Efficacy of behavioural activation in treating prenatal depression: a systematic review and meta-analysis

BackgroundPrenatal depression is a significant and increasingly recognised public health issue, with symptoms often intensifying as pregnancy progresses. Behavioural activation is an established treatment for depression; however, its effectiveness in treating depression during the prenatal period has not been systematically evaluated. ObjectiveTo compare the effectiveness of behavioural activation against any comparators in reducing depressive symptoms in pregnant women. MethodsWe searched six primary databases (CINAHL, Cochrane Library, Ovid Embase, Ovid Emcare, Ovid MEDLINE, and Ovid PsycINFO) for randomised controlled trials (RCTs) comparing behavioural activation with comparators for depression in pregnant women. We also searched for major international clinical trial registries and manually reviewed reference lists of included studies. Risk of bias was assessed using the Cochrane Collaborations risk-of-bias 2 tool. We calculated a random-effects, inverse-variance weighting meta-analysis to examine the association between behavioural activation and depressive symptoms during the prenatal period. ResultsOf the 4,129 records identified, four RCTs from three countries comparing behavioural activation with comparators for the treatment of depression in pregnant women met the inclusion criteria. One study was rated as low risk of bias. Meta-analysis showed that behavioural activation was associated with a small reduction in depressive symptoms among pregnant women diagnosed with depression, compared to treatment as usual (standardised mean difference = -0.33; 95% CI, -0.57 to -0.10), with high heterogeneity across studies (I{superscript 2} = 82.8%). Two of the four included studies reported on adverse events; however, none reported any harm resulting from participation in the treatment trials. ConclusionsThis systematic review indicated that behavioural activation may be more effective than treatment as usual in reducing depressive symptoms during the prenatal period. However, the findings should be interpreted with caution due to limitations in the quality of the available evidence.