Dear editor
We express our gratitude to the authors of the review article on acupuncture as an alternative or complementary therapy for the treatment of postpartum depression (PPD).1 The review effectively utilized the PICOS framework to articulate the key issues and significantly enhanced the stringency of the inclusion criteria for the literature, thereby increasing the robustness of its conclusions.2 However, we propose several suggestions to further enhance the accuracy of the results.
Firstly, it is important to highlight that the quality of the randomized controlled trials (RCTs) included in the study is notably suboptimal. Despite reaching certain conclusions, the trials did not account for the varying severity of PPD at the time of enrollment, resulting in different baseline scores, commonly referred to as covariates. The absence of stratified analysis for these covariates in the statistical analysis introduces confounding bias, which the review acknowledged but did not adequately address in terms of its adverse effects on the results.3 Secondly, the review did not thoroughly examine the heterogeneity introduced by the use of different antidepressants in the control groups of the included RCTs. Given that various antidepressants exhibit differing effectiveness in treating PPD, this heterogeneity could significantly impact the results. The review failed to discuss this issue in detail or provide relevant statistical countermeasures. We recommend incorporating heterogeneity tests to bolster the credibility of the review’s conclusions.4
The limitations stemming from these methodological defects in the trials hinder a clear determination of acupuncture’s efficacy, potentially leading to a misassessment of its therapeutic effect on PPD.
In summary, while this systematic review offers valuable insights into the treatment of PPD, statistical enhancements are necessary to improve the accuracy and generalizability of the research findings, thereby providing a more robust scientific basis for the clinical treatment of PPD.
Disclosure
The authors declare that they have no conflicts of interest in this communication.
References
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