Appraisal of systematic reviews on interventions for postpartum depression: systematic review

Ryan Chow, Eileen Huang, Allen Li, Sophie Li, Sarah Y Fu, Jin S Son, Warren G Foster, Ryan Chow, Eileen Huang, Allen Li, Sophie Li, Sarah Y Fu, Jin S Son, Warren G Foster

Abstract

Background: Postpartum depression (PPD) is a highly prevalent mental health problem that affects parental health with implications for child health in infancy, childhood, adolescence and beyond. The primary aim of this study was to critically appraise available systematic reviews describing interventions for PPD. The secondary aim was to evaluate the methodological quality of the included systematic reviews and their conclusions.

Methods: An electronic database search of MEDLINE, Embase, and the Cochrane Library from 2000 to 2020 was conducted to identify systematic reviews that examined an intervention for PPD. A Measurement Tool to Assess Systematic Reviews was utilized to independently score each included systematic review which was then critically appraised to better define the most effective therapeutic options for PPD.

Results: Of the 842 studies identified, 83 met the a priori criteria for inclusion. Based on the systematic reviews with the highest methodological quality, we found that use of antidepressants and telemedicine were the most effective treatments for PPD. Symptoms of PPD were also improved by traditional herbal medicine and aromatherapy. Current evidence for physical exercise and cognitive behavioural therapy in treating PPD remains equivocal. A significant, but weak relationship between AMSTAR score and journal impact factor was observed (p = 0.03, r = 0.24; 95% CI, 0.02 to 0.43) whilst no relationship was found between the number of total citations (p = 0.27, r = 0.12; 95% CI, - 0.09 to 0.34), or source of funding (p = 0.19).

Conclusion: Overall the systematic reviews on interventions for PPD are of low-moderate quality and are not improving over time. Antidepressants and telemedicine were the most effective therapeutic interventions for PPD treatment.

Keywords: AMSTAR; Cochrane reviews; Mental health; Methodological rigor; PRISMA; women’s health.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow Diagram illustrating the management of article titles identified in our literature search, rationale for study exclusion and ultimate inclusion for critical appraisal
Fig. 2
Fig. 2
The Characteristics of the AMSTAR Assessment of Included Studies. A: The AMSTAR scores from 2000 to 2020, grouped into five-year intervals. Data represented as mean (SD). The mean AMSTAR score throughout the past twenty years was 5.6 (1.6). B: The number (%) of studies adhering to each AMSTAR criteria. Criteria: 1. Was an ‘a priori’ design provided? 2. Was there duplicate study selection and data extraction? 3. Was a comprehensive literature search performed? 4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? 5. Was a list of studies (included and excluded) provided? 6. Were the characteristics of the included studies provided? 7. Was the scientific quality of the included studies assessed and documented? 8. Was the scientific quality of the included studies used appropriately in formulating conclusions? 9. Were the methods used to combine the findings of studies appropriate? 10. Was the likelihood of publication bias assessed? 11. Was the conflict of interest included?
Fig. 3
Fig. 3
Association Between Publication Factors and Methodological Quality. A: AMSTAR score vs. journal impact factor (p = 0.03, r = 0.24; 95% CI, 0.02 to 0.43). B: AMSTAR score vs. number of citations (p = 0.27, r = 0.12; 95% CI, − 0.09 to 0.34). C: AMSTAR score vs. publication year (p = 0.14, r = 0.16; 95% CI, − 0.05 to 0.37). D: Differences in AMSTAR score in papers funded by government vs. non-government sources. (p = 0.18) E: Differences in AMSTAR score for papers published by the Cochrane Collaboration vs. published in non-Cochrane journals (**p = 0.007)

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