Running head: POSTPARTUM DEPRESSION AND INTERPERSONAL PSYCHOTHERAPY 1
Interpersonal Psychotherapy as an Evidence-Based Treatment Practice for
Women with Postpartum Depression: An Annotated Bibliography
CEP 653 Foundations of Counseling Theory
Emily Shields
University at Buffalo
State University of New York
POSTPARTUM DEPRESSION AND INTERPERSONAL PSYCHOTHERAPY
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Topic: Research supporting the use of interpersonal psychotherapy as an effective treatment
method for women diagnosed with postpartum depression or suffering from postpartum
depression symptoms.
Description of Literature Search:
 Search engines: Academic Search Complete, PsychInfo, PsychArticles, MEDLINE,
JSTOR, ERIC, Articles+, and specific searches of the American Journal of Nursing and
American Journal of Psychotherapy.
 Keywords: “Postpartum depression” alone displayed nearly 8,000 articles. I continued
my search adding “interpersonal psychotherapy” or “interpersonal therapy” after finding
several articles related to this effective treatment. Also used “treatment” and
“psychotherapy” in conjunction with “postpartum depression” to find more relevant
articles.
 Process and Results: I began searching for articles related to the treatment of postpartum
depression. I limited my search to scholarly articles (peer reviewed) published from the
year 2000 up to 2012. It was helpful to view a broad range of articles, but many were
related to medical interventions such as pharmacological drugs. When limited to
“psychiatry” related articles, about 1,400 articles were displayed. I did several searches of
both medical and psychology-related databases.
I will present clinical results from research studies as well as data-based reviews to
support the use of interpersonal psychotherapy (IPT) for women with postpartum
depression. Across the literature, I found that there are several subsets of IPT that are
considered effective with this population. Individual interpersonal psychotherapy is
largely the most studied intervention. I have included a study that investigated IPT
delivered via telephone and several that support the use of group interpersonal
psychotherapy. Although the method of delivery varies somewhat, these findings are
relevant to the interpersonal psychotherapeutic approach with mothers experiencing
postpartum depression. The literature overwhelmingly supported the use of IPT as a firstline treatment, especially for nursing mothers. Research has been devoted to this
population in part because many new mothers refuse to take antidepressants or other
medications. Although some medications have been approved for use with breastfeeding
mothers, the evidence for their safety and efficacy is still inconclusive. Therefore, an
effective psychological intervention is necessary. Research also shows that women favor
“talk”-based therapies, and through this synthesis of current findings, it is clear that IPT
is both favored and successful.
POSTPARTUM DEPRESSION AND INTERPERSONAL PSYCHOTHERAPY
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Interpersonal Psychotherapy as an Evidence-Based Treatment Practice for
Women with Postpartum Depression: An Annotated Bibliography
O’Hara, M.W., Stuart, S., Gorman, L.L., Wenzel, A. (2000). Efficacy of interpersonal
psychotherapy for postpartum depression. Archives of General Psychiatry. (57), 10391045.
Researchers conducted a study to determine the efficacy of IPT for women with major
depression after childbirth. One-hundred and twenty women who met DSM-IV criteria for major
depression were assigned randomly to 12 weeks of IPT or to a waiting list control group. Ninetynine women completed all treatments by the end of the study. All participants completed selfreport inventories and interviews that measured depressive symptoms and social adjustment
every four weeks. Participants in the IPT group received 12 one-hour individual sessions with an
experienced psychotherapist in which their interpersonal relationships, social and work
conditions, role transitions, and grief were addressed. Waiting List Condition (WLC) participants
waited 12 weeks before receiving any type of treatment; however, they completed Hamilton
Rating Scale for Depression (HRSD) assessments via telephone at 4, 8, and 12 weeks and
contacts were made at 2, 6, and 10 weeks to assess lethality. All participants were given the
HRSD, Beck Depression Inventory (BDI), Postpartum Adjustment Questionnaire (PPAQ), and
the Social Adjustment Scale – Self-Report (SAS-SR). Statistical analyses were conducted to
compare the scores throughout the study from the IPT group and the WLC group.
