“ A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women” : a review by Mennesson Laétitia, Muller Elodie and Manikon Amandine
The Introduction:
Sockol, L. E. (2018). A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women. Journal of affective disorders, 232, 316-328.
Interpersonal Psychotherapy is frequently prescribed for major depression (Klerman et al., 2000). It outlines the role of interpersonal relationships in the development and maintenance of psychological distress. Recently, there has been renewed interest in the attachment and interpersonal theories which explains the development of this kind of intervention. Previous studies have been conducted to adapt this intervention for a range of other disorders including postpartum outcomes.
Laura Sockol is a Doctor of Psychology. Her research focuses on perinatal mental health. She is particularly interested in understanding risk factors for distress during pregnancy and the early postpartum period, as well as identifying characteristics of effective treatments for perinatal psychopathology. Therefore, she carried out a meta-analysis to assess the effects of Interpersonal Psychotherapy on postpartum depression and other outcomes.
Keywords: Interpersonal Psychotherapy – Meta-analysis – Postpartum – Pregnancy – Prevention – Treatment
Summary:
Interpersonal Psychotherapy (IPT) is a time-limited psychotherapy based on attachment and interpersonal theories. The purpose of this intervention is to decrease depressive symptoms, to enhance social support and to improve interpersonal functioning (Stuart and Robertson, 2012). In the last few years, more attention has been given to the perinatal period, which includes pregnancy and the first year postpartum, as this is a high-risk period for experiencing depression and anxiety (10 to 20 percent of perinatal women). Indeed, the transition to parenthood is a real role transition and can be a challenge to interpersonal relationships. Some risk factors, including interpersonal problems such as low social support or marital dissatisfaction, highlings the interest of this kind of intervention. In addition, a majority of these women are reluctant to use medication during this period. That’s why this intervention can be an especially appropriate treatment option for perinatal women (Goodman, 2009). Moreover, two previous meta-analyses showed that IPT can be more effective for the treatment of perinatal depression than other forms of psychotherapy such as Cognitive Behavior Therapy or couple therapy (Sockol et al., 2011; Claridge, 2014). So far, however, most studies in the field have only focused on the impact on depression symptoms and there has been little discussion about the effects of this intervention on other symptoms such as anxiety or the quality of interpersonal relationships. The particularity of this paper is that it attempts to evaluate the efficacy of IPT on these several outcomes.
A systematic literature review was conducted on studies that examined IPT during the perinatal period. The final sample consisted of 28 studies, 11, of which assessed preventing interventions and 17, treatment interventions. Publications were only included in the analysis if the data and the sample were sufficient, if the design of the study met the expectations of the researcher and if they were elements concerning the validity of the measures. Then, the selected studies were coded using various references of coding instructions. No previous meta-analysis had included in their analysis factors or moderators, that could be influencing the efficacy of the intervention (duration, group or individual,…). Finally, they assess separately, prevention and treatment studies, on two effect sizes:
- Within group effect sizes : the change from pre to post treatment within the group receiving IPT.
- Between group effect sizes : the difference in mean change scores between the group receiving IPT and the comparison group.
In summary, strong evidence of the efficacy of IPT as an intervention for the prevention and treatment of psychosocial problems among perinatal women was found in this meta-analysis. First, concerning the prevention studies, the major finding of this analysis is that IPT is better at reducing the prevalence of postpartum depressive episodes. A 32% reduction in the risk of postpartum depressive episode is estimated. A significant improvement in the depressive symptoms was also found.
Then, for the treatment studies, results also show that IPT leads to an improvement in depressive symptoms. However, no significant differences were found between the groups for the prevalence of postpartum depressive episodes. Then, for the first time, evidence of the reduction of anxiety was revealed. This reduction is set to be more important for the group receiving IPT than the control group. This is promising evidence, especially with the prevalence of perinatal anxious disorder (Dennis et al., 2017). Nevertheless, these results must be taken with caution as they are based on a unique study. Concerning the interpersonal effects, an amelioration over the course of treatment of the relationship’s quality was noted. A significant improvement of social adjustment was also found, as well as an improvement of social support. However, the results on this last point are contradictory. Indeed, Bowen et al. (2014) observe no differences between receiving IPT and mindful-based therapy whereas Gao et al. (2010) found that it helps maintain the level of social support which may decrease in other conditions. For this reason, conclusions cannot be drawn as there are not enough studies on interpersonal effects. The author, then, emphasizes the lack and need of studies concerning those matters.
Overall, this meta-analysis shows a lot of promising effects of IPT for prenatal women in addition to the effects on depression but more studies need to be done to clarify these effects.
The critical evaluation :
This systematic review and meta-analysis goal was to evaluate the efficacy of IPT on several outcomes to better understand its relevance. We think the objective of the paper has been partially achieved. On one hand, we find data showing that IPT is indeed relevant for perinatal women but not only for depression. Unlike previous work, this meta-analysis evaluates a wider range of outcomes such as anxiety and interpersonal relationships. However, on the other hand, the sample of studies, on which those observations are based, is very small. Some effects are even based on only three or five studies, which is not very reliable. We can therefore say that the effects stated in this meta-analysis may not be representative of reality and cannot be generalized. Nevertheless, the authors emphasize the caution that comes with the data of this meta-analysis. We find that it is very well explained and clear how it is needed to do more research on the field as some few studies seem promising. This meta-analysis is less about ruling on the demonstrated and validated effect of IPT on perinatal women but more about reviewing the existing literature and giving indication on where to go with further research.
Concerning the data, the coding system of the different studies seems to be reliable and scientifically proven. However, we still think that it can be subject to the coder’s subjectivity.
Then, the selection of studies is as selective as it results in an especially small sample which may not be representative. Thus, conclusions of this paper must be taken with caution.
Overall, the writing style allows one to understand the author’s goals, as well as his conclusions. However, the statistical part proved to be quite complex because of the large number of not so common statistical analyses presented, which are not sufficiently explained. Sustained attention and sometimes rereading was necessary to understand all the elements presented in the result part, due to the lack of explanation. However, those not so common analyses seem to be very interesting. Indeed, one of them is set to tell if there’s a lack of some data and what effet we then might expect. It could have been interesting to know how it was evaluated but maybe that is because it’s a scientific paper and not a statistics course.
Conclusion : The contribution of this article
Results strongly support the interest of using IPT on perinatal women and suggest directions for further research in the field. Indeed, another aspect of this meta-analysis, that we did not develop in the summary, is the evaluation of potential moderators. But considering the small amount of studies specifying these elements, it is still difficult to draw conclusions. According to the author, it could be interesting to know if a certain type of population can benefit more from it, if the efficacity is increase in a individual setting rather than a group setting or the contrary, if the women partener should be included or not, the more effective number of seance and so on. It is also said that a promising field is the use of IPT on perinatal women with a stress post traumatic disorder. The author’s message is well conveyed: IPT is a promising intervention but more research needs to be done to know more on how to make it more efficient and for whom.
Words we learn :
- a range of = un éventail de
- discrepancies : Divergences
- Well-suited : bien adapté
- seeking : En cherchant