International Units of vitamin D shows some promise. Women with postpartum depression often prefer psychotherapy as the primary treatment method due to its demonstrated efficacy and the absence of medication-related risks(Jiang et al., 2022 ; Li et al., 2023 , 2022a ; Sockol, 2018a ). Existing meta-analyses predominantly focus on Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT), with limited attention given to other types of psychotherapy, such as Problem-Solving Therapy (PST), Behavioral Activation (BA), and Mindfulness-Based Interventions (MBI). To date, no single review has comprehensively summarized the effects of psychotherapeutic interventions, including their implications for clinical decision-making by pregnant and postpartum women and their healthcare providers. Therefore, this systematic review and meta-analysis aim to evaluate the effectiveness of published psychotherapeutic interventions for perinatal depression and related variables. We seek to investigate the design features and components of intervention programs associated with better treatment outcomes. Our goal is to explore more targeted psychotherapeutic approaches for treating perinatal depression and to provide valuable insights for researchers, perinatal care providers, and related healthcare professionals. Methods Protocol registration The guidelines and checklists from PRISMA were followed ( Appendix S1 ). The study protocol guiding this systematic review and meta-analysis was published in the PROSPERO database (CRD42024526766). Search strategy A systematic search of electronic databases（MEDLINE, Embase, PsychINFO and Cochrane Library (Cochrane Central Register of Controlled Trials) via Ovid until 11 March 2024. We cross‐checked the reference lists of the key reviews. We formed the searching strategy by combining the keywords and Medical Subject Headings (MeSH) terms ( Appendix S2 ), including 3 concepts: pregnancy and/or postpartum period, depression, and psychological intervention. Eligibility criteria Studies were included if they 1) included psychological intervention for depression during pregnancy or within 1 year postpartum, 2) measured depression symptom changes using standardized depression assessment instruments, 3) contained a RCT, 4) we decided to include studies published only in English due to feasibility and most high‐quality RCTs were published in English(Crutchfield and Enderson, 1989). Studies were excluded if 1) women had other perinatal mental disorders/comorbidities (i.e., OCD and personality disorders), 2) studies such as reviews, systematic evaluations, meta-analyses, and animal experiments, 3) evaluated the efficacy of therapeutic interventions delivered via a mobile app on smartphones and/or tablets. 4）Participants' use of antidepressants during the perinatal period。 Two reviewers independently screened the title/abstract. We resolved differences through discussion, if needed, by consulting a third reviewer. Data extraction Two researchers independently extracted the data using standardized form, which was pilot-teste with 5 randomly selected studies to ensure adequate data capture. we checking duplicate data through Excel, and any disagreements were adjudicated by a tertius reviewer. Extracted the following information: 1) study characteristics (author, publication year, region and setting, sample size, intervention implementer, duration of treatment, intervention type, funding source, follow‐up and treatment duration and treatment strategy); 2) patients' characteristics (age); 3) outcome data (mean and standard deviation of results for all continuous point-in-time scoring). We prioritized intention-to-treat analysis outcomes over per-protocol outcomes. When ITT analysis was not available for most continuous outcomes, we used data from the conforming protocol analysis. For reports with missing data, we excluded the study. Risk‐of‐bias assessment Two reviewers independently assessed risk of bias, in case of disagreement, a third evaluator discusses it together to reach consensus, assessed the methodological risk of bias for eligible studies using the Cochrane Risk of Bias 2 scale for RCTs. Random‐sequence generation, allocation concealment, blinding, missing outcome data and selective reporting of outcomes were each graded as low, some concerns, or high risk. Publication bias was assessed visually using funnel plots generated through RevMan 5.4 and statistically assessed using the Egger test. Data analysis Review Manager 5.4 software was used to assess heterogeneity, merge data, and generate forest and funnel plots for the literature included in the study. Effect size assessed by standardized mean difference (SMD) and 95% confidence interval (CI) as many studies have used different rating instruments [e.g., Edinburgh Postnatal Depression Scale (EPDS), Patien Health Questionnaire (PHQ), Beck Depression Inventory (BDI), and Hamilton Depression Scal (HAMD)]. |SMD| < 0.5 represents a small effect size, 0.5 ≤ |SMD| < 0.8 indicates a medium effect size, and |SMD| ≥ 0.8 signifies a large effect size. I 2 values were calculated for the degree of heterogeneity, with 25% indicating low; 50%, moderate; and 75%, high heterogeneity(Fritzberg et al., 1977). Subgroup analyses were used to explore relevant variables to assess the effectiveness and differences between different forms of psychological interventions for perinatal depression. Including study characteristics (such as participant age, geographic location, duration of the intervention, and methods for evaluating inclusion criteria) and components of the intervention (such as face-to-face versus telemedicine interventions, professional psychotherapists versus trained non-psychotherapy professionals, interventions delivered in clinical versus non-clinical settings, group versus individual interventions (including women-only or women plus partners), interventions during pregnancy versus postpartum, and different psychological approaches). Finally, we completed sensitivity analyses to assess the impact of risk of bias, the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology was also followed to assess the overall quality of the key results. Results Study Selection Our search identified 5,827 potentially relevant articles. After removing 2,596 duplicates, 3,050 studies were screened based on their titles and abstracts, with 181 studies selected for full-text review. Ultimately, 33 studies met the inclusion criteria ( Figure. 1 ), including 5 studies on online-based interventions and 27 studies on face-to-face psychological interventions. Characteristics of the Included Studies The 33 studies collectively enrolled a total of 4,570 participants, with 2,281 individuals receiving psychological interventions and 2,289 serving as controls. Four studies utilized a waitlist control group, while the remaining 29 employed active control groups. Eleven studies were conducted in the United States, eight in Canada, five in China, two each in the United Kingdom, Australia, and Iran, and one each in Sweden, Kenya, and Jordan. The average age of participants primarily ranged from 20 to 35 years. All 33 studies designated depression as the primary outcome. Twenty-six studies utilized the Edinburgh Postnatal Depression Scale (EPDS), with most setting an inclusion threshold of a score ≥10. Five studies employed the Beck Depression Inventory (BDI), while the remaining two used the Hamilton Depression Rating Scale (HAMD) and the Patient Health Questionnaire-9 (PHQ-9), respectively. TABLE 1 lists the characteristics of all eligible studies. Quality Assessment Among the 33 included studies, 6 were assessed as having a high risk of bias, 16 were deemed to have some concerns of bias, and 11 were rated as having a low risk of bias ( Appendix S3 ). The inherent challenges of blinding participants and treatment providers in psychological interventions for perinatal women often result in deviations from intended interventions, which can increase the overall bias scores. This may affect the reliability of the outcome assessments. Overall association of psychotherapy with perinatal depression Our meta-analysis of 33 studies on psychological interventions for perinatal depression revealed considerable heterogeneity (p<0.00001, I 2 =92%), prompting the use of a random-effects model for outcome analysis. The results indicated that depression scores were lower in the psychological intervention group compared to the control group (SMD: -0.65; 95%CI: -0.87 to -0.43), with the overall effect size reflecting a moderate magnitude and statistically significant differences ( Figure. 2 ). Although the funnel plot exhibited slight asymmetry, a supplementary formal statistical test (Egger's test) confirmed the symmetry of the plot (p=0.265) ( Appendix S4 ) and also support an absence of publication bias. Sensitivity analyses We performed a sensitivity analysis by leave-one-out method and comparing the newly calculated effect sizes (95% CI) after each omission with the overall effect size. The results demonstrated that each new estimate was consistent with the overall estimate, indicating the stability of the findings ( Appendix S5 ). Subgroup analyses Subgroup Analyses of Study Characteristics We performed a subgroup analysis based on study characteristics( TABLE 2 ), revealing that studies employing ITT analysis showed a smaller effect size (SMD: -0.54; 95% CI: -0.71 to -0.36). In contrast, studies with a low risk of bias (ROB) demonstrated a larger effect size (SMD: -0.83; 95% CI: -1.25 to -0.40). Interestingly, studies with a high ROB exhibited a higher effect size (SMD: -0.70; 95% CI: -1.27 to -0.12) than those with some ROB (SMD: -0.50; 95% CI: -0.74 to -0.25). Additionally, we conducted a subgroup analysis based on the mean and median duration of interventions across all studies. Interventions lasting more than 8 weeks demonstrated a moderate to high effect size (SMD: -0.64; 95% CI: -0.90 to -0.39) compared to the control group, while those lasting 8 weeks or less showed a smaller improvement in depression (SMD: -0.45; 95% CI: -0.61 to -0.29). However, the estimated subgroup difference between these two duration groups was not significant TABLE 1 Characteristics of the included studies. Study (author, year, country) Age ± SD (years) Duration of treatment Treatment group(s) (n) Comparison group(s) (n) Baseline and assessment timepoint(s) Outcome’ scales Main results: SMD 1 (95% CI) 2 (van Ravesteyn et al., 2017) 31.6±5.2 1 Day CBT:229 Placebo (TAU): 232 Baseline: a year of delivery ATP: 12 wk after baseline EPDS EPDS: -0.40 [-0.60, -0.20] (Ngai and Gao, 2022) 33.3±3.5 6 weeks IPT:224 Placebo (TAU):231 Baseline:12-30 wk of postpartum ATP:6 wk and 6 mo after baseline EPDS EPDS 6 wk: -0.31 [-0.50, -0.13] 6 mo: -0.14 [-0.32, 0.04] (Gao et al., 2015) 28.49±2.73 2 weeks IPT:90 Placebo (TAU): 90 Baseline:a month of delivery ATP: 2 wk after baseline EPDS EPDS: -0.33 [-0.63, -0.04] (Lenze and Potts, 2017) 26.90 ±5.81 9 weeks IPT:21 Placebo (EUC): 21 Baseline:12-30 wk of GA ATP:37-39 wk of GA EPDS EPDS:0.14 [-0.66, 0.95] (O’Mahen et al., 2013) 27.40±5.32 16 weeks CBT:30 Placebo (TAU): 25 Baseline:over 24 wk of GA ATP:16 wk and 3 mo after baseline BDI-Ⅱ BDI-Ⅱ 16 wk: -0.61 [-1.15, -0.07] 3 mo: -0.43 [-0.97, 0.11] (Mulcahy et al., 2010) 32.00±3.27 8 weeks IPT:29 Placebo (TAU): 28 Baseline: a year of delivery ATP:4 w and 8 w after baseline EPDS EPDS 4 wk.: -0.09 [-0.64, 0.47] 8 wk: -0.63 [-1.20, -0.06] (Burns et al., 2013) 28.20±5.0 12 weeks CBT：18 Placebo (UC): 18 Baseline:8-18 wk of GA ATP:15 wk and 33 wk after baseline EPDS EPDS 15wk: -0.94 [-1.72, -0.16] 33wk: -1.18 [-2.02, -0.34] (Dimidjian et al., 2016) 30.98±4.08 8 weeks MBI:43 Placebo (TAU):43 Baseline:32 wk of GA ATP:8 wk of baseline、1 mo and 6 mo of delivery EPDS EPDS 8 wk: -0.24 [-0.77, 0.30] 1 mo: -0.31 [-0.87, 0.24] 6 mo: -0.33 [-0.90, 0.23] (Liu and Yang, 2021) 26.89±4.12 6 weeks CBT:130 Placebo (TAU): 130 Baseline:a year of delivery ATP:6 wk and 6 mo after baseline EPDS EPDS 6 wk: -1.35 [-1.63, -1.06] 6 mo:Not applicable (6 mo data was not reported) (Le et al., 2011) 25.8±4.4 8 weeks CBT：112 Placebo (UC): 105 Baseline: 24 wk of GA ATP:during early and late pregnancy（T1）,6 wk(T2)、4 mo(T3) and 12 mo of postpartum(T4) BDI-Ⅱ BDI-Ⅱ T1: -0.24 [-0.51, 0.03] T2: 0.04 [-0.23, 0.30] T3: 0.09 [-0.18, 0.35] T4: 0.13 [-0.14, 0.39] (Zlotnick et al., 2001) 23.4±4.41 4 weeks IPT:17 Placebo (TAU): 18 Baseline:20-32 wk of GA ATP:3 mo of postpartum BDI BDI: -0.44 [-1.11, 0.23] (Grote et al., 2009) 24.3±5.30 8 weeks IPT:25 Placebo (EUC): 28 Baseline:10-32 wk of GA ATP:3 mo after baseline and 6 mo of postpartum EPDS EPDS 3 mo: -1.35 [-1.96, -0.75] 6 mo: -1.99 [-2.66, -1.32] (Amani et al., 2021) 32.4±4.3 9 weeks CBT:37 Placebo (WL): 36 Baseline:a year of delivery ATP:9wk and 6 mo after baseline EPDS EPDS 9 wk: -1.31 [-2.02, -0.59] 6 mo:Not applicable (6 mo data was not reported) (Prendergast and Austin, 2001) \ 6 weeks CBT:17 Placebo (TAU): 20 Baseline:a year of delivery ATP:6 wk and 6 mo after baseline EPDS EPDS 6 wk:0.31 [-0.34, 0.97] 6 mo: -0.36 [-1.02, 0.29] (Hankin et al., 2023) 29.7±5.9 24 weeks IPT:115 Placebo (EUC): 119 Baseline:under 25 wk of GA ATP:4 wk、8 wk、12 wk、16 wk、20 wk and 24 wk after baseline EPDS EPDS 4 wk: -1.20 [-1.47, -0.92] 8 wk: -2.28 [-2.61, -1.95] 12 wk: -3.14 [-3.52, -2.75] 16 wk: -3.68 [-4.11, -3.26] 20 wk: -4.01 [-4.46, -3.56] 24 wk:-4.13 [-4.59, -3.67] (Dimidjian et al., 2017) 28.75±5.67 10 weeks BA：86 Placebo (TUA): 77 Baseline: During pregnancy ATP: 5 wk and 10 wk afterbaseline、3 mo of postpartum PHQ-9 PHQ-9 5 wk: -0.09 [-0.44, 0.25] 10 wk: -0.33 [-0.67, 0.00] 3 mo: -0.25 [-0.59, 0.10] (McGregor et al., 2014) \ 6 weeks CBT:21 Placebo (TAU):21 Baseline:20-28 wk of GA ATP:38 wk of GA and 6 wk of postpartum EPDS EPDS 38 wk: -0.34 [-0.95, 0.27] 6 wk: -0.48 [-1.10, 0.13] (Van Lieshout et al., 2022) 31.4±4.9 9 weeks CBT:70 Placebo (TAU): 71 Baseline: a year of delivery ATP: 9 wk and 6 mo after baseline EPDS EPDS 9 wk: -0.61 [-0.98, -0.24] 6 mo: -0.73 [-1.11, -0.36] (Khamseh et al., 2019) 27.80±4.57 5 weeks PST：35 Placebo (TAU): 35 Baseline:the third trimester of pregnancy ATP:5 wk and 1 mo after baseline BDI BDI 5 wk: -0.56 [-1.04, -0.08] 1 mo: -0.51 [-0.98, -0.03] (Leung et al., 2016) 31.56±3.78 6 weeks CBT:82 Placebo (TAU): 82 Baseline: 6-8 wk of postpartum ATP: 3 mo and 6 mo after baseline EPDS EPDS 3 mo: -0.25 [-0.56, 0.06] 6 mo: -0.20 [-0.51, 0.11] (Zhang et al., 2023) 28.54±3.70 4 weeks MBI:54 Placebo (HE): 54 Baseline:12-24 wk of GA ATP:4 wk and 15 wk after baseline EPDS EPDS 4 wk: -0.61 [-1.00, -0.22] 15 wk: -0.71 [-1.10, -0.32] (Husain et al., 