Results indicated that participants in the IPT group reported significant reduction in
symptom levels compared with the WLC group. A higher proportion of the participants in the
IPT group met HRSD and BDI criteria for recovery by the end of the study, in addition to no
longer meeting DSM-IV criteria for major depression. In contrast, the WLC group participants
reported little improvement over 12 weeks (15% and 17% symptom reduction based on HRSD
and BDI assessments) compared to the ≥ 50% from the IPT group. Based on the SAS-SR and
the PPAQ, participants receiving interpersonal psychotherapy also showed significant
improvement in their psychosocial functioning. Interviews were also part of the assessment
process, which provided more detailed, qualitative insight on each participant’s changes and
improvements over the treatment cycle. This study showed clear evidence that IPT is an
effective, non-pharmacologic treatment that should be implemented as quickly as possible for
new mothers in need of therapy. The article referenced the damaging effects of postpartum
depression on both mother and child if left untreated. According to the American Academy of
Pediatrics, the effects of antidepressants on nursing infants are unknown and could possibly be
harmful. Since more than 40% of the new mothers in this sample were breastfeeding, a therapy
that did not include psychotropic medications was essential, and researchers believe that this
percentage is possibly even higher in the general population. This study was published by the
American Medical Association and funded by a grant from the National Institute of Mental
Health..
Zlotnick, C., Miller, I. W., Pearlstein, T., Howard, M., & Sweeney, P. (2006). A preventive
intervention for pregnant women on public assistance at risk for postpartum depression.
American Journal of Psychiatry, 163(8), 1443-1445.
POSTPARTUM DEPRESSION AND INTERPERSONAL PSYCHOTHERAPY
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This study examined the efficacy of interpersonally-based interventions for low-income
African American women at risk for postpartum depression. Researchers first presented evidence
that African American women have a higher risk of experiencing PPD than Caucasian women. A
variety of socioeconomic and cultural factors including possible single marital status, poor social
support, and lack of financial resources contribute to this increased risk. A number of negative
consequences for mother, baby, and family were discussed, such as cognitive development
problems for the infant, decreased compliance with routine health care visits, and inability of the
depressed mother to care for herself and family. Additionally, the unique cultural influences and
coping mechanisms of African American women often make it difficult to recognize PPD. They
are often hesitant to seek professional help, instead accepting stressors and managing their
feelings with spirituality.
This study was aimed at preventing PPD in women who presented high risk after a
clinical evaluation in a prenatal clinic. The ROSE Program (Reach Out, Stand Strong: Essentials
for New Moms) was implemented with a group of African American women (n=19) and
compared with outcomes from a Treatment As Usual (TAU) group (n=17). The Rose Program
was an interpersonal therapy-based intervention that focused on familial communication,
managing role transitions, interpersonal conflicts, enhancing social support, and reducing
depressive symptoms. The therapy was designed for brief delivery and was comprised of four
90-minute weekly group sessions and a 50-minute individual session two weeks after the birth of
the child. Participants were evaluated using the Edinburgh Postnatal Depression Scale (EPDS),
the Social-Adjustment Scale Self-Report Questionnaire (SAS-SR), the Postpartum Adjustment
Questionnaire (PPAQ), and the Parenting Stress Index (PSI). Statistical analyses showed that
participants enrolled in the ROSE Program group experienced a decline in depressive symptoms
compared to the TAU group. However, no significant differences were seen between groups
regarding parenting stress and social adjustment.
This study seemed promising and although there were some interesting findings, flaws in
the study design may have contributed to the failure to find real significance between groups.
The only other area in which significant differences were reported was between groups at the
three-month postpartum follow-up. Women in the ROSE Program group reported better
adjustment than those in the TAU group three months after delivering. Researchers suggested
that a larger sample size with equal numbers in each group might yield better results in the
future. Participants also shared their level of satisfaction with the treatment and many suggested
longer or more sessions would be even more helpful, and that the intervention should be
available to all new mothers. The sample in this study offered a valuable look at an underserved
and understudied population, low-income, rural African American women. After discussing the
study’s limitations, researchers concluded that this study was an important step in developing an
effective intervention for at-risk mothers and should be evaluated further to be more
generalizable.
