Sockol, L.E. (2018). A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women, Journal of Affective Disorders 232, pp.316-328.
The aim of this article is to make a systematic review of interpersonal psychotherapy for perinatal women and to review its efficacy in prevention and treatment therapy for depression and anxiety.
Laura Sockol works for the Davidson College Laboratory for Risk and Treatment Studies. She is a doctor in psychology and works on perinatal mental health. Her interest is dedicated to understanding risk factors for distress during pregnancy and the early postpartum period. She also studies the effective treatments for perinatal psychopathology and tries to understand which characteristics are essential. As such, she is an expert in this field.
Interpersonal Psychotherapy (IPT) is time-limited psychotherapy initially developed for depression, which has been adapted to other disorders like anxiety (Klerman et al., 2000). It’s based on attachment and interpersonal theories (Stuart & Robertson, 2012). The purpose of IPT is to foster symptom remission, promote social support, and improve interpersonal functioning and emphasize the role of interpersonal relationships.
From 10 to 20 % of pregnant and perinatal women experience anxiety and depression symptoms. These symptoms are enhanced by a non-satisfactory husband and problematic and low social support. Furthermore, the author states that becoming a mother is an interpersonal challenge in itself, and so this specific therapy might be well relevant for this population. The author also adds that IPT is an intervention well-liked by women in general.
She made the statement that some studies already show some encouraging results on effects on depression for prevention and treatment. However, she underlines the fact that there is little to no information on the effect of IPT on anxiety or on interpersonal relationships, as well as not enough indications of the effect of moderators (such as length of the therapy, social support, personal characteristics, …).
Sockol conducted research of articles with the use of keywords (e.g., IPT, pregnancy, the first year postpartum). She then coded them by seven criteria (methodology quality, type of intervention, …) and chose the highest-scoring one.
The author has compared the conditions, results, prevalence, effect size and she has studied the results compared to the control group, for each prevention and treatment study.
Sockol elected 28 studies, each with various characteristics. For prevention studies, the results showed a significant decrease in depression, especially if the sessions were numerous, if the mothers were younger and if they were more depressed. A 32% of risk reduction for postpartum pregnancy was calculated. As for the treatment studies, they tend to show the same results for depression, but regarding anxiety, even though there is a decrease in symptoms, the reduction is not significantly bigger than for other therapies. The results highlight an improvement in relationships and social improvement.
As such, the author deemed this therapy as efficient and even better than others for treating anxiety. She encourages futures studies to evaluate anxiety and personal issues as well as diversifying samples.
This article tries to do a meta-analysis of articles on the subject of interpersonal therapy (IPT). The purpose of IPT, the methodology used to choose articles, and the results are well explained. I did not know of IPT prior to reading this article, and it made me want to know more about it. By the look of it, it seems to be an innovative approach, focalizing on relationships in the social circle. I think it is a great thing, as pregnant women tend to focus a lot on themselves during pregnancy, and helping them open to others might help with a smoother transition after childbirth. Although, I wonder about the need for a parallel therapy, focused on the mother. Indeed, many types of research showed that women need to have some narcissistic support during pregnancy, to help build their self-worth as a mother. It is unclear if IPT helps enough in this area.
As the author stated, I think this field needs to enhance its group samples, thus, include women with specific disorders (psychological ones, as well as corporeal ones) and women with no disorder, or no apparent risks of developing one. I would also encourage researchers to focus on the perceived skill of being a good mother after birth, as this is the symptom of a non-sufficiently narcissistically enhanced mother. Thereby, my worry about this lack of narcissistic support in this therapy would be answered.
This article shows encouraging results on the efficacy of IPT. However, I question the quality of the sample of articles. Indeed, there are only 28 studies represented in this article. This number of articles might well be sufficient to do a meta-analysis, but the decision-making process of getting rid of articles seems a little too strict for me. For example, articles in which “all participants had experienced a perinatal loss were excluded” (p. 317), which I regret, as this would have been a great enhancement of the sample’s diversity. We can imagine that the author wanted to concentrate on a specific population, to not have too much data, but it also gives the impression that she excluded some populations, as if, for these, the therapy might not work. If I were to study this therapy more thoroughly, I would research this part of the population, or I would, at least, contact Sockol to understand her choice.
Finally, I think her coding of articles is a nice addition to the meta-analysis, as it helps to pick only great articles for the meta-analysis. Some other meta-analyses that I have read did not do this coding and have added average researches in their studies. Nonetheless, I still wonder if this does not create a bias, by eliminating all studies with no positive results. For example, only studies with an “intent-to-treat” (p.318) were used. We can query the impact of the therapy with a broader approach.
To conclude, I really appreciated reading this article and look forward to reading more articles written by Sockol, as she seems to have done thorough work on this paper and I want to learn more about therapy for pregnant women. I liked asking myself questions about the methodology, and even though I questioned it in this report, I think it would be difficult to do a better job without jeopardising the rigour of the author. As for the question “Is a meta-analysis effective for judging the effect of interpersonal psychotherapy on perinatal depression and anxiety?”, I would argue that it is effective, but we need to keep an open mind and understand that not every study have been integrated into the meta-analysis, hence the need to read further articles on this subject to have a more exhaustive point of view.
Vocabulary:
- Breastfeeding : allaitement
- Miscarriage : fausse couche
- Stillbirth : mort-né
- Infant death : mort du nourrisson
- Encompass : inclure, comprendre
- Consistent : cohérent
- Assessed : évalué