2023) 30.4±6.0 3 months CBT:42 Placebo (TUA): 41 Baseline: a year of delivery ATP:3 mo and 6 mo after baseline EPDS EPDS 3 mo: -0.05 [-0.54, 0.44] 6 mo:0.03 [-0.47, 0.53] (Fathi-Ashtiani et al., 2015) 25.8±3.7 8 weeks CBT：64 Placebo (TAU): 71 Baseline:the third trimester ATP:2 wk of postpartum EPDS EPDS：0.11 [-0.23, 0.44] (O’Hara et al., 2000) 29.4±4.9 12 weeks IPT:60 Placebo (WL): 60 Baseline:a year of delivery ATP:4 wk、 8 wk and 12 wk after baseline HAM-D HAM-D 4 wk: -0.56 [-0.96, -0.16] 8 wk: -0.56 [-0.96, -0.16] 12 wk: -1.19 [-1.62, -0.76] (Gennaro et al., 2024) 26.34±5.28 15 weeks CBT:177 Placebo (PE): 122 Baseline: under 19 wk of GA ATP:34 wk of GA EPDS EPDS:0.13 [-0.18, 0.43] (Yator et al., 2022) 23.0±3.0 8 weeks IPT:12 Placebo (WL): 12 Baseline:6-12 wk of postpartum ATP: 8 wk、16 wk and 24 wk after baseline EPDS EPDS 8 wk: -0.91 [-1.76, -0.06] 12 wk: -0.40 [-1.21, 0.41] 16 wk: -0.23 [-1.04, 0.57] (Zhang and Emory, 2015) 25.3±4.6 8 weeks MBI:34 Placebo (TAU):31 Baseline:12-31 wk of GA ATP:4 wk and 8 w after baseline BDI-Ⅱ BDI-Ⅱ 4 wk:0.23 [-0.46, 0.91] 8 wk: -0.17 [-1.00, 0.67] (Babiy et al., 2024) 32.3±4.3 1 Day iCBT:202 Placebo (TUA): 203 Baseline:a year of delivery ATP: 12 wk after baseline EPDS EPDS: -0.41 [-0.60, -0.21] (Merza et al., 2023) 31.7±4.8 9 weeks iCBT (92) Placebo (WL):91 Baseline: a year of delivery ATP: 9 wk and 3 mo of postpartum EPDS EPDS 9 wk: -0.81 [-1.11, -0.51] 3 mo:Not applicable (3 mo data was not reported) (Abujilban et al., 2024) 29.2±5.2 1 momth iIPT (53) Placebo (TUA):51 Baseline:24-37 wk of GA ATP: 1 mo of GA EPDS EPDS: -1.46 [-1.90, -1.01] (Van Lieshout et al., 2021) 31.5±4.6 1 Day iCBT(202) Placebo (TUA): 201 Baseline: a year of delivery ATP: 12 wk after baseline EPDS EPDS: -0.51 [-0.71, -0.31] (Dennis et al., 2020) \ 12 weeks iIPT (120) Placebo (TUA):121 Baseline:2-24 wk of delivery ATP:12 wk、24 wk and 36 wk after baseline EPDS EPDS 12 wk: -1.07 [-1.36, -0.78] 24 wk: -1.09 [-1.38, -0.79] 36 wk: -0.59 [-0.87, -0.30] (Forsell et al., 2017) 31.2±3.7 10 weeks iCBT(22) Placebo (TUA):20 Baseline:10-28 wk of GA ATP: 10 wk after baseline EPDS EPDS: -0.52 [-1.14, 0.10] GA, Gestational Age; ATP, assessment time point(s); EPDS, Edinburgh Postnatal Depression Scale; BDI, Beck’s Depression Inventory; BDI-Ⅱ, Beck’s Depression Inventory-Ⅱ; PHQ-9, Patient Health Questionnaire-9; HAM-D,Hamilton Depression Rating Scale; CBT, Cognitive-Behavioral Therapy; IPT, Interpersonal Psychotherapy; PST, Problem‑solving Training; BA, Behavioral Activation; MBI, Mindfulness-based Intervention; Icbt, Internet-delivered Cognitive-behavioral Therapy; iIPT, Internet-interpersonal Psychotherapy; TUA, Treatment as usual; EUC, Enhanced Usual Care; WL, Waitlist; UC, Usual Care; PE, Perinatal education; HE, Health Education. 1 At the study endpoint unless otherwise stated. 2 All values are SMDs. Negative values indicate that treatment is better than control. (p=0.22). In terms of age, participants with an average age between 20 and 30 years exhibited a greater effect size compared to the control group (SMD: -0.80; 95% CI: -1.25 to -0.40). Furthermore, the effect sizes for studies using the EPDS versus non-EPDS scales, as well as those conducted in high-income versus low-to-middle-income countries, were moderate, with no significant differences between groups. TABLE 2 Subgroup Analyses Based on Study Characteristics Characteristic Number of literature Sample size intervention/control, No. SMD (95 % CI) P -value I ² % P -value Chi ² P -value ITT analysis 24 1842/1846 -0.54 [-0.71, -0.36] <0.00001 83 <0.00001 0.95 0.33 PP analysis 9 439/443 -0.96 [-1.78, -0.13] 0.02 96 <0.00001 Low ROB 11 1330/1359 -0.83 [-1.25, -0.40] 0.0001 96 <0.00001 1.92 0.38 Some ROB Concerns 16 668/638 -0.50 [-0.74, -0.25] <0.0001 77 <0.00001 High ROB 6 283/292 -0.70 [-1.27, -0.12] 0.02 89 <0.00001 Intervention duration ,wk ≤8 19 1517/1558 -0.45 [-0.61, -0.29] <0.00001 75 <0.00001 1.51 0.22 ＞8 14 851/815 -0.64 [-0.90, -0.39] <0.00001 82 <0.00001 Mean age, y 20s 18 936/949 -0.80 [-1.24, -0.35] 0.004 95 <0.00001 2.34 0.13 30s 13 1188/1219 -0.43 [-0.57, -0.30] <0.00001 52 0.02 Mix 2 125/121 -0.84 [-1.40, -0.28] 0.03 65 0.09 Standard for evaluation EPDS 26 1958/1976 -0.69 [-0.95, -0.42] <0.00001 93 <0.00001 0.78 0.38 Non-EPDS 7 323/313 -0.52 [-0.79, -0.24] 0.0002 61 0.02 Country High 24 1557/1549 -0.67 [-0.96, -0.38] <0.00001 93 <0.00001 0.06 0.8 Middle and Low 9 724/740 -0.61 [-0.95, -0.27] <0.0004 89 <0.00001 Abbreviations: ITT, intention-to-treat; PP, per-protocol; ROB, risk of bias. Subgroup Analyses of Components of the Intervention Programs We also performed a subgroup analysis based on the components of the intervention programs. Compared to both the control group and group-based interventions, individualized psychotherapy (including sessions with individual women or with women and their partners) significantly reduced depression levels (SMD: -0.99; 95% CI: -1.43 to -0.54), showing a statistically significant difference between groups (p=0.006)( TABLE 3 ). Moreover, interventions conducted in non-clinical settings (such as community centers, homes, or public buildings) demonstrated a greater effect size compared to those delivered in clinical settings (SMD: -0.85; 95% CI: -1.56 to -0.15). In contrast, there was no significant difference in effect sizes between interventions conducted during pregnancy (SMD: -0.62; 95% CI: -1.03 to -0.21) and postpartum (SMD: -0.67; 95% CI: -0.87 to -0.47), both of which showed moderate effect sizes. Further analysis of this subgroup indicated that IPT had significant effect sizes during both periods, specifically (SMD: -1.27; 95% CI: -2.55 to 0.01) during pregnancy and (SMD: -0.82; 95% CI: -1.21 to -0.43) postpartum. Regarding the delivery mode, telemedicine interventions (SMD: -0.78; 95% CI: -1.07 to -0.49) displayed slightly superior effect sizes compared to face-to-face interventions. Notably, interventions led by trained non-professional therapists exhibited moderate to high effect sizes (SMD: -0.80; 95% CI: -1.19 to -0.40), while those conducted by professional therapists showed moderate to low effect sizes. Lastly, our analysis of different types of psychological interventions revealed that PST did not show a significant effect compared to the control group (p=0.05), with the most significant effect size observed in IPT (SMD: -1.07; 95% CI: -1.70 to -0.44), followed by CBT, MBT and BA. TABLE 3 Subgroup analysis based on intervention programme components Characteristic Number of literature Sample size intervention/control, No. SMD (95 % CI) P -value I ² % P -value Chi ² P -value Intervention number Group Intervention 17 1307/1327 -0.33 [-0.47, -0.20] <0.00001 58 0.002 7.45 0.006 Individual Intervention 15 944/937 -0.99 [-1.43, -0.54] <0.0001 95 <0.00001 Intervening Period Gestation 19 1013/1004 -0.62 [-1.03, -0.21] 0.03 94 <0.00001 0.05 0.82 Postnatal 14 1268/1285 -0.67 [-0.87, -0.47] <0.00001 81 <0.00001 Setting Medical Environment 12 870/856 -0.51 [-0.78, -0.23] 0.0003 86 <0.00001 0.8 0.37 Non-medical Environment 11 552/576 -0.85 [-1.56, -0.15] 0.02 96 <0.00001 Professional Support Yes 15 885/906 -0.52 [-0.73, -0.31] <0.00001 75 <0.00001 0.32 1.42 No 16 1325/1311 -0.80 [-1.19, -0.40] <0.0001 95 <0.00001 Way of Intervention Face-to-face 27 1609/1624 -0.62 [-0.90, -0.34] <0.0001 93 <0.00001 0.6 0.44 Telehealth 6 672/665 -0.78 [-1.07, -0.49] <0.00001 83 <0.0001 Intervention Category CBT 17 1367/1352 -0.45 [-0.64, -0.26] <0.00001 82 <0.00001 4.37 0.36 IPT 11 720/738 -1.07 [-1.70, -0.44] 0.0008 96 <0.00001 MBI 3 89/96 -0.44 [-0.74, -0.15] 0.003 0 0.42 BA 1 70/68 -0.33 [-0.67, 0.00] 0.02 NA NA PST 1 35/35 -0.56 [-1.04, -0.08] 0.05 NA NA Discussion This systematic review and meta-analysis identified 33 randomized controlled trials assessing the efficacy of various psychotherapies for perinatal depression(Cuijpers et al., 2023; Li et al., 2022b; Sockol, 2018b). Overall, psychotherapy significantly reduced perinatal depressive symptoms, yielding a moderate effect size consistent with prior meta-analyses. Notably, individualized therapy showed a more pronounced effect compared to group interventions among perinatal women, and interventions delivered by trained non-specialist therapists demonstrated effect sizes comparable to those of professional therapists. Additionally, interventions conducted in non-clinical settings appeared more effective than those in clinical environments. Among the psychotherapeutic approaches for perinatal depression, IPT ranked highest in effectiveness, followed by CBT, MBT, and BA. Study Characteristics Firstly, the average age of study participants may play a significant role as a moderator of treatment outcomes in psychological interventions for perinatal depression. In this study, younger pregnant women and new mothers, particularly those aged 20 to 30, showed lower depression scores following psychological interventions. This improvement could be attributed to their greater physiological and psychological resilience, stronger social support networks, higher levels of treatment acceptance and adherence, and greater cognitive flexibility and emotional responsiveness(Bonanno, 2004; Collins and Feeney, 2000; Kazdin, 2008). These factors collectively contribute to more pronounced therapeutic effects. Future research should focus on strategies to maximize treatment outcomes across different age groups of perinatal women. Secondly, the greater reduction in depression scores observed in interventions lasting more than 8 weeks may be due to the extended duration allowing for the development of a robust therapeutic relationship between mothers and therapists. This prolonged period facilitates deeper exploration and resolution of underlying issues, enabling patients to establish and reinforce new behavioral and cognitive patterns. Additionally, longer interventions provide more opportunities to practice and master coping skills, accumulate therapeutic benefits, and offer sustained support, all of which help patients better adapt to and manage the challenges of the perinatal period. Furthermore, extended treatment duration accommodates individual differences, helps prevent relapse, and ultimately results in more durable therapeutic outcomes(Bränn et al., 2024b; Freeman and Davis, 2010). Third, although the Edinburgh Postnatal Depression Scale (EPDS) is recognized as a standard screening tool for perinatal depression(Cox et al., 1987), there appears to be no significant difference in the effectiveness of psychological interventions for participants diagnosed with depressive symptoms using the EPDS compared to those diagnosed with other screening tools. This indicates that cultural adaptations of screening tools are equally important when addressing perinatal depression among women from diverse cultural backgrounds. Fourth, there is no significant difference in the effectiveness of psychological interventions in reducing depression scores between high-income countries and low- to middle-income countries. Previous research has shown that more than a quarter of perinatal women in low- to middle-income countries may be affected by depression (PMID: 36884232). Therefore, it is equally necessary to implement psychological interventions for perinatal women in these countries (PMID: 29352530). Future research should investigate the universal effectiveness of psychological interventions across different cultural and economic settings. Additionally, policies should aim to provide low- to middle-income countries with mental health resources and services comparable to those available in high-income countries, thereby promoting equal treatment outcomes. Components of the Intervention Programs First, our study demonstrates that individualized treatment approaches yield better outcomes than group-based psychological interventions, with the former showing a higher effect size and the latter a lower one. This finding is consistent with previous reviews(Li et al., 2022c; Sampogna et al., 2024; Sockol et al., 2011a) and may be due to the ability of individualized treatment to tailor interventions to a patient's specific symptoms, medical history, and personal needs, thereby enhancing the precision and effectiveness of the therapy. The private setting allows mothers to express their emotions and concerns more freely, reducing stigma and providing deeper emotional support and psychological understanding(Moore et al., 2020). Moreover, this setting alleviates the social pressures often associated with group environments, making patients feel more comfortable and relaxed. Individualized treatment also promotes trust and collaboration between the therapist and the patient, which enhances therapeutic outcomes. It allows for flexible treatment strategies that can be adjusted promptly based on the patient's responses and progress, ensuring the adaptability of the treatment process(Flückiger et al., 2018). Therefore, our findings highlight the importance of personalized treatment, which typically requires a longer duration to offer sustained support and interventions, enabling women to more effectively manage and cope with their symptoms. Second, our analysis indicates that psychological interventions demonstrate moderate effect sizes both during pregnancy and within the first year postpartum. This may be attributed to the significant physiological and psychological changes women undergo during these periods, including hormonal fluctuations, bodily changes, decreased sleep quality, role transitions, lifestyle adjustments, and variations in social support. These changes can precipitate similar psychological issues, such as anxiety, depression, and emotional instability. Psychological therapy effectively addresses these common psychological concerns, yielding comparable outcomes in both pregnancy and the postpartum period(Grote et al., 2010; Maguire et al., 2020; O’Hara and Wisner, 2014). Moreover, psychological therapies (e.g., CBT, IPT) have demonstrated broad applicability in treating anxiety and depression by effectively identifying and modifying negative thought patterns, enhancing coping skills, and improving emotional regulation. Thus, psychological therapy provides consistent support and coping strategies across both stages. Consequently, research should focus on developing and implementing more standardized intervention protocols to improve the efficiency and effectiveness of these treatments. Third, psychological treatments delivered in non-medical settings show a high effect size, whereas those conducted in medical settings exhibit a moderate effect size. Research indicates that patient engagement is positively correlated