Stuart, S. (2012). Interpersonal psychotherapy for postpartum depression. Clinical Psychology
and Psychotherapy. (19), 134-140. doi: 10.1002/cpp.1778
This article outlined how to use specific techniques in the interpersonal
psychotherapeutic approach to treat women with postpartum depression (PPD). It referenced
numerous resources to illustrate the prevalence of PPD (currently thought to be approximately
13%) and stressed the importance of immediate treatment to prevent lasting negative
POSTPARTUM DEPRESSION AND INTERPERSONAL PSYCHOTHERAPY
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consequences for mother and child. PPD can contribute to negative attachment and psychosocial
issues in children, and is associated with mothers who exhibit more hostile and rejecting
behaviors, and are less responsive toward their children. The relationship of PPD and social
factors was also explored. Women with lower incomes, lower socioeconomic status, poor
support from partners and/or other friends and family are at a higher risk of PPD. Stuart argued
that interpersonal psychotherapy has shown more significant improvements in PPD symptoms
than cognitive therapies, as shown by recent research. He referenced several empirical studies in
which women with PPD chose interpersonal psychotherapy (IPT) significantly more than
antidepressant medications, and across the treatment options (IPT alone, IPT with
antidepressants, and antidepressants alone) outcomes were similar. IPT follows a
biopsychosocial model that integrates and understanding of new mothers’ biological and
hormonal changes with their emotional and mental states and social conditions. Clinicians should
inform patients about this approach from the beginning as a technique to alleviate some of the
anxiety and guilt over their condition.
The IPT approach has three main goals: improve interpersonal functioning in
relationships, alleviate psychiatric symptoms, and develop more avenues of social support. A
woman’s partner should be included in therapy as much as possible, both to educate him/her
about PPD and to strengthen the intimate relationship. Therapy should be conducted on a weekly
basis initially, and once the patient is stabilized, treatment may move to biweekly sessions.
Maintenance sessions may be conducted on an as-needed basis with a “check-up” contact around
six months after therapy conclusion. A thorough initial examination should address qualitative
symptoms and difficulties that may include personal feelings about pregnancy, motherhood, and
relationships with family and intimate partners. IPT utilizes analysis of communication in
relationships, interpersonal disputes, grief and loss (often associated with loss of spontaneity and
lifestyle), and role transition. Clinicians provide psychoeducation about PPD and treatment, as
well as child development and care, which can be especially helpful when the patient’s partner is
also present. Therapy should be sensitive to the normal changes and demands of being a new
mother (and therefore avoid over-diagnosing depressive symptoms) while also assessing any risk
of lethality or disturbing thoughts that may be present. Stuart argued that IPT should be a firstline treatment, especially for breastfeeding mothers as opposed to pharmacological interventions.
It directly addressed the challenges facing new mothers and is a time-efficient, problem-focused,
empirically verified treatment for PPD.
Mulcahy, R., Reay, R.E., Wilkinson, R.B., Owen, C. (2010). A randomized control trial for the
effectiveness of group interpersonal psychotherapy for postnatal depression. Archives of
Women’s Mental Health. (13), 125-139. doi: 10.1007/s00737-009-0101-6
This Australian study compared outcomes from an eight-week Interpersonal
Psychotherapy Group (IPT-G) for postnatal depression with a “treatment as usual” (TAU) group,
which was conducted in a community setting. Fifty women were initially assessed and then
randomly divided into the two groups. Additional assessments were conducted mid-treatment, at
the end of treatment, and three months following the end of treatment. Clinical assessments
sought to compare depressive symptoms, marital adjustment, mother-infant bonding, and social
support throughout the study. Researchers employed a battery of tests, including the Hamilton
Depression Rating Scale (HAM-D), the Million Clinical Multiaxial Inventory-III (MCMI-III),
Beck Depression Inventory, 2nd Edition (BDI-II), Edinburgh Postnatal Depression Scale (EPDS),
POSTPARTUM DEPRESSION AND INTERPERSONAL PSYCHOTHERAPY
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Dyadic Adjustment Scale (DAS), Interpersonal Support Evaluation List (ISEL), and the
Maternal Attachment Inventory (MAI). As a precursor, researchers referenced many scholarly
articles and studies that identify relationship conflict as a significant risk factor for PPD. This
study drew on the aforementioned research of O’Hara et al., (2000) that showed the efficacy of
IPT for depressed mothers. It went further to hypothesize that there are additional benefits to
administering IPT in a group setting.
Mulcahy and colleagues argued that the social support of group therapy is integral to
combating feelings of loneliness and isolation that new mothers often feel. The opportunity to
share feelings and struggles with other mothers bolsters the effectiveness of IPT. Traditional IPT
is at the core of the group setting, just modified somewhat to include more modeling and
encouragement through peer support. The TAU group in this study received various types of
community-based treatment, including medications, support groups, nurse support, individual
counseling, and natural remedies. With the data collected from periodic assessments, numerous
statistical analyses were conducted.
