Optimizing cognitive and behavioral approaches for perinatal depression: A systematic review and meta-regression analysis.

Cognitive behavioral therapies (CBT) have been demonstrated efficacious in treating perinatal depression (PND). This has been demonstrated in several meta-analyses of randomized controlled trials and quasi-experimental studies. However, there is a need for up-to-date meta-analytical evidence providing reliable estimates for CBT's effectiveness in treating and preventing PND. Furthermore, with the world moving toward precision medicine, approaches require a critical synthesis of psychotherapies, especially to unpack their mechanisms of action and to understand what approaches work best for whom. Therefore, the present systematic review and meta-regression analyses aim to answer these research questions. We searched six academic databases through February 2022 and identified 56 studies for an in-depth review. Using pretested data extraction sheets, we extracted patient-level and intervention-level characteristics and effect size data from each study. Random-effects meta-analyses and mixed-effect subgroup analyses were run to delineate the effectiveness and moderators of CBT interventions for PND, respectively. CBT-based interventions yielded a strong effect size (SMD = -0.74, 95% confidence interval [CI]: -0.91 to -0.56, n = 9,722) in alleviating depressive symptoms. These interventions were effective across different delivery formats (individual, group, and electronic) and could be delivered effectively by specialists and nonspecialists. Longer duration CBT interventions may not necessarily be more effective than shorter ones. Moreover, CBT-based interventions should consider including various behavioral ingredients to maximize intervention benefits.

Effectiveness of relaxation techniques 'as an active ingredient of psychological interventions' to reduce distress, anxiety and depression in adolescents: a systematic review and meta-analysis.

BACKGROUND: Adolescent depression and anxiety are among the leading contributors to health burden worldwide. 'Relaxation Techniques (RTs)' are a "set of strategies to improve physiological response to stress" and are frequently cited as an active ingredient of trans-diagnostic, psychosocial interventions for scaling-up care for preventing and treating these conditions in adolescents. However, there is a little evidence on the effectiveness of 'relaxation techniques' for this age group. AIM: As a part of the Wellcome Trust's Active Ingredients commission, we did a systematic review and meta-analysis to evaluate the effectiveness of RTs to reduce the symptoms of distress, anxiety and depression in young people, aged 14 to 24 years old, globally. METHODS: We searched 10 academic databases to include 65 Randomized Controlled Trials (RCTs) of relaxation-based interventions for young people with the symptoms of anxiety and depression. Primary outcomes were reduction in symptoms of distress, anxiety and/or depression. We employed the Cochrane risk of bias tool and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) guidelines to assess certainty of outcomes pertaining to anxiety, depression and distress. Standardized mean difference was estimated using effect size. RESULTS: The analysis of 65 RCTs with 8009 young people showed that RTs were highly effective in treating anxiety (pooled effect size of (Standardized Mean Difference-SMD) - 0.54 (95% CI - 0.69 to - 0.40); moderately effective in reducing distress (SMD = - 0.48, 95% CI - 0.71 to - 0.24) and had only a weak effect on improving depression in young people (SMD = - 0.28 (95% CI - 0.40% to - 0.15). Face-to-face delivered relaxation techniques yielded higher effect size (SMD = - 0.47, 95% CI - 0.64 to - 0.30) compared to online delivery (SMD = - 0.22, 95% CI - 0.48 to 0.04) for anxiety. CONCLUSION: Most of the included studies were from High Income Countries (HICs) and had a high risk of bias. Further high-quality studies with low risk of bias, especially from low resource settings are needed to evaluate the evidence for effectiveness of RTs as an active ingredient of psychological interventions to reduce the symptoms of distress, anxiety and depression in young people.

Prevention of common mental disorders among women in the perinatal period: a critical mixed-methods review and meta-analysis.

Perinatal depression and anxiety account for a high burden of perinatal morbidity and poor psychosocial functioning. There is a growing interest among mental health professionals, to devise interventions to prevent this condition. This review synthesizes evidence for the effectiveness of psychological and psychosocial interventions aimed at the prevention of perinatal depression and anxiety. We also explore qualitative evidence to understand the acceptability and feasibility of these interventions. Using a mixed-methods approach, data from a total of 21 studies were collated to inform the evidence for preventive interventions for perinatal depression and anxiety. Based on their theoretical orientations, these interventions were described by authors as cognitive-behavioral (n = 7); psychoeducational (n = 6); mindfulness (n = 2); and interpersonal psychotherapy (n = 2). These also included psychosocial approaches such as social support (n = 1) and multicomponent interventions (n = 3). For depressive symptoms, these interventions yielded moderate to strong effect sizes in favor of the intervention group [standardized mean difference (SMD) = -0.59; 95% confidence interval (CI) -0.95 to -0.23]. For anxiety symptoms, a strong effect size was estimated in favor of the intervention group (SMD = -1.43, 95% CI -2.22 to -0.65). Preventive interventions significantly reduce the severity of perinatal depressive and anxiety symptoms. These interventions are also acceptable and feasible in many settings.

Implementation and effectiveness of adolescent life skills programs in low- and middle-income countries: A critical review and meta-analysis.

BACKGROUND: Adolescence represents an unprecedented opportunity to invest in health. Individual adolescent life skills programs in low- and middle-income countries (LMICs) have demonstrated success but neither their relative effectiveness across multiple health arenas, including mental health, nor their key ingredients have been examined. METHODS: We conducted a systematic review and meta-analysis to identify key implementation processes and effectiveness of life skills programs among adolescents in LMICs which targeted at least one mental health outcome, as well as their relative effectiveness. Six academic databases, including PubMed and PsychInfo and bibliographies of related reviews, were systematically searched until July 1, 2016, with no restrictions on language or publication year. Studies were excluded if they were conducted in HIC settings, among chronically ill populations or lacking adolescents aged 10-19 years. Data from published reports related to the characteristics of RCTs and their implementation processes related to 'who, what, how and where' were extracted, including the development of a taxonomy to determine which life skills constituted each program. Meta-analyses with random effects models examined the overall trial effectiveness, as determined by their primary outcomes. Subsequent exploratory analyses determined which implementation processes predicted trial effectiveness (PROSPERO CRD42016043448). RESULTS: We included 50 eligible RCTs from 45 articles with a focus on an adolescent health program, which targeted at least one or more mental health outcomes. Most of the RCTs, conducted across 19 LMICs, targeted students (82%) and refugees (7%), and both genders (71%). Most of the interventions were delivered by teachers (n = 12), and specialist providers (n = 11), and most were focused on high-risk groups rather than clinically-disordered populations. These interventions were effective in reducing symptoms of anger (SMD = 1.234), improving life skills (SMD = 0.755) and functioning (SMD = 0.491), and decreasing PTSD (SMD = 0.327), depression and anxiety (SMD = 0.305). Trial effectiveness was positively associated with the following life skills: interventions focused on parent-child interactions (ß = 0.557, p < 0.05), assessing interpersonal relations (ß = 0.204, p < 0.05) and stress management (ß = 0.216, p < 0.05). DISCUSSION: Our results demonstrate the benefits of life skills programs targeting one or more mental health outcomes and co-occurring risk factors in school and community settings. Comprehensive programs focusing on multiple life skills related to the individual, his or her social environment and, in particular, interventions promoting parent-child interactions may hold particular promise in LMICs to address the burden of poor mental health and other health arenas.