with treatment outcomes. In non-medical settings, therapy is often conducted in a more comfortable and informal environment, which helps patients relax, reduces psychological defenses, and encourages more open participation in therapy. The natural setting also contributes to enhancing treatment effectiveness(Wampold, 2015). Furthermore, non-medical settings provide therapists with more time and flexibility to establish a strong therapeutic alliance with patients. Studies have shown that a strong therapeutic alliance is a key factor in successful psychotherapy and can significantly improve treatment outcomes. Finally, non-medical settings allow therapists to deliver a higher degree of personalized treatment tailored to individual patient needs. This personalized approach can more effectively address specific issues and enhance treatment effectiveness. Fourth, the analysis indicates that both professional psychotherapists and trained non-specialist providers (NSPs) demonstrate a moderate effect size in reducing perinatal depression scores. However, we observed that the current availability of professional psychotherapists is limited due to high costs, insufficient funding, lack of insurance coverage, and limited access(Fitelson et al., 2010). In real-world settings(Singla et al., 2017), the majority of patients in low- and middle-income countries seek treatment through primary healthcare or community-based platforms, where psychotherapy is often delivered by NSPs through task-sharing. The most common NSPs include community health workers employed by the health system, as well as peers, trial staff recruited from the same community, nurses, and midwives. Moreover, NSPs often belong to the patient’s community, allowing them to provide more immediate and everyday social support. This support extends beyond psychotherapy, including assistance with daily life and emotional support, which is particularly critical during the perinatal period. Such comprehensive social support has been shown to significantly improve perinatal depression symptoms. Consequently, future policies should consider prioritizing the training of non-specialist providers to effectively deliver therapeutic interventions. Fifth, both telehealth and face-to-face therapy demonstrate moderate effect sizes in their intervention outcomes, aligning with previous research findings(Aemissegger et al., 2022; Hagi et al., 2023; Scott et al., 2022). The COVID-19 pandemic has significantly accelerated the adoption and development of telehealth(Asbury, 2023; Wind et al., 2020), leading to a marked increase in the number of studies and digital interventions, particularly those involving telehealth(Holmes et al., 2020). Despite this growth, most digital interventions remain focused on cognitive behavioral therapy (CBT), either as self-guided modules or as asynchronously guided by therapists. Recent studies indicate that telehealth is a viable alternative for managing residual depressive symptoms in perinatal women and provides essential support to those in remote areas(Milgrom et al., 2021, 2016; Segal et al., 2020). However, other research suggests that future studies should conduct individual patient data meta-analyses to optimize and personalize telehealth interventions(Shaker et al., 2023). Finally, our study shows that IPT demonstrates a high effect size in treating perinatal depression, whereas CBT, MBI and BA show lower effect sizes. PST did not demonstrate significant efficacy for perinatal depression. Further research is needed to validate the effects of MBI, BA, and PST. Our findings are consistent with previous studies(Sockol et al., 2011b), and we suggest the following explanations: earlier research(Gelaye et al., 2016) has identified persistent interpersonal issues as a key risk factor for perinatal depression, emphasizing the importance of personalized interventions that address these issues. IPT, which focuses on enhancing social support, improving interpersonal relationships, and managing role transitions(Sockol, 2018c), is particularly effective in addressing interpersonal problems. This therapy helps women cope with the unique stressors of the perinatal period, encourages emotional expression and problem-solving(Bright et al., 2019), reduces psychological burden, and strengthens coping mechanisms. However, some studies present results that are contrary to ours(van Ravesteyn et al., 2017). This discrepancy may be attributed to the fact that our included studies did not restrict the severity of perinatal depression, whereas the referenced study focused exclusively on severe cases. Based on our findings, we recommend IPT as the primary intervention for effectively managing perinatal depression. However, due to the unique characteristics of the perinatal depression population and the lack of direct comparisons among these therapies, future research should undertake network meta-analyses to determine the most effective treatments for perinatal depression across different stages and severities. Strengths and limitations In this review, we conducted an extensive search and included a large sample size of studies on perinatal depression. The current systematic review and meta-analysis are restricted to RCT to support depressed mothers in making informed choices and clinical decisions based on the highest quality evidence. Few existing reviews address specific aspects of interventions, such as timing (during pregnancy and postpartum), setting, target populations, and implementation methods. We incorporated existing studies into various subgroup analyses. Additionally, our findings suggest that personalized psychological interventions in non-medical settings may yield better treatment outcomes for mothers with perinatal depression. Thus, our evaluation of the current evidence on psychological interventions for perinatal depression provides clinically relevant guidance for pregnant and new mothers, as well as for clinicians and researchers. However, this study has several limitations. First, we excluded studies that involved the use of additional medications during the perinatal period. Additionally, there is a limited number of studies on perinatal depression within certain intervention subgroups (e.g., MBT, BA, PST), and since we only included studies published in English, trials published in other languages or as grey literature may have been omitted. Second, there is significant variability in the treatment doses and durations used across the studies, with session lengths ranging from 30 minutes to 2 hours, which makes it challenging to determine the optimal treatment regimen. Furthermore, blinding of the intervention for the participants was difficult throughout the process, with only 11 studies assessed as having low risk of bias. Additionally, many studies lacked consistency in baseline assessment of perinatal depression symptoms using scales (though the majority of trials required an EPDS score ≥9 for inclusion), so we did not address prevention or treatment of perinatal depression. Overall, due to variations in doses, durations, settings, and inclusion criteria, the results should be interpreted with caution. Conclusion In summary, this systematic review and meta-analysis of psychological interventions for perinatal depression indicate that IPT, CBT, MBI, and BA are effective in improving perinatal depression, while PST is not, though further research is needed for a more accurate assessment. Additionally, IPT shows superior efficacy compared to other psychotherapies. Our study also underscores the importance of research design features and study components in enhancing the effectiveness of psychological therapies, particularly personalized interventions conducted in non-medical settings. Furthermore, trained non-psychotherapeutic professionals can also demonstrate better therapeutic outcomes during psychological interventions. Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data and materials The authors confirm that the data supporting the findings of this study are available within the study and the Supplemental Material. Raw data that supports the finding of the study are available from the corresponding author, upon reasonable request. Conflict of Interest The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors’ Contributions The authors’ responsibilities were as follows: GSH,KLY,MJZ: designed and conducted the research, and provided essential materials; GSH,KLY,YZ: conducted the research; GSH,KLY,FCY: wrote the paper; GSH,MJZ: take primary responsibility for the final content; and all authors read and approved the final manuscript. Acknowledgments None. References Abujilban, S., Al-Omari, H., Issa, E., ALhamdan, A., Al-Nabulsi, L., Mrayan, L., Mahmoud, K.F., Kernohan, W.G., 2024. 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Effects of a psychological nursing intervention on prevention of anxiety and depression in the postpartum period: a randomized controlled trial. Ann Gen Psychiatry 20, 2. https://doi.org/10.1186/s12991-020-00320-4 Maguire, J., McCormack, C., Mitchell, A., Monk, C., 2020. Neurobiology of maternal mental illness. Handb Clin Neurol 171, 97–116. https://doi.org/10.1016/B978-0-444-64239-4.00005-9 McGregor, M., Coghlan, M., Dennis, C.-L., 2014. The effect of physician-based cognitive behavioural therapy among pregnant women with depressive symptomatology: a pilot quasi-experimental trial. Early Interv Psychiatry 8, 348–57. https://doi.org/10.1111/eip.12074 Merza, D., Amani, B., Savoy, C., Babiy, Z., Bieling, P.J., Streiner, D.L., Ferro, M.A., Van Lieshout, R.J., 2023. Online peer-delivered group cognitive-behavioral therapy for postpartum depression: A randomized controlled trial. 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A randomised control trial for the effectiveness of group Interpersonal Psychotherapy for postnatal depression. Arch Womens Ment Health 13, 125–39. https://doi.org/10.1007/s00737-009-0101-6 Ngai, F.-W., Gao, L.-L., 2022. Effect of couple-based interpersonal psychotherapy on postpartum depressive symptoms: A randomised controlled trial. Asian J Psychiatr 78, 103274. https://doi.org/10.1016/j.ajp.2022.103274 O’Hara, M.W., Stuart, S., Gorman, L.L., Wenzel, A., 2000. Efficacy of interpersonal psychotherapy for postpartum depression. Arch Gen Psychiatry 57, 1039–45. https://doi.org/10.1001/archpsyc.57.11.1039 O’Hara, M.W., Wisner, K.L., 2014. Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol 28, 3–12. https://doi.org/10.1016/j.bpobgyn.2013.09.002 O’Mahen, H., Himle, J.A., Fedock, G., Henshaw, E., Flynn, H., 2013. A pilot randomized controlled trial of cognitive behavioral therapy for perinatal depression adapted for women with low incomes. Depress Anxiety 30, 679–87. https://doi.org/10.1002/da.22050 Prendergast, J., Austin, M.-P., 2001. Early Childhood Nurse-Delivered Cognitive Behavioural Counselling for Post-Natal Depression. Australasian Psychiatry 9, 255–259. https://doi.org/10.1046/j.1440-1665.2001.00330.x Sampogna, G., Toni, C., Catapano, P., Rocca, B. Della, Di Vincenzo, M., Luciano, M., Fiorillo, A., 2024. New trends in personalized treatment of depression. Curr Opin Psychiatry 37, 3–8. https://doi.org/10.1097/YCO.0000000000000903 Scott, A.M., Clark, J., Greenwood, H., Krzyzaniak, N., Cardona, M., Peiris, R., Sims, R., Glasziou, P., 2022. Telehealth v. face-to-face provision of care to patients with depression: a systematic review and meta-analysis. Psychol Med 52, 2852–2860. https://doi.org/10.1017/S0033291722002331 Segal, Z. V, Dimidjian, S., Beck, A., Boggs, J.M., Vanderkruik, R., Metcalf, C.A., Gallop, R., Felder, J.N., Levy, J., 2020. Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive Symptoms: A Randomized Clinical Trial. JAMA Psychiatry 77, 563–573. https://doi.org/10.1001/jamapsychiatry.2019.4693 Shaker, A.A., Austin, S.F., Storebø, O.J., Schaug, J.P., Ayad, A., Sørensen, J.A., Tarp, K., Bechmann, H., Simonsen, E., 2023. Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis. JMIR Ment Health 10, e44790. https://doi.org/10.2196/44790 Singla, D.R., Kohrt, B.A., Murray, L.K., Anand, A., Chorpita, B.F., Patel, V., 2017. Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries. Annu Rev Clin Psychol 13, 149–181. https://doi.org/10.1146/annurev-clinpsy-032816-045217 Sockol, L.E., 2018a. A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women. J Affect Disord 232, 316–328. https://doi.org/10.1016/j.jad.2018.01.018 Sockol, L.E., 2018b. A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women. J Affect Disord 232, 316–328. https://doi.org/10.1016/j.jad.2018.01.018 Sockol, L.E., 2018c. A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women. J Affect Disord 232, 316–328. https://doi.org/10.1016/j.jad.2018.01.018 Sockol, L.E., Epperson, C.N., Barber, J.P., 2011a. A meta-analysis of treatments for perinatal depression. Clin Psychol Rev 31, 839–49. https://doi.org/10.1016/j.cpr.2011.03.009 Sockol, L.E., Epperson, C.N., Barber, J.P., 2011b. A meta-analysis of treatments for perinatal depression. Clin Psychol Rev 31, 839–49. https://doi.org/10.1016/j.cpr.2011.03.009 The Lancet, 2023a. Perinatal depression: a neglected aspect of maternal health. Lancet 402, 667. https://doi.org/10.1016/S0140-6736(23)01786-5 The Lancet, 2023b. Perinatal depression: a neglected aspect of maternal health. Lancet 402, 667. https://doi.org/10.1016/S0140-6736(23)01786-5 Tsai, Z., Shah, N., Tahir, U., Mortaji, N., Owais, S., Perreault, M., Van Lieshout, R.J., 2023. Dietary interventions for perinatal depression and anxiety: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 117, 1130–1142. https://doi.org/10.1016/j.ajcnut.2023.03.025 Van Lieshout, R.J., Layton, H., Savoy, C.D., Brown, J.S.L., Ferro, M.A., Streiner, D.L., Bieling, P.J., Feller, A., Hanna, S., 2021. Effect of Online 1-Day Cognitive Behavioral Therapy-Based Workshops Plus Usual Care vs Usual Care Alone for Postpartum Depression: A Randomized Clinical Trial. JAMA Psychiatry 78, 1200–1207. https://doi.org/10.1001/jamapsychiatry.2021.2488 Van Lieshout, R.J., Layton, H., Savoy, C.D., Haber, E., Feller, A., Biscaro, A., Bieling, P.J., Ferro, M.A., 2022. Public Health Nurse-delivered Group Cognitive Behavioural Therapy for Postpartum Depression: A Randomized Controlled Trial. Can J Psychiatry 67, 432–440. https://doi.org/10.1177/07067437221074426 van Ravesteyn, L.M., Lambregtse-van den Berg, M.P., Hoogendijk, W.J.G., Kamperman, A.M., 2017. Interventions to treat mental disorders during pregnancy: A systematic review and multiple treatment meta-analysis. PLoS One 12, e0173397. https://doi.org/10.1371/journal.pone.0173397 Wampold, B.E., 2015. How important are the common factors in psychotherapy? An update. World Psychiatry 14, 270–7. https://doi.org/10.1002/wps.20238 Wind, T.R., Rijkeboer, M., Andersson, G., Riper, H., 2020. The COVID-19 pandemic: The “black swan” for mental health care and a turning point for e-health. Internet Interv 20, 100317. https://doi.org/10.1016/j.invent.2020.100317 Yator, O., John-Stewart, G., Khasakhala, L., Kumar, M., 2022. Preliminary Effectiveness of Group Interpersonal Psychotherapy for Young Kenyan Mothers With HIV and Depression: A Pilot Trial. Am J Psychother 75, 89–96. https://doi.org/10.1176/appi.psychotherapy.20200050 Zhang, H., Emory, E.K., 2015. A Mindfulness-Based Intervention for Pregnant African-American Women. Mindfulness (N Y) 6, 663–674. https://doi.org/10.1007/s12671-014-0304-4 Zhang, X., Lin, P., Sun, J., Sun, Y., Shao, D., Cao, D., Cao, F., 2023. Prenatal stress self-help mindfulness intervention via social media: a randomized controlled trial. J Ment Health 32, 206–215. https://doi.org/10.1080/09638237.2021.1952947 Zlotnick, C., Johnson, S.L., Miller, I.W., Pearlstein, T., Howard, M., 2001. Postpartum depression in women receiving public assistance: pilot study of an interpersonal-therapy-oriented group intervention. Am J Psychiatry 158, 638–40. https://doi.org/10.1176/appi.ajp.158.4.638 Additional Declarations No competing interests reported. 