Which therapy works best for maternal depressive symptoms? A network meta-analysis of psychotherapeutic interventions

PURPOSE: Maternal depression is a significant public health concern that can adversely affect both mothers and their children. Although various psychotherapeutic interventions have been proposed, their relative comparative efficacy remains unclear. This network meta-analysis (NMA) aimed to evaluate and compare the efficacy of different psychotherapeutic interventions in reducing maternal depressive symptoms. METHODS: A systematic search was conducted in the Web of Science Core Collection (Science Citation Index Expanded and Social Sciences Citation Index) to identify randomized controlled trials (RCTs) published between 1 February 2021 and 1 February 2025. Eligible studies included mothers aged ≥ 18 years who were assessed for maternal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) and received any form of psychotherapy. Data were extracted using a predefined format (PROSPERO ID: CRD420251010916). Random-effects models were used to perform the NMA in R, reporting mean differences (MD) with 95% confidence intervals (CIs) and P-scores. RESULTS: A total of 8 RCTs involving 2,919 participants were included. Cognitive behavioral therapy (CBT) was the only intervention that showed a statistically significant reduction in depressive symptoms compared to treatment as usual (TAU) (MD = -3.22, 95%CI: -5.91 to -0.54; p = 0.019; P-score = 0.92). Other interventions showed trends toward improvement, but these were not statistically significant (p > 0.05). CONCLUSION: CBT emerged as the most efficacious psychotherapeutic approach in both direct and indirect comparisons, supported by statistical evidence from the NMA.