This study investigated many different variables as a part of postpartum depression, and
thus was able to make conclusions about effectiveness of IPT in many psychosocial areas. Not
only did participants in the IPT-G group experience decreased depressive symptoms, but also
achieved greater mother-infant bonding, higher relationship satisfaction, and better adjustment to
motherhood by the end of treatment. Almost 70% of participants in the IPT-G group met criteria
for recovery by the end of treatment, compared to 33% of participants from the TAU group.
Researchers also concluded that therapy in this IPT-G format is feasible from a community
mental health perspective. The generalizability of this study is somewhat debatable due to the
relatively homogeneous sample. Most mothers in this study were Australian-born, well-educated,
and in a stable relationship with a partner. Socioeconomic status may have also been a restriction
of range in this study. Additionally, the researchers in this study did not address the lack of
control of treatments included in the TAU group sufficiently. As with most studies, this article
could benefit from replications and greater control of extraneous variables.
Reay, R., Fisher, Y., Robertson, M., Adams, E., Owen, C. (2006). Group interpersonal
psychotherapy for postnatal depression: a pilot study. Archives of Women’s Mental
Health. (9), 31-39.
This study explored the effectiveness of IPT in a group setting. As a precursor,
researchers discussed numerous studies that have been conducted on different treatments for
women with postpartum depression (referred to as PND in this study), including cognitive
behavioral therapy, different types of antidepressant medications, and structured
psychotherapies. Previous results have indicated that interpersonal psychotherapy has shown
significant improvement for both mothers with PND and individuals with other depressive
disorders. Prior to beginning their study, the researchers discussed several studies that revealed
conflicting evidence as to the efficacy of IPT. Their perspective was that despite the flaws of
previously conducted research, there was a need to expand upon it to truly determine if IPT in a
group setting was an appropriate treatment for postpartum depression. To investigate the effects
of interpersonal therapy further, 18 new mothers with a postpartum depression diagnosis
participated in two individual therapy sessions and eight sessions of group IPT. The participants’
partners also were able to participate in a two-hour psychoeducational session. The first few
sessions were devoted to uniting the participants to collaborate together with a common focus.
POSTPARTUM DEPRESSION AND INTERPERSONAL PSYCHOTHERAPY
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Women shared personal stories and the therapists facilitated communication in the group. The
middle sessions covered interpersonal issues and included several specific IPT techniques,
including communication analysis and training, brainstorming, role playing, clarification, and
facilitation of affect. The last few sessions helped participants focus on the progress they had
made. Many of the participants arranged to meet beyond the treatment trial for additional
support.
Participants were evaluated using the Hamilton Depression Rating Scale (HAM-D), the
Beck Depression Inventory (BDI), the Edinburgh Postnatal Depression Scale (EPDS) and the
Social Adjustment Scale-Self Report (SAS-SR) to evaluate their progress over the course of the
treatment. Participants’ depressive symptoms and social adjustment were evaluated at baseline,
four weeks, eight weeks, and three months by an independent clinician. Participants also reported
their satisfaction with the treatment throughout the cycle. Scores on the HAM-D, BDI, and
EPDS significantly decreased over the course of treatment, while the SAS-SR scores remained
relatively stable. Three of the six women who received IPT experienced a full remission
according to the evaluations. There were several issues with the external validity of this study.
One issue with this study was that 66.7% of the participants were taking antidepressant
medication during the treatment. Additionally, that same percentage of participants had a history
of psychiatric illness of some kind. Finally, only three women from the entire sample received
the IPT treatment alone (with no antidepressants of any other type of therapeutic intervention),
and with such a small sample it was difficult to generalize those results to a larger population.
Despite the limitations of this study, it proposed some important ideas for further research. Many
women in the study continued to improve after the conclusion of the treatment (the follow-up at
6 months determined these results) which may demonstrate the longevity of effects of IPT. More
could be discovered with additional research that extends the IPT therapy longer than eight
weeks.
Fam, J., Chen, H., & Wang, J. (2011). Supportive counseling for postpartum depression in Asian
mothers. Asia-Pacific Psychiatry, 3(2), 61-66. doi:10.1111/j.1758-5872.2011.00122.x
This research article summarized the findings of a naturalistic prospective cohort study of
87 new mothers (all of whom were Asian). Participants were screened for postpartum depression
(PPD) through a program in a maternity hospital. The screening process included completion of
the Edinburgh Postnatal Depression Scale (EPDS), for which a baseline score of ≥ 13 indicated
clinically significant postpartum depression. Participants were then screened again at six months.