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13:08:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6134884/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6134884/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12888-025-07462-3","type":"published","date":"2025-10-14T15:57:12+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81503225,"identity":"c4a7ee00-7b5b-40ca-9d5a-aab914c10635","added_by":"auto","created_at":"2025-04-28 04:49:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":179154,"visible":true,"origin":"","legend":"\u003cp\u003eLiterature screening flowchart.\u003c/p\u003e\n\u003cp\u003ePRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6134884/v1/fe0de133a30faa714f9f4081.png"},{"id":81503770,"identity":"ba9b6999-a771-495f-a5ac-1d6bc406a174","added_by":"auto","created_at":"2025-04-28 04:57:53","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":337206,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of a randomised controlled trial testing the effectiveness of a psychological intervention for the treatment of perinatal depression.\u003c/p\u003e\n\u003cp\u003eA random effects model was used to generate the graphs using RevMan.RCT, Randomised Controlled Trial.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6134884/v1/d57c19d732846a6dcb09a3a1.png"},{"id":93955927,"identity":"e440130d-d803-4347-8ff4-d4d209ac4639","added_by":"auto","created_at":"2025-10-20 16:07:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2509901,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6134884/v1/f9802377-e9c7-49cf-8d44-57db37fc351a.pdf"},{"id":81503232,"identity":"a017a822-b208-4414-aac4-24bb1898e0a4","added_by":"auto","created_at":"2025-04-28 04:49:52","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":6670101,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryappendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-6134884/v1/9e6898b85bbb51ad66441f71.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Different Psychological Interventions for Perinatal Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePerinatal depression (PPD) is identified as a significant manifestation of major depressive disorder, typically emerging during pregnancy or within a few weeks postpartum. In both clinical and research settings, this timeframe is often extended to encompass the entire first postpartum year(The Lancet, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2023a\u003c/span\u003e). The global prevalence of perinatal depression is estimated to range between 13% and 30%, with higher incidence rates observed in middle- and low-income countries. Although the precise pathophysiology remains unclear, prevailing theories suggest that increased sensitivity to hormonal fluctuations during the perinatal period, dysregulation of the hypothalamic-pituitary-adrenal axis, and immune system alterations play crucial roles in its development. Identified risk factors include a history of psychiatric disorders, lack of social support, intimate partner violence, low socioeconomic status, and maternal and child health problems(Br\u0026auml;nn et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024a\u003c/span\u003e). Contrary to the common misconception that perinatal depression may resolve spontaneously, many cases can persist for months or even longer, particularly in the absence of timely intervention. Beyond the hallmark symptoms of persistent depressive mood, fatigue, sadness, and feelings of guilt, women with perinatal depression are at heightened risk for adverse health outcomes during the perinatal period. The condition has been linked to pregnancy complications such as preeclampsia and gestational diabetes. Moreover, women clinically diagnosed with perinatal depression exhibit an elevated risk of mortality(Hagatulah et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), particularly from unnatural causes, including suicide, with the most pronounced risk occurring within the first year following diagnosis. Notably, this risk appears to be independent of any prior psychiatric history or familial predisposition.\u003c/p\u003e \u003cp\u003eCurrently, various screening tools for perinatal depression (e.g. Edinburgh Postnatal Depression Scale), have been widely incorporated into clinical settings to assess symptomatic women. However, the stigma associated with perinatal depression and the lack of cognitive symptoms may impact further evaluation. A range of interventions has been employed during the perinatal period to attempt to treat or prevent depression (including pharmacotherapy, dietary interventions, and psychotherapy). On August 4, 2023, the U.S. Food and Drug Administration (FDA) approved zuranolone(Deligiannidis et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Heo, 2023), the first oral medication for the treatment of postpartum depression. Zuranolone, a neuroactive steroid γ-aminobutyric acid receptor\u0026ndash;positive allosteric modulator, is considered a novel and potentially rapid-acting oral treatment for postpartum depression (PPD). However, it seems unlikely that any single medication will substantially alleviate the overall burden of perinatal depression. For most mothers, pharmacotherapy is not recommended as a first-line treatment. The best approach appears to involve strategies that address the psychosocial factors associated with the development of perinatal depression(The Lancet, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2023b\u003c/span\u003e). Additionally, dietary interventions for perinatal depression have shown limited efficacy(Tsai et al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Despite the widespread use of polyunsaturated fatty acids (PUFAs) and trace elements in the diets of perinatal women, they do not seem to significantly alleviate perinatal depression. However, daily intake of 1800\u0026ndash;3500 International Units of vitamin D shows some promise.\u003c/p\u003e \u003cp\u003eWomen with postpartum depression often prefer psychotherapy as the primary treatment method due to its demonstrated efficacy and the absence of medication-related risks(Jiang et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Li et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022a\u003c/span\u003e; Sockol, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2018a\u003c/span\u003e). Existing meta-analyses predominantly focus on Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT), with limited attention given to other types of psychotherapy, such as Problem-Solving Therapy (PST), Behavioral Activation (BA), and Mindfulness-Based Interventions (MBI). To date, no single review has comprehensively summarized the effects of psychotherapeutic interventions, including their implications for clinical decision-making by pregnant and postpartum women and their healthcare providers. Therefore, this systematic review and meta-analysis aim to evaluate the effectiveness of published psychotherapeutic interventions for perinatal depression and related variables. We seek to investigate the design features and components of intervention programs associated with better treatment outcomes. Our goal is to explore more targeted psychotherapeutic approaches for treating perinatal depression and to provide valuable insights for researchers, perinatal care providers, and related healthcare professionals.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eProtocol registration\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe guidelines and checklists from PRISMA were followed (\u003cstrong\u003eAppendix S1\u003c/strong\u003e). The study protocol guiding this systematic review and meta-analysis was published in the PROSPERO database (CRD42024526766).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSearch strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA systematic search of electronic databases（MEDLINE, Embase, PsychINFO and Cochrane Library (Cochrane Central Register of Controlled Trials)\u0026nbsp;via Ovid until 11 March 2024. We cross‐checked the reference lists of the key reviews. We formed the searching strategy by combining the keywords and Medical Subject Headings (MeSH) terms (\u003cstrong\u003eAppendix S2\u003c/strong\u003e), including 3 concepts: pregnancy and/or postpartum period, depression, and psychological intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEligibility criteria\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudies were included if they 1) included psychological intervention for depression during pregnancy or within 1 year postpartum, 2) measured depression symptom changes using standardized depression assessment instruments, 3) contained a RCT, 4) we decided to include studies published only in English due to feasibility and most high‐quality RCTs were published in English(Crutchfield and Enderson, 1989). Studies were excluded if 1) women had other perinatal mental disorders/comorbidities (i.e., OCD and personality disorders), 2) studies such as reviews, systematic evaluations, meta-analyses, and animal experiments, 3) evaluated the efficacy of therapeutic interventions delivered via a mobile app on smartphones and/or tablets. 4）Participants\u0026apos; use of antidepressants during the perinatal period。\u003c/p\u003e\n\u003cp\u003eTwo reviewers independently screened the title/abstract. We resolved differences through discussion, if needed, by consulting a third reviewer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData extraction\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo researchers independently extracted the data using standardized form, which was pilot-teste with 5 randomly selected studies to ensure adequate data capture. we checking duplicate data through Excel, and any disagreements were adjudicated by a tertius reviewer. Extracted the following information: 1) study characteristics (author, publication year, region and setting, sample size, intervention implementer, duration of treatment, intervention type, funding source, follow‐up and treatment duration and\u0026nbsp;treatment strategy); 2) patients\u0026apos; characteristics (age); 3) outcome data (mean and standard deviation of results\u0026nbsp;for all continuous point-in-time scoring).\u0026nbsp;We prioritized intention-to-treat analysis outcomes over per-protocol outcomes. When ITT analysis was not available for most continuous outcomes, we used data from the conforming protocol analysis. For reports with missing data, we excluded the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRisk‐of‐bias assessment\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo reviewers independently assessed risk of bias, in case of disagreement, a third evaluator discusses it together to reach consensus, assessed the methodological risk of bias for eligible studies using the Cochrane Risk of Bias 2 scale for RCTs. Random‐sequence generation, allocation concealment, blinding, missing outcome data and selective reporting of outcomes were each graded as low, some concerns, or high risk. Publication bias was assessed visually using funnel plots generated through RevMan 5.4 and statistically assessed using the Egger test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReview Manager 5.4 software was used to assess heterogeneity, merge data, and generate forest and funnel plots for the literature included in the study. Effect size assessed by standardized mean difference (SMD) and 95% confidence interval (CI) as many studies have used different rating instruments [e.g., Edinburgh Postnatal Depression Scale (EPDS), Patien Health Questionnaire (PHQ), Beck Depression Inventory (BDI), and Hamilton Depression Scal (HAMD)]. |SMD| \u0026lt; 0.5 represents a small effect size, 0.5 \u0026le; |SMD| \u0026lt; 0.8 indicates a medium effect size, and |SMD| \u0026ge; 0.8 signifies a large effect size. \u003cem\u003eI\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e values were calculated for the degree of heterogeneity, with 25% indicating low; 50%, moderate; and 75%, high heterogeneity(Fritzberg et al., 1977).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSubgroup analyses were used to explore relevant variables to assess the effectiveness and differences between different forms of psychological interventions for perinatal depression. Including study characteristics (such as participant age, geographic location, duration of the intervention, and methods for evaluating inclusion criteria) and components of the intervention (such as face-to-face versus telemedicine interventions, professional psychotherapists versus trained non-psychotherapy professionals, interventions delivered in clinical versus non-clinical settings, group versus individual interventions (including women-only or women plus partners), interventions during pregnancy versus postpartum, and different psychological approaches). Finally, we completed sensitivity analyses to assess the impact of risk of bias, the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology was also followed to assess the overall quality of the key results.