Table 1.
GRADE evaluation of interventions for postnatal depression
| Important outcomes | Depression score, quality of life, suicide, adverse effects | ||||||||
| Number of studies (participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of drug treatments for postnatal depression? | |||||||||
| 1 (87) [31] | Depression scores | Fluoxetine plus CBT v placebo plus CBT | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and poor follow-up. Directness point deducted for recruitment issues |
| 1 (109) [35] | Depression score | Sertraline v nortriptyline | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and poor follow-up. Directness point deducted for recruitment issues |
| 1 (61) [39] | Depression score | Oestrogen v placebo | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for narrow inclusion criteria |
| What are the effects of non-drug treatments for postnatal depression? | |||||||||
| 1 (37)[41] | Depression score | Individual CBT v ideal standard care | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 1 (92) [42] | Depression score | Individual CBT v routine primary care | 4 | –1 | –1 | 0 | 0 | Low | Quality point deducted for sparse data. Consistency point deducted for conflicting results at different end points |
| 1 (84)[42] | Depression score | Individual CBT v non-directive counselling | 4 | –4 | 0 | 0 | 0 | Very low | Quality points deducted for poor follow-up, incomplete reporting of results, sparse data, and other methodological flaws |
| 1 (192)[52] | Depression score | Group CBT v non-directive counselling | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and poor follow-up |
| 1 (193) [43] | Proportion free of depression | Individual CBT v psychodynamic therapy | 4 | –2 | –1 | 0 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Consistency point deducted for conflicting results at different end points |
| 1 (35)[45] | Depression score | Paroxetine plus CBT v paroxetine alone | 4 | –1 | 0 | –1 | 0 | Low | Quality points deducted for sparse data. Directness point deducted for exclusion of suicidal women |
| 1 (120)[47] | Proportion free of depression | Interpersonal therapy v waiting list | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for recruitment issues |
| 3 (293)[50] [51] [42] | Proportion free of depression | Non-directive counselling v routine primary care | 4 | –2 | –1 | 0 | 0 | Very low | Quality points deducted for baseline differences and statistical flaws. Consistency point deducted for conflicting results |
| 1 (193) [43] | Depression score | Non-directive counselling v routine primary care | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, baseline differences, and statistical flaws. |
| 1 (193) [43] | Proportion free of depression | Non-directive counselling v psychodynamic therapy | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, baseline differences, statistical flaws, and incomplete reporting of results |
| 1 (192)[52] | Depression score | Individual non-directive counselling v group counselling | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and poor follow-up |
| 1 (45)[46] | Depression score | Group CBT v routine primary care | 4 | –2 | 0 | 0 | 0 | Low | Quality point deducted for sparse data and issues about definition of response |
| 1 (1220)[57] | Depression score | Interaction coaching v usual care | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (20) [59] | Depression score | Exercise plus social support v control | 4 | –2 | 0 | –1 | 0 | Very low | Quality point deducted for sparse data and issues about baseline differences. Directness point deducted for use of combined social and exercise interventions |
| 1 (193) [43] | Depression score | Psychodynamic therapy v routine primary care | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, baseline differences, and statistical flaws |
| 1 (29)[60] | Depression score | Psychoeducation with partner v psychoeducation without partner | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and uncertainty about baseline differences |
| 1 (42) [61] | Depression score | Telephone-based peer support v usual care | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for recruitment issues |
Type of evidence: 4 = RCT; 2 = Observational; 1 = Non-analytical/expert opinion. Consistency: similarity of results across studies. Directness: generalisability of population or outcomes.Effect size: based on relative risk or odds ratio.