All of the women who participated were found to qualify for major or minor depression
according to the Diagnostic and Statistical Manual of Mental Diseases, Fourth Edition. Women
who were younger than 18 and mothers who were already receiving psychiatric care were
excluded from the study. All participants agreed to participate in supportive counseling with a
trained clinician, and some also agreed to take antidepressant medications such as tricyclic
antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs).
Researchers compared the outcomes of participants receiving supportive counseling
alone against the outcomes of those receiving both counseling and antidepressants. Supportive
counseling consisted of individual therapy sessions with both clinicians and case managers that
focused on the immediate stressors of the participants’ lives, including adjustment to
motherhood, and relationships with partner, newborns, and family. Participants were also
encouraged to participate in facilitated support groups periodically. Those with severe marital
POSTPARTUM DEPRESSION AND INTERPERSONAL PSYCHOTHERAPY
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issues, domestic violence, and/or financial difficulties also received support from case
management workers and other community resources. It was found that overall, 69% of the
participants achieved remission at six months following the start of treatment. Although the
differences between groups were not found to be statistically significant, there were some
differences worth noting. Among the participants who remitted, those on SSRIs in conjunction
with counseling appeared to take longer to remit than those on TCAs with counseling, and the
counseling group alone. Eighty-six percent of the women treated with counseling alone had
remission around seven weeks. Researchers did not discuss the therapy intervention in depth,
which could be considered a weakness of the study. However, they discovered that contrary to
their belief that most women are reluctant to take medications for postpartum depression, 72%
agreed to participate in antidepressant therapy. They also found through the psychiatric
evaluations that marital problems were the most prominent psychosocial stressor for all
participants at 36%.
Dennis, C., Ravitz, P., Grigoriadis, S., Jovellanos, M., Hodnett, E., Ross, L., & Zupancic, J.
(2012). The effect of telephone-based interpersonal psychotherapy for the treatment of
postpartum depression: study protocol for a randomized controlled trial. Trials, 13(1), 3854. doi:10.1186/1745-6215-13-38
The researchers conducting this study argued that although interpersonal psychotherapy
(IPT) has shown efficacy in the treatment of postpartum depression (PPD), it is not widely
available, especially in rural areas. Background was provided on the damaging effects of PPD,
including sleep problems, changes in appetite, guilt, suicidal thoughts, dysphoria, sadness,
loneliness, low self-esteem, and feelings of incompetence. These symptoms are often exhibited
within the first 12 weeks following the birth of a child. PPD is prevalent across many cultures
and statistics vary from 3% to 25% of women experiencing PPD symptoms. Untreated PPD can
also lead to child development issues, such as social and emotional delays, attachment insecurity,
behavioral and attention problems, and expressive language impediments. IPT is an empirically
based, time-limited psychotherapy that focuses on providing support, solving problems,
challenging maladaptive behaviors, and encouraging positive change. Traditionally, IPT has
been delivered in individual or group settings. However, Dennis and colleagues argued that
group therapy is generally poorly attended by new mothers with PPD. They proposed that access
to care could be improved by implementing telephone-based therapy with new mothers. IPT via
telephone would offer a flexible, private, non-stigmatizing option that could also eliminate
socioeconomic and geographic barriers to treatment. Two other trials were referenced that
showed positive results of telephone-delivered IPT (both conducted in the U.S.).
In this randomized controlled trial, researchers sought to establish the efficacy of
telephone-delivered IPT with 240 Canadian women, all of whom were between 2 and 24 weeks
postpartum. Participants either self identified as depressed and sought treatment or were referred
by a health professional based on a score of 12 or higher on the Edinburgh Postnatal Depression
Scale (EPDS). Participants were assigned randomly to either the control group or the treatment
group. The control group received standard postpartum care (as provided to all mothers)
including community services for PPD. The treatment group received standard postpartum care
in addition to 12 weekly sessions of telephone-based IPT. All participants were evaluated at
baseline, 12 weeks, 24 weeks, and 36 weeks post-randomization using the SCID-I, EPDS, STAIState Anxiety Inventory, Dyadic Adjustment Scale, Experiences in Close Relationships-Revised,
POSTPARTUM DEPRESSION AND INTERPERSONAL PSYCHOTHERAPY
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and demographic variables. These measures evaluated role adjustment, depressive symptoms,
anxiety levels, attachment, relationship quality, and health service utilization. This study is very
current and the results have not been published yet, but the researchers postulated that the
ongoing results will contribute greatly to the body of knowledge about effective IPT treatments,
and could be integral to adopting a new method of healthcare delivery in rural or large areas like
Canada. In addition, researchers collected valuable information on comorbid symptoms and
disorders such as anxiety and attachment issues. Recruitment for the study was ongoing as of
March 9, 2012.
Carter, W., Grigoriadis, S., & Ross, L. E. (2010). Relationship distress and depression in
postpartum women: literature review and introduction of a conjoint interpersonal
psychotherapy intervention. Archives of Women's Mental Health, 13(3), 279-284.
doi:10.1007/s00737-009-0136-8
This literature review and treatment proposal was written by several respected Canadian
clinicians in the mental health and women’s health fields and sought to uncover the importance
of relationships in the recovery process from postpartum depression (PPD). It cited 30 scholarly
articles and research studies and an example case study to support interpersonal psychotherapy
(IPT) interventions that are adapted for couples in the treatment of PPD. Research has shown that
new mothers experiencing relationship distress are much more likely to be diagnosed with PPD
than those who are not. IPT interventions include four major areas: interpersonal disputes, role
transitions, grief, and interpersonal deficits. Researchers proposed that IPT in a couples-focused
context can greatly improve depressive symptoms and overall relationship functioning.
Clinicians can facilitate communication between partners by discussing the fluidity of parenting
roles and tasks, encouraging positive communication styles, and resolving conflicts in a more
effective manner. In this paper, researchers proposed that couples meet with a therapist on a
weekly basis for 12 90-minute sessions. Each individual would also meet with the therapist for
one private session each.
The initial sessions of couples IPT are focused on obtaining an accurate construction of
the relationship and nurturing the therapeutic alliance. The middle sessions identify key conflicts,
develop a plan of action, and attempt to resolve disputes. The final sessions are dedicated to
developing a plan for future obstacles, celebrating the couple’s growth, and discussing the
changes they have seen in themselves. To illustrate the progression of their proposed treatment
model, the researchers included a case study along with the numerous studies summarized in the
article. The case study followed couples IPT with Ellen and Daniel, the parents of two children
(aged 2 years and 4 months, respectively). Both individuals agreed that relationship stress had
contributed greatly to Ellen’s depressive symptoms, which included a significant number of
cognitive and physical issues. Ellen completed the EPDS, and both partners completed the
Dyadic Adjustment Scale (DAS). In therapy, it was discovered that the couple was suffering with
trust issues, stemming from Daniel’s inappropriate email correspondence with another woman.
Ellen had withdrawn emotionally and sexually from the relationship. Both partners had begun to
avoid spending time together at all. Throughout treatment, Ellen and Daniel’s relationship issues
were discussed in detail and the therapist engaged them in many IPT exercises designed to
improve interpersonal communication and intimacy. By the end of treatment, Ellen no longer
reported a clinically significant EPDS score and both partners reported improved scores on the
DAS, indicated higher marital satisfaction. Although this article included one case study and not
POSTPARTUM DEPRESSION AND INTERPERSONAL PSYCHOTHERAPY
10
a full research design, it drew on many established studies within the field that support IPT as an
effective therapy for PPD, and others that recognize the importance of relationships and
interpersonal communication to the recovery process. The researchers recognized a few
limitations. This intervention may be most appropriate for couples who have been in an
established relationship for at least two years and currently live together in the same household.
Both members should be willing to attend therapy and work toward improving the quality of
their relationship. Women in potentially abusive or violent relationships or situations in which
the relationship is already over are not good candidates for this intervention. This article
proposed that a randomized controlled clinical trial would be the next step for establishing
couples IPT as an accepted treatment for PPD.
Kopelman, R. & Stuart, S. (2005). Psychological treatments for postpartum depression.
Psychiatric Annals (35)7, 556-566.