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy Selection\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur search identified 5,827 potentially relevant articles. After removing 2,596 duplicates, 3,050 studies were screened based on their titles and abstracts, with 181 studies selected for full-text review. Ultimately, 33 studies met the inclusion criteria (\u003cstrong\u003eFigure. 1\u003c/strong\u003e), including 5 studies on online-based interventions and 27 studies on face-to-face psychological interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCharacteristics of the Included Studies\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 33 studies collectively enrolled a total of 4,570 participants, with 2,281 individuals receiving psychological interventions and 2,289 serving as controls. Four studies utilized a waitlist control group, while the remaining 29 employed active control groups. Eleven studies were conducted in the United States, eight in Canada, five in China, two each in the United Kingdom, Australia, and Iran, and one each in Sweden, Kenya, and Jordan. The average age of participants primarily ranged from 20 to 35 years.\u003c/p\u003e\n\u003cp\u003eAll 33 studies designated depression as the primary outcome. Twenty-six studies utilized the Edinburgh Postnatal Depression Scale (EPDS), with most setting an inclusion threshold of a score \u0026ge;10. Five studies employed the Beck Depression Inventory (BDI), while the remaining two used the Hamilton Depression Rating Scale (HAMD) and the Patient Health Questionnaire-9 (PHQ-9), respectively.\u003cstrong\u003e\u0026nbsp;TABLE 1\u003c/strong\u003e lists the characteristics of all eligible studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuality Assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 33 included studies, 6 were assessed as having a high risk of bias, 16 were deemed to have some concerns of bias, and 11 were rated as having a low risk of bias (\u003cstrong\u003eAppendix S3\u003c/strong\u003e). The inherent challenges of blinding participants and treatment providers in psychological interventions for perinatal women often result in deviations from intended interventions, which can increase the overall bias scores. This may affect the reliability of the outcome assessments.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOverall association of psychotherapy with perinatal depression\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur meta-analysis of 33 studies on psychological interventions for perinatal depression revealed considerable heterogeneity (p\u0026lt;0.00001, I\u003csup\u003e2\u003c/sup\u003e=92%), prompting the use of a random-effects model for outcome analysis. The results indicated that depression scores were lower in the psychological intervention group compared to the control group (SMD: -0.65; 95%CI: -0.87 to -0.43), with the overall effect size reflecting a moderate magnitude and statistically significant differences (\u003cstrong\u003eFigure. 2\u003c/strong\u003e). Although the funnel plot exhibited slight asymmetry, a supplementary formal statistical test (Egger\u0026apos;s test) confirmed the symmetry of the plot (p=0.265) (\u003cstrong\u003eAppendix S4\u003c/strong\u003e) and also support an absence of publication bias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSensitivity analyses\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe performed a sensitivity analysis by leave-one-out method and comparing the newly calculated effect sizes (95% CI) after each omission with the overall effect size. The results demonstrated that each new estimate was consistent with the overall estimate, indicating the stability of the findings (\u003cstrong\u003eAppendix S5\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubgroup analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubgroup Analyses of Study Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe performed a subgroup analysis based on study characteristics(\u003cstrong\u003eTABLE 2\u003c/strong\u003e), revealing that studies employing ITT analysis showed a smaller effect size (SMD: -0.54; 95% CI: -0.71 to -0.36). In contrast, studies with a low risk of bias (ROB) demonstrated a larger effect size (SMD: -0.83; 95% CI: -1.25 to -0.40). Interestingly, studies with a high ROB exhibited a higher effect size (SMD: -0.70; 95% CI: -1.27 to -0.12) than those with some ROB (SMD: -0.50; 95% CI: -0.74 to -0.25).\u003c/p\u003e\n\u003cp\u003eAdditionally, we conducted a subgroup analysis based on the mean and median duration of interventions across all studies. Interventions lasting more than 8 weeks demonstrated a moderate to high effect size (SMD: -0.64; 95% CI: -0.90 to -0.39) compared to the control group, while those lasting 8 weeks or less showed a smaller improvement in depression (SMD: -0.45; 95% CI: -0.61 to -0.29). However, the estimated subgroup difference between these two duration groups was not significant\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 1\u0026nbsp;\u003c/strong\u003eCharacteristics of the included studies.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"949\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy (author, year, country)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge \u0026plusmn; SD (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eof treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003egroup(s) (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComparison\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003egroup(s) (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline and assessment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003etimepoint(s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u0026rsquo;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003escales\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMain results:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSMD\u003csup\u003e1\u003c/sup\u003e (95% CI)\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(van Ravesteyn et al., 2017)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e31.6\u0026plusmn;5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 Day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCBT:229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU): 232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline: a year of delivery\u003cbr\u003e\u0026nbsp;ATP: 12 wk after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS: -0.40 [-0.60, -0.20]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Ngai and Gao, 2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e33.3\u0026plusmn;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e6 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eIPT:224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU):231\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:12-30 wk of postpartum\u003cbr\u003e\u0026nbsp;ATP:6 wk and 6 mo after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;6 wk: -0.31 [-0.50, -0.13]\u003cbr\u003e\u0026nbsp;6 mo: -0.14 [-0.32, 0.04]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Gao et al., 2015)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e28.49\u0026plusmn;2.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e2 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eIPT:90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU): 90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:a month of delivery\u003cbr\u003e\u0026nbsp;ATP: 2 wk after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS: -0.33 [-0.63, -0.04]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Lenze and Potts, 2017)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e26.90 \u0026plusmn;5.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eIPT:21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (EUC): 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:12-30 wk of GA\u003cbr\u003e\u0026nbsp;ATP:37-39 wk of GA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS:0.14 [-0.66, 0.95]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(O\u0026rsquo;Mahen et al., 2013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e27.40\u0026plusmn;5.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e16 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCBT:30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU): 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:over 24 wk of GA\u003cbr\u003e\u0026nbsp;ATP:16 wk and 3 mo after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eBDI-Ⅱ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eBDI-Ⅱ\u003cbr\u003e\u0026nbsp;16 wk: -0.61 [-1.15, -0.07]\u003cbr\u003e\u0026nbsp;3 mo: -0.43 [-0.97, 0.11]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Mulcahy et al., 2010)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e32.00\u0026plusmn;3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eIPT:29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU): 28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline: a year of delivery\u0026nbsp;\u003cbr\u003e\u0026nbsp;ATP:4 w and 8 w after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;4 wk.: -0.09 [-0.64, 0.47]\u003cbr\u003e\u0026nbsp;8 wk: -0.63 [-1.20, -0.06]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Burns et al., 2013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e28.20\u0026plusmn;5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e12 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCBT：18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (UC): 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:8-18 wk of GA\u003cbr\u003e\u0026nbsp;ATP:15 wk and 33 wk after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;15wk: -0.94 [-1.72, -0.16]\u003cbr\u003e\u0026nbsp;33wk: -1.18 [-2.02, -0.34]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e(Dimidjian et al., 2016)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e30.98\u0026plusmn;4.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eMBI:43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU):43\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:32 wk of GA\u003cbr\u003eATP:8 wk of baseline、1 mo and 6 mo of delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;8 wk: -0.24 [-0.77, 0.30]\u003cbr\u003e\u0026nbsp;1 mo: -0.31 [-0.87, 0.24]\u003cbr\u003e\u0026nbsp;6 mo: -0.33 [-0.90, 0.23]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Liu and Yang, 2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e26.89\u0026plusmn;4.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e6 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCBT:130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU): 130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:a year of delivery\u003cbr\u003e\u0026nbsp;ATP:6 wk and 6 mo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eafter baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;6 wk: -1.35 [-1.63, -1.06]\u003cbr\u003e\u0026nbsp;6 mo:Not applicable (6 mo data was not reported)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Le et al., 2011)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e25.8\u0026plusmn;4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCBT：112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (UC): 105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline: 24 wk of GA\u003cbr\u003eATP:during early and late pregnancy（T1）,6 wk(T2)、4 mo(T3) and 12 mo of postpartum(T4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eBDI-Ⅱ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eBDI-Ⅱ\u003cbr\u003e\u0026nbsp;T1: -0.24 [-0.51, 0.03]\u003cbr\u003e\u0026nbsp;T2: 0.04 [-0.23, 0.30]\u003cbr\u003e\u0026nbsp;T3: 0.09 [-0.18, 0.35]\u003cbr\u003e\u0026nbsp;T4: \u0026nbsp; \u0026nbsp; 0.13 \u0026nbsp; \u0026nbsp; [-0.14, 0.39]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Zlotnick et al., 2001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e23.4\u0026plusmn;4.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e4 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eIPT:17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU): 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:20-32 wk of GA\u003cbr\u003e\u0026nbsp;ATP:3 mo of postpartum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eBDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eBDI: -0.44 [-1.11, 0.23]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Grote et al., 2009)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e24.3\u0026plusmn;5.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eIPT:25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (EUC): 28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:10-32 wk of GA\u003cbr\u003e\u0026nbsp;ATP:3 mo after baseline and 6 mo of postpartum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;3 mo: -1.35 [-1.96, -0.75]\u003cbr\u003e\u0026nbsp;6 mo: -1.99 [-2.66, -1.32]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Amani et al., 2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e32.4\u0026plusmn;4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCBT:37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (WL): 36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:a year of delivery\u003cbr\u003e\u0026nbsp;ATP:9wk and 6 mo after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;9 wk: -1.31 [-2.02, -0.59]\u003cbr\u003e\u0026nbsp;6 mo:Not applicable (6 mo data was not reported)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Prendergast and Austin, 2001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e6 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCBT:17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU): 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:a year of delivery\u0026nbsp;\u003cbr\u003e\u0026nbsp;ATP:6 wk and 6 mo after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;6 wk:0.31 [-0.34, 0.97]\u003cbr\u003e\u0026nbsp;6 mo: -0.36 [-1.02, 0.29]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Hankin et al., 2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e29.7\u0026plusmn;5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e24 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eIPT:115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (EUC): 119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:under 25 wk of GA\u003cbr\u003eATP:4 wk、8 wk、12 wk、16 wk、20 wk and 24 wk after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;4 wk: -1.20 [-1.47, -0.92]\u003cbr\u003e\u0026nbsp;8 wk: -2.28 [-2.61, -1.95]\u003cbr\u003e\u0026nbsp;12 wk: -3.14 [-3.52, -2.75]\u003cbr\u003e\u0026nbsp;16 wk: -3.68 [-4.11, -3.26]\u003cbr\u003e\u0026nbsp;20 wk: -4.01 [-4.46, -3.56]\u003cbr\u003e\u0026nbsp;24 wk:-4.13 [-4.59, -3.67]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e(Dimidjian et al., 2017)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e28.75\u0026plusmn;5.