Psychosocial interventions on perinatal depression in China: A systematic review and meta-analysis

Background: The prevalence of perinatal depression is 16.3% in China and has shown a rising trend in the last decade. However, few studies summarized psychosocial interventions for perinatal depression in this country. This study aimed at evaluating and characterizing psychosocial interventions for perinatal depression in Mainland China. Methods: Ten major English and Chinese language electronic bibliographic databases were searched for RCTs examining the effect of psychosocial interventions for perinatal depressed women in Mainland China. Studies meeting eligibility criteria and published before 25th February 2019 were included, while those focusing on a very specific sub-population or reporting non-psychosocial interventions were excluded. Data was extracted by a standard form. Meta-analysis was conducted to obtain a summary measure of the effectiveness of the interventions in reducing perinatal depressive symptoms. The theoretical underpinnings and implementation processes of the interventions were also characterised. Results: A total of 6857 articles were identified in the initial database searching, of which, 26 studies were eligible for data analysis, representing a sample size of 4673. Meta-analysis indicated that psychosocial interventions in China significantly reduced perinatal depressive symptoms (standard difference in means 0.81, 95% confidence intervals -1.03 to -0.58, P < 0.001). However, the overall evidence presented substantial heterogeneity (I-2 = 91.12%). Most interventions were implemented in hospitals in urban areas by non-specialist health care providers. Few studies reported details of implementation procedures or scale-up strategies. Limitations: The evidence in this review is of moderate to low quality and therefore, should be interpreted with caution. Some of the trials were inadequately powered and tended to overestimate effect sizes. Conclusions: Current psychosocial interventions in China are somewhat effective in reducing perinatal depressive symptoms. High quality RCTs on scale-up interventions are required, especially in rural areas.