This comprehensive literature review summarized the findings of numerous empirical
studies regarding the efficacy of different psychological interventions for postpartum depression
(PPD), most commonly IPT. Although the results of each individual study discussed are beyond
the scope of this paper, the conclusions are nonetheless important. Studies covering the outcomes
of individual IPT, group-based IPT, cognitive behavioral therapy (CBT), pharmacological
treatments (including paroxetine and fluoxetine; accepted medications for depression treatment),
and non-directive treatment with a trained clinician as opposed to treatment with a nonspecialized healthcare worker were discussed in detail. This analysis of research allowed
Kopelman and Stuart to proposed a first-line treatment model based on a step-wise
psychotherapeutic method. Since so many women are reluctant to take antidepressants or other
medications after giving birth (and owing to the lacking empirical research available), it is
accepted that “talk-based” therapies are considered the first step in treatment and are also the
most successful in symptom reduction.
Kopelman and Stuart proposed that a step-based treatment model would be beneficial and
cost-effective, based on the level of severity of PPD of each patient. They argued that groupbased IPT interventions are most effective for women with mild depressive symptoms. In
addition, group or individual treatment can be provided to mildly depressed women by nonmental health professionals (such as nurses or in informal support groups). However, women
with more severe depressive symptoms should be treated with IPT by a trained professional.
Treatment interventions that incorporate partners need to be studied more rigorously, as the
research in that area is sparse and inconclusive (as of 2005, when this article was written). They
recognized the limitations of psychotherapeutic interventions and postulated that more research
on pharmacological treatments in combination with therapy could uncover a combination
treatment method appropriate for severe PPD. An interesting element to this article was its
spotlight on non-directive therapies versus focused treatments administered by mental health
professionals. Several studies have conducted research on the efficacy of treatments delivered
via primary care physicians, midwives, and nurses. Although the studies discussed in this article
lacked control of extraneous variables (such as antidepressant medication), they did find that
non-directive counseling can be a good option for women with mild PPD. Educating all primary
care workers about PPD is important since women are most commonly treated in this type of
setting. Kopelman and Stuart presented strong arguments backed by extensive research and
analysis of a broad variety of studies and included 41 credible sources in their literature review.
POSTPARTUM DEPRESSION AND INTERPERSONAL PSYCHOTHERAPY
11
Gao, L., Chan, S., Li, X., Chen, S., & Hao, Y. (2010). Evaluation of an interpersonalpsychotherapy-oriented childbirth education programme for Chinese first-time
childbearing women: A randomised controlled trial. International Journal Of Nursing
Studies, 47(10), 1208-1216. doi:10.1016/j.ijnurstu.2010.03.002
This randomized controlled trial study was conducted in the maternity clinic of a regional
hospital in China. The goals were to investigate the efficacy of an interpersonal
psychotherapeutic treatment featuring psychoeducation on postpartum depression (referred to as
postnatal depression or PND in this article), psychological well-being, and interpersonal
relationships of Chinese mothers who had given birth for the first time. The study featured 194
pregnant women who were assigned randomly to the intervention group (N=96) or the control
group (N=98). The intervention group received therapy based on the principles of IPT and
included two 90-minute antenatal classes and telephone follow-up two weeks after delivery.
Researchers stressed the importance of studying PND, as it affects 10-20% of postpartum
Chinese women, a statistic that is similar in North America and Europe. It was observed that
traditional antenatal care consisted primarily of delivery and child care concerns, with little
attention to psychosocial issues, role changes, and stress management. Much like the IPT
conducted in other studies, the treatment group in this study received IPT therapy focused on
interpersonal relationships, communication skills, role transitions, and social support.
Participants were evaluated using the Edinburgh Postnatal Depression Scale (EPDS), the
General Health Questionnaire (GHQ), and the Satisfaction With Interpersonal Relationship Scale
(SWIRS). The SWIRS was devised by one of the authors of the study and designed to measure
satisfaction level with the participant’s partner and mother-in-law. It was also evaluated by
several outside experts for face validity. At six weeks postpartum, mean scores on the EPDS and
GHQ were significantly different between the two groups, with the treatment group displaying
less depressive symptoms and better psychological well-being. The treatment group also
indicated more satisfaction with interpersonal relationships (as indicated by the SWIRS) than the
control group, but no significant changes over time were found on that level of measurement.
Overall, the IPT treatment seemed to have a positive outcome for the treatment group. However,
the researchers noted several limitations. The sample (though sufficiently large) was pulled from
women who were already attending routine antenatal education classes and were largely middleclass. All were also first-time mothers with no pregnancy complications. This study did not
target at-risk women or women with diagnosed PND. Despite its limitations, this study provided
a valuable contribution. It proposed that introducing a