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e10 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eBA：86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TUA): 77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline: During pregnancy\u003cbr\u003eATP: 5 wk and 10 wk afterbaseline、3 mo of postpartum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003ePHQ-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003ePHQ-9\u003cbr\u003e\u0026nbsp;5 wk: -0.09 [-0.44, 0.25]\u003cbr\u003e\u0026nbsp;10 wk: -0.33 [-0.67, 0.00]\u003cbr\u003e\u0026nbsp;3 mo: -0.25 [-0.59, 0.10]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e(McGregor et al., 2014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e6 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCBT:21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU):21\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:20-28 wk of GA\u003cbr\u003e\u0026nbsp;ATP:38 wk of GA and 6 wk of postpartum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;38 wk: -0.34 [-0.95, 0.27]\u003cbr\u003e\u0026nbsp;6 wk: -0.48 [-1.10, 0.13]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Van Lieshout et al., 2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e31.4\u0026plusmn;4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCBT:70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU): 71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline: a year of delivery\u003cbr\u003e\u0026nbsp;ATP: 9 wk and 6 mo after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;9 wk: -0.61 [-0.98, -0.24]\u003cbr\u003e\u0026nbsp;6 mo: -0.73 [-1.11, -0.36]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Khamseh et al., 2019)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e27.80\u0026plusmn;4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e5 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003ePST：35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU): 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:the third trimester of pregnancy\u003cbr\u003e\u0026nbsp;ATP:5 wk and 1 mo after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eBDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eBDI\u003cbr\u003e\u0026nbsp;5 wk: -0.56 [-1.04, -0.08]\u003cbr\u003e\u0026nbsp;1 mo: -0.51 [-0.98, -0.03]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Leung et al., 2016)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e31.56\u0026plusmn;3.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e6 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCBT:82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU): 82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline: 6-8 wk of postpartum\u003cbr\u003e\u0026nbsp;ATP: 3 mo and 6 mo after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;3 mo: -0.25 [-0.56, 0.06]\u003cbr\u003e\u0026nbsp;6 mo: -0.20 [-0.51, 0.11]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Zhang et al., 2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e28.54\u0026plusmn;3.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e4 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eMBI:54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (HE): 54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:12-24 wk of GA\u003cbr\u003e\u0026nbsp;ATP:4 wk and 15 wk after baseline\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;4 wk: -0.61 [-1.00, -0.22]\u003cbr\u003e\u0026nbsp;15 wk: -0.71 [-1.10, -0.32]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Husain et al., 2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e30.4\u0026plusmn;6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCBT:42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TUA): 41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline: \u0026nbsp;a year of delivery\u003cbr\u003e\u0026nbsp;ATP:3 mo and 6 mo after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;3 mo: -0.05 [-0.54, 0.44]\u003cbr\u003e\u0026nbsp;6 mo:0.03 [-0.47, 0.53]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Fathi-Ashtiani et al., 2015)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e25.8\u0026plusmn;3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCBT：64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU): 71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:the third trimester\u003cbr\u003e\u0026nbsp;ATP:2 wk of postpartum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS：0.11 [-0.23, 0.44]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(O\u0026rsquo;Hara et al., 2000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e29.4\u0026plusmn;4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e12 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eIPT:60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (WL): 60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:a year of delivery\u003cbr\u003eATP:4 wk、 8 wk and 12 wk after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eHAM-D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eHAM-D\u003cbr\u003e\u0026nbsp;4 wk: -0.56 [-0.96, -0.16]\u003cbr\u003e\u0026nbsp;8 wk: -0.56 [-0.96, -0.16]\u003cbr\u003e\u0026nbsp;12 wk: -1.19 [-1.62, -0.76]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Gennaro et al., 2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e26.34\u0026plusmn;5.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e15 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCBT:177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (PE): 122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline: under 19 wk of GA\u003cbr\u003e\u0026nbsp;ATP:34 wk of GA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS:0.13 [-0.18, 0.43]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Yator et al., 2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e23.0\u0026plusmn;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eIPT:12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (WL): 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:6-12 wk of postpartum\u003cbr\u003eATP: 8 wk、16 wk and 24 wk after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;8 wk: -0.91 [-1.76, -0.06]\u003cbr\u003e\u0026nbsp;12 wk: -0.40 [-1.21, 0.41]\u003cbr\u003e\u0026nbsp;16 wk: -0.23 [-1.04, 0.57]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Zhang and Emory, 2015)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e25.3\u0026plusmn;4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eMBI:34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TAU):31\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:12-31 wk of GA\u0026nbsp;\u003cbr\u003e\u0026nbsp;ATP:4 wk and 8 w after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eBDI-Ⅱ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eBDI-Ⅱ\u003cbr\u003e\u0026nbsp;4 wk:0.23 [-0.46, 0.91]\u003cbr\u003e\u0026nbsp;8 wk: -0.17 [-1.00, 0.67]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Babiy et al., 2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e32.3\u0026plusmn;4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 Day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eiCBT:202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TUA): 203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:a year of delivery\u0026nbsp;\u003cbr\u003e\u0026nbsp;ATP: 12 wk after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS: -0.41 [-0.60, -0.21]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Merza et al., 2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e31.7\u0026plusmn;4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eiCBT (92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (WL):91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline: a year of delivery\u003cbr\u003e\u0026nbsp;ATP: 9 wk and 3 mo of postpartum\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;9 wk: -0.81 [-1.11, -0.51]\u003cbr\u003e\u0026nbsp;3 mo:Not applicable (3 mo data was not reported)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Abujilban et al., 2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e29.2\u0026plusmn;5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 momth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eiIPT (53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TUA):51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:24-37 wk of GA\u003cbr\u003e\u0026nbsp;ATP: 1 mo of GA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS: -1.46 [-1.90, -1.01]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Van Lieshout et al., 2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e31.5\u0026plusmn;4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 Day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eiCBT(202)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TUA): 201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline: a year of delivery\u003cbr\u003e\u0026nbsp;ATP: 12 wk after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS: -0.51 [-0.71, -0.31]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Dennis et al., 2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e12 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eiIPT (120)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TUA):121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:2-24 wk of delivery\u003cbr\u003e\u0026nbsp;ATP:12 wk、24 wk and 36 wk after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS\u003cbr\u003e\u0026nbsp;12 wk: -1.07 [-1.36, -0.78]\u003cbr\u003e\u0026nbsp;24 wk: -1.09 [-1.38, -0.79]\u003cbr\u003e\u0026nbsp;36 wk: -0.59 [-0.87, -0.30]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp class=\"MsoNormal\"\u003e(Forsell et al., 2017)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e31.2\u0026plusmn;3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e10 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eiCBT(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlacebo (TUA):20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBaseline:10-28 wk of GA\u003cbr\u003e\u0026nbsp;ATP: 10 wk after baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eEPDS: -0.52 [-1.14, 0.10]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eGA, Gestational Age; ATP, assessment time point(s); EPDS, Edinburgh Postnatal Depression Scale; BDI, Beck\u0026rsquo;s Depression Inventory; BDI-Ⅱ, Beck\u0026rsquo;s Depression Inventory-Ⅱ; PHQ-9, Patient Health Questionnaire-9;\u0026nbsp;HAM-D,Hamilton Depression Rating Scale; CBT,\u0026nbsp;Cognitive-Behavioral Therapy; IPT,\u0026nbsp;Interpersonal Psychotherapy; PST,\u0026nbsp;Problem‑solving Training; BA, Behavioral Activation; MBI, Mindfulness-based Intervention; Icbt, Internet-delivered Cognitive-behavioral Therapy; iIPT, Internet-interpersonal Psychotherapy; TUA, Treatment as usual; EUC, Enhanced Usual Care; WL,\u0026nbsp;Waitlist; UC,\u0026nbsp;Usual Care; PE,\u0026nbsp;Perinatal education; HE,\u0026nbsp;Health Education.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eAt the study endpoint unless otherwise stated.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e All values are SMDs. Negative values indicate that treatment is better than control.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;(p=0.22). In terms of age, participants with an average age between 20 and 30 years exhibited a greater effect size compared to the control group (SMD: -0.80; 95% CI: -1.25 to -0.40). Furthermore, the effect sizes for studies using the EPDS versus non-EPDS scales, as well as those conducted in high-income versus low-to-middle-income countries, were moderate, with no significant differences between groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 2\u0026nbsp;\u003c/strong\u003eSubgroup Analyses Based on Study Characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"584\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of literature\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample size intervention/control, No.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSMD (95 % CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eI\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026sup2;\u003c/strong\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eChi\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eITT analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1842/1846\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.54 [-0.71, -0.36]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"68\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"19\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"19\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003ePP analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e439/443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.96 [-1.78, -0.13]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eLow ROB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1330/1359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.83 [-1.25, -0.40]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eSome ROB Concerns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e668/638\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.50 [-0.74, -0.25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eHigh ROB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e283/292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.70 [-1.27, -0.12]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention duration ,wk\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026le;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1517/1558\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.45 [-0.61, -0.29]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e＞8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e851/815\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.64 [-0.90, -0.39]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean age, y\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e20s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e936/949\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.80 [-1.24, -0.35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e30s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1188/1219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.43 [-0.57, -0.30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eMix\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e125/121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.84 [-1.40, -0.28]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard for evaluation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1958/1976\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.69 [-0.95, -0.42]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eNon-EPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e323/313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.52 [-0.79, -0.24]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.0002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCountry\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1557/1549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.67 [-0.96, -0.38]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eMiddle and Low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e724/740\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.61 [-0.95, -0.27]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.0004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: ITT, intention-to-treat; PP, per-protocol; ROB, risk of bias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubgroup Analyses of Components of the Intervention Programs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe also performed a subgroup analysis based on the components of the intervention programs. Compared to both the control group and group-based interventions, individualized psychotherapy (including sessions with individual women or with women and their partners) significantly reduced depression levels (SMD: -0.99; 95% CI: -1.43 to -0.54), showing a statistically significant difference between groups (p=0.006)(\u003cstrong\u003eTABLE 3\u003c/strong\u003e). Moreover, interventions conducted in non-clinical settings (such as community centers, homes, or public buildings) demonstrated a greater effect size compared to those delivered in clinical settings (SMD: -0.85; 95% CI: -1.56 to -0.15). In contrast, there was no significant difference in effect sizes between interventions conducted during pregnancy (SMD: -0.62; 95% CI: -1.03 to -0.21) and postpartum (SMD: -0.67; 95% CI: -0.87 to -0.47), both of which showed moderate effect sizes. Further analysis of this subgroup indicated that IPT had significant effect sizes during both periods, specifically (SMD: -1.27; 95% CI: -2.55 to 0.01) during pregnancy and (SMD: -0.82; 95% CI: -1.21 to -0.43) postpartum. Regarding the delivery mode, telemedicine interventions (SMD: -0.78; 95% CI: -1.07 to -0.49) displayed slightly superior effect sizes compared to face-to-face interventions. Notably, interventions led by trained non-professional therapists exhibited moderate to high effect sizes (SMD: -0.80; 95% CI: -1.19 to -0.40), while those conducted by professional therapists showed moderate to low effect sizes. Lastly, our analysis of different types of psychological interventions revealed that PST did not show a significant effect compared to the control group (p=0.05), with the most significant effect size observed in IPT (SMD: -1.07; 95% CI: -1.70 to -0.44), followed by CBT, MBT and BA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 3\u0026nbsp;\u003c/strong\u003eSubgroup analysis based on intervention programme components\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"574\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of literature\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample size intervention/control, No.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 100px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 105px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSMD (95 % CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eI\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026sup2;\u003c/strong\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eChi\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention number\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eGroup Intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1307/1327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.33 [-0.47, -0.20]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 57px;\"\u003e\n \u003cp\u003e7.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eIndividual Intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e944/937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.99 [-1.43, -0.54]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervening Period\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eGestation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1013/1004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.62 [-1.03, -0.21]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003ePostnatal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1268/1285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.67 [-0.87, -0.47]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eMedical Environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e870/856\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.51 [-0.78, -0.23]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eNon-medical Environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e552/576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.85 [-1.56, -0.15]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional Support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e885/906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.52 [-0.73, -0.31]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1325/1311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.80 [-1.19, -0.40]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWay of Intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eFace-to-face\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1609/1624\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.62 [-0.90, -0.34]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eTelehealth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e672/665\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.78 [-1.07, -0.49]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention Category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eCBT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1367/1352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.45 [-0.64, -0.26]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 57px;\"\u003e\n \u003cp\u003e4.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eIPT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e720/738\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-1.07 [-1.70, -0.44]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.0008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eMBI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e89/96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.44 [-0.74, -0.15]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eBA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e70/68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.33 [-0.67, 0.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003ePST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e35/35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.56 [-1.04, -0.08]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis systematic review and meta-analysis identified 33 randomized controlled trials assessing the efficacy of various psychotherapies for perinatal depression(Cuijpers et al., 2023; Li et al., 2022b; Sockol, 2018b). Overall, psychotherapy significantly reduced perinatal depressive symptoms, yielding a moderate effect size consistent with prior meta-analyses. Notably, individualized therapy showed a more pronounced effect compared to group interventions among perinatal women, and interventions delivered by trained non-specialist therapists demonstrated effect sizes comparable to those of professional therapists. Additionally, interventions conducted in non-clinical settings appeared more effective than those in clinical environments. Among the psychotherapeutic approaches for perinatal depression, IPT ranked highest in effectiveness, followed by CBT, MBT, and BA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirstly, the average age of study participants may play a significant role as a moderator of treatment outcomes in psychological interventions for perinatal depression. In this study, younger pregnant women and new mothers, particularly those aged 20 to 30, showed lower depression scores following psychological interventions. This improvement could be attributed to their greater physiological and psychological resilience, stronger social support networks, higher levels of treatment acceptance and adherence, and greater cognitive flexibility and emotional responsiveness(Bonanno, 2004; Collins and Feeney, 2000; Kazdin, 2008). These factors collectively contribute to more pronounced therapeutic effects. Future research should focus on strategies to maximize treatment outcomes across different age groups of perinatal women.\u003c/p\u003e\n\u003cp\u003eSecondly, the greater reduction in depression scores observed in interventions lasting more than 8 weeks may be due to the extended duration allowing for the development of a robust therapeutic relationship between mothers and therapists. This prolonged period facilitates deeper exploration and resolution of underlying issues, enabling patients to establish and reinforce new behavioral and cognitive patterns. Additionally, longer interventions provide more opportunities to practice and master coping skills, accumulate therapeutic benefits, and offer sustained support, all of which help patients better adapt to and manage the challenges of the perinatal period. Furthermore, extended treatment duration accommodates individual differences, helps prevent relapse, and ultimately results in more durable therapeutic outcomes(Br\u0026auml;nn et al., 2024b; Freeman and Davis, 2010).\u003c/p\u003e\n\u003cp\u003eThird, although the Edinburgh Postnatal Depression Scale (EPDS) is recognized as a standard screening tool for perinatal depression(Cox et al., 1987), there appears to be no significant difference in the effectiveness of psychological interventions for participants diagnosed with depressive symptoms using the EPDS compared to those diagnosed with other screening tools. This indicates that cultural adaptations of screening tools are equally important when addressing perinatal depression among women from diverse cultural backgrounds.\u003c/p\u003e\n\u003cp\u003eFourth, there is no significant difference in the effectiveness of psychological interventions in reducing depression scores between high-income countries and low- to middle-income countries. Previous research has shown that more than a quarter of perinatal women in low- to middle-income countries may be affected by depression (PMID: 36884232). Therefore, it is equally necessary to implement psychological interventions for perinatal women in these countries (PMID: 29352530). Future research should investigate the universal effectiveness of psychological interventions across different cultural and economic settings. Additionally, policies should aim to provide low- to middle-income countries with mental health resources and services comparable to those available in high-income countries, thereby promoting equal treatment outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComponents of the Intervention Programs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst, our study demonstrates that individualized treatment approaches yield better outcomes than group-based psychological interventions, with the former showing a higher effect size and the latter a lower one. This finding is consistent with previous reviews(Li et al., 2022c; Sampogna et al., 2024; Sockol et al., 2011a) and may be due to the ability of individualized treatment to tailor interventions to a patient\u0026apos;s specific symptoms, medical history, and personal needs, thereby enhancing the precision and effectiveness of the therapy. The private setting allows mothers to express their emotions and concerns more freely, reducing stigma and providing deeper emotional support and psychological understanding(Moore et al., 2020). Moreover, this setting alleviates the social pressures often associated with group environments, making patients feel more comfortable and relaxed. Individualized treatment also promotes trust and collaboration between the therapist and the patient, which enhances therapeutic outcomes. It allows for flexible treatment strategies that can be adjusted promptly based on the patient\u0026apos;s responses and progress, ensuring the adaptability of the treatment process(Fl\u0026uuml;ckiger et al., 2018). Therefore, our findings highlight the importance of personalized treatment, which typically requires a longer duration to offer sustained support and interventions, enabling women to more effectively manage and cope with their symptoms.\u003c/p\u003e\n\u003cp\u003eSecond, our analysis indicates that psychological interventions demonstrate moderate effect sizes both during pregnancy and within the first year postpartum. This may be attributed to the significant physiological and psychological changes women undergo during these periods, including hormonal fluctuations, bodily changes, decreased sleep quality, role transitions, lifestyle adjustments, and variations in social support. These changes can precipitate similar psychological issues, such as anxiety, depression, and emotional instability. Psychological therapy effectively addresses these common psychological concerns, yielding comparable outcomes in both pregnancy and the postpartum period(Grote et al., 2010; Maguire et al., 2020; O\u0026rsquo;Hara and Wisner, 2014). Moreover, psychological therapies (e.g., CBT, IPT) have demonstrated broad applicability in treating anxiety and depression by effectively identifying and modifying negative thought patterns, enhancing coping skills, and improving emotional regulation. Thus, psychological therapy provides consistent support and coping strategies across both stages. Consequently, research should focus on developing and implementing more standardized intervention protocols to improve the efficiency and effectiveness of these treatments.\u003c/p\u003e\n\u003cp\u003eThird, psychological treatments delivered in non-medical settings show a high effect size, whereas those conducted in medical settings exhibit a moderate effect size. Research indicates that patient engagement is positively correlated with treatment outcomes. In non-medical settings, therapy is often conducted in a more comfortable and informal environment, which helps patients relax, reduces psychological defenses, and encourages more open participation in therapy. The natural setting also contributes to enhancing treatment effectiveness(Wampold, 2015). Furthermore, non-medical settings provide therapists with more time and flexibility to establish a strong therapeutic alliance with patients. Studies have shown that a strong therapeutic alliance is a key factor in successful psychotherapy and can significantly improve treatment outcomes. Finally, non-medical settings allow therapists to deliver a higher degree of personalized treatment tailored to individual patient needs. This personalized approach can more effectively address specific issues and enhance treatment effectiveness.\u003c/p\u003e\n\u003cp\u003eFourth, the analysis indicates that both professional psychotherapists and trained non-specialist providers (NSPs) demonstrate a moderate effect size in reducing perinatal depression scores. However, we observed that the current availability of professional psychotherapists is limited due to high costs, insufficient funding, lack of insurance coverage, and limited access(Fitelson et al., 2010). In real-world settings(Singla et al., 2017), the majority of patients in low- and middle-income countries seek treatment through primary healthcare or community-based platforms, where psychotherapy is often delivered by NSPs through task-sharing. The most common NSPs include community health workers employed by the health system, as well as peers, trial staff recruited from the same community, nurses, and midwives. Moreover, NSPs often belong to the patient\u0026rsquo;s community, allowing them to provide more immediate and everyday social support. This support extends beyond psychotherapy, including assistance with daily life and emotional support, which is particularly critical during the perinatal period. Such comprehensive social support has been shown to significantly improve perinatal depression symptoms. Consequently, future policies should consider prioritizing the training of non-specialist providers to effectively deliver therapeutic interventions.\u003c/p\u003e\n\u003cp\u003eFifth, both telehealth and face-to-face therapy demonstrate moderate effect sizes in their intervention outcomes, aligning with previous research findings(Aemissegger et al., 2022; Hagi et al., 2023; Scott et al., 2022). The COVID-19 pandemic has significantly accelerated the adoption and development of telehealth(Asbury, 2023; Wind et al., 2020), leading to a marked increase in the number of studies and digital interventions, particularly those involving telehealth(Holmes et al., 2020). Despite this growth, most digital interventions remain focused on cognitive behavioral therapy (CBT), either as self-guided modules or as asynchronously guided by therapists. Recent studies indicate that telehealth is a viable alternative for managing residual depressive symptoms in perinatal women and provides essential support to those in remote areas(Milgrom et al., 2021, 2016; Segal et al., 2020). However, other research suggests that future studies should conduct individual patient data meta-analyses to optimize and personalize telehealth interventions(Shaker et al., 2023).\u003c/p\u003e\n\u003cp\u003eFinally, our study shows that IPT demonstrates a high effect size in treating perinatal depression, whereas CBT, MBI and BA show lower effect sizes. PST did not demonstrate significant efficacy for perinatal depression. Further research is needed to validate the effects of MBI, BA, and PST. Our findings are consistent with previous studies(Sockol et al., 2011b), and we suggest the following explanations: earlier research(Gelaye et al., 2016) has identified persistent interpersonal issues as a key risk factor for perinatal depression, emphasizing the importance of personalized interventions that address these issues. IPT, which focuses on enhancing social support, improving interpersonal relationships, and managing role transitions(Sockol, 2018c), is particularly effective in addressing interpersonal problems. This therapy helps women cope with the unique stressors of the perinatal period, encourages emotional expression and problem-solving(Bright et al., 2019), reduces psychological burden, and strengthens coping mechanisms.\u003c/p\u003e\n\u003cp\u003eHowever, some studies present results that are contrary to ours(van Ravesteyn et al., 2017). This discrepancy may be attributed to the fact that our included studies did not restrict the severity of perinatal depression, whereas the referenced study focused exclusively on severe cases. Based on our findings, we recommend IPT as the primary intervention for effectively managing perinatal depression. However, due to the unique characteristics of the perinatal depression population and the lack of direct comparisons among these therapies, future research should undertake network meta-analyses to determine the most effective treatments for perinatal depression across different stages and severities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this review, we conducted an extensive search and included a large sample size of studies on perinatal depression. The current systematic review and meta-analysis are restricted to RCT to support depressed mothers in making informed choices and clinical decisions based on the highest quality evidence. Few existing reviews address specific aspects of interventions, such as timing (during pregnancy and postpartum), setting, target populations, and implementation methods. We incorporated existing studies into various subgroup analyses. Additionally, our findings suggest that personalized psychological interventions in non-medical settings may yield better treatment outcomes for mothers with perinatal depression. Thus, our evaluation of the current evidence on psychological interventions for perinatal depression provides clinically relevant guidance for pregnant and new mothers, as well as for clinicians and researchers.\u003c/p\u003e\n\u003cp\u003eHowever, this study has several limitations. First, we excluded studies that involved the use of additional medications during the perinatal period. Additionally, there is a limited number of studies on perinatal depression within certain intervention subgroups (e.g., MBT, BA, PST), and since we only included studies published in English, trials published in other languages or as grey literature may have been omitted. Second, there is significant variability in the treatment doses and durations used across the studies, with session lengths ranging from 30 minutes to 2 hours, which makes it challenging to determine the optimal treatment regimen. Furthermore, blinding of the intervention for the participants was difficult throughout the process, with only 11 studies assessed as having low risk of bias. Additionally, many studies lacked consistency in baseline assessment of perinatal depression symptoms using scales (though the majority of trials required an EPDS score \u0026ge;9 for inclusion), so we did not address prevention or treatment of perinatal depression. Overall, due to variations in doses, durations, settings, and inclusion criteria, the results should be interpreted with caution.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, this systematic review and meta-analysis of psychological interventions for perinatal depression indicate that IPT, CBT, MBI, and BA are effective in improving perinatal depression, while PST is not, though further research is needed for a more accurate assessment. Additionally, IPT shows superior efficacy compared to other psychotherapies. Our study also underscores the importance of research design features and study components in enhancing the effectiveness of psychological therapies, particularly personalized interventions conducted in non-medical settings. Furthermore, trained non-psychotherapeutic professionals can also demonstrate better therapeutic outcomes during psychological interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm that the data supporting the findings of this study are available within the study and the Supplemental Material. Raw data that supports the finding of the study are available from the corresponding author, upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors\u0026rsquo; responsibilities were as follows: GSH,KLY,MJZ: designed and conducted the research, and provided essential materials; GSH,KLY,YZ: conducted the research; GSH,KLY,FCY: wrote the paper; GSH,MJZ: take primary responsibility for the final content; and all authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbujilban, S., Al-Omari, H., Issa, E., ALhamdan, A., Al-Nabulsi, L., Mrayan, L., Mahmoud, K.F., Kernohan, W.G., 2024. Effectiveness of Telephone-Based Interpersonal Psychotherapy on Antenatal Depressive Symptoms: A Prospective Randomized Controlled Trial in The Kingdom of Jordan. J Am Psychiatr Nurses Assoc 30, 635\u0026ndash;645. https://doi.org/10.1177/10783903231171595\u003c/li\u003e\n \u003cli\u003eAemissegger, V., Lopez-Alcalde, J., Witt, C.M., Barth, J., 2022. Comparability of Patients in Trials of eHealth and Face-to-Face Psychotherapeutic Interventions for Depression: Meta-synthesis. J Med Internet Res 24, e36978. https://doi.org/10.2196/36978\u003c/li\u003e\n \u003cli\u003eAmani, B., Merza, D., Savoy, C., Streiner, D., Bieling, P., Ferro, M.A., Van Lieshout, R.J., 2021. Peer-Delivered Cognitive-Behavioral Therapy for Postpartum Depression: A Randomized Controlled Trial. J Clin Psychiatry 83. https://doi.org/10.4088/JCP.21m13928\u003c/li\u003e\n \u003cli\u003eAsbury, E.T., 2023. Telehealth and the COVID-19 Pandemic: Making the Pivot from Offline to Online Therapeutic Interventions. Cyberpsychol Behav Soc Netw 26, 686\u0026ndash;689. https://doi.org/10.1089/cyber.2022.0242\u003c/li\u003e\n \u003cli\u003eBabiy, Z., Layton, H., Savoy, C.D., Xie, F., Brown, J.S.L., Bieling, P.J., Streiner, D.L., Ferro, M.A., Van Lieshout, R.J., 2024. One-Day Peer-Delivered Cognitive Behavioral Therapy-Based Workshops for Postpartum Depression: A Randomized Controlled Trial. Psychother Psychosom 93, 129\u0026ndash;140. https://doi.org/10.1159/000536040\u003c/li\u003e\n \u003cli\u003eBonanno, G.A., 2004. Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? Am Psychol 59, 20\u0026ndash;8. https://doi.org/10.1037/0003-066X.59.1.20\u003c/li\u003e\n \u003cli\u003eBr\u0026auml;nn, E., Shen, Q., Lu, D., 2024a. Perinatal depression and its health impact. BMJ 384, 2777. https://doi.org/10.1136/bmj.p2777\u003c/li\u003e\n \u003cli\u003eBr\u0026auml;nn, E., Shen, Q., Lu, D., 2024b. Perinatal depression and its health impact. 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Clin Psychol Rev 31, 839\u0026ndash;49. https://doi.org/10.1016/j.cpr.2011.03.009\u003c/li\u003e\n \u003cli\u003eSockol, L.E., Epperson, C.N., Barber, J.P., 2011b. A meta-analysis of treatments for perinatal depression. Clin Psychol Rev 31, 839\u0026ndash;49. https://doi.org/10.1016/j.cpr.2011.03.009\u003c/li\u003e\n \u003cli\u003eThe Lancet, 2023a. Perinatal depression: a neglected aspect of maternal health. Lancet 402, 667. https://doi.org/10.1016/S0140-6736(23)01786-5\u003c/li\u003e\n \u003cli\u003eThe Lancet, 2023b. Perinatal depression: a neglected aspect of maternal health. Lancet 402, 667. https://doi.org/10.1016/S0140-6736(23)01786-5\u003c/li\u003e\n \u003cli\u003eTsai, Z., Shah, N., Tahir, U., Mortaji, N., Owais, S., Perreault, M., Van Lieshout, R.J., 2023. Dietary interventions for perinatal depression and anxiety: a systematic review and meta-analysis of randomized controlled trials. 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Am J Psychother 75, 89\u0026ndash;96. https://doi.org/10.1176/appi.psychotherapy.20200050\u003c/li\u003e\n \u003cli\u003eZhang, H., Emory, E.K., 2015. A Mindfulness-Based Intervention for Pregnant African-American Women. Mindfulness (N Y) 6, 663\u0026ndash;674. https://doi.org/10.1007/s12671-014-0304-4\u003c/li\u003e\n \u003cli\u003eZhang, X., Lin, P., Sun, J., Sun, Y., Shao, D., Cao, D., Cao, F., 2023. Prenatal stress self-help mindfulness intervention via social media: a randomized controlled trial. J Ment Health 32, 206\u0026ndash;215. https://doi.org/10.1080/09638237.2021.1952947\u003c/li\u003e\n \u003cli\u003eZlotnick, C., Johnson, S.L., Miller, I.W., Pearlstein, T., Howard, M., 2001. Postpartum depression in women receiving public assistance: pilot study of an interpersonal-therapy-oriented group intervention. Am J Psychiatry 158, 638\u0026ndash;40. https://doi.org/10.1176/appi.ajp.158.4.638\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Perinatal depression, Psychotherapy, Meta-analysis","lastPublishedDoi":"10.21203/rs.3.rs-6134884/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6134884/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/em\u003ePsychological interventions are the preferred treatment for women with perinatal depression, but there is a lack of comprehensive meta-analyses evaluating their effectiveness and the impact of related variables.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e\u003c/em\u003eWe performed a systematic review and meta-analysis to assess the efficacy of psychological interventions for perinatal depression and to examine the influence of associated variables.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/em\u003eWe systematically searched the Ovid platform, covering the MEDLINE, EMBASE, PsycINFO, and Web of Science databases from their inception to March 11, 2024.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/em\u003eWe screened 5,827 articles, and 33 were included in a random-effects meta-analysis. Compared to the control groups, psychological interventions showed a moderate pooled effect size (SMD: -0.65; 95% CI: -0.87 to -0.43, moderate certainty of evidence). Subgroup analyses revealed that individualized interventions were more effective than group-based approaches. Additionally, interventions delivered in non-clinical settings were more effective than those in clinical settings. It was also observed that non-specialist therapists, who were professionally trained, achieved outcomes comparable to those of specialist therapists in treating perinatal depression. The effectiveness of different psychological interventions varied, with IPT demonstrating a larger effect size compared to CBT.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eLimitations:\u003c/strong\u003e\u003c/em\u003e The limited number of studies on MBI, BA and PST may affect the accuracy of the meta-analysis results.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/em\u003eIPT, CBT, MBI, and BA have been shown to effectively alleviate perinatal depression, while PST did not demonstrate significant efficacy. Notably, IPT outperformed the other interventions. Additionally, personalized interventions in non-clinical settings proved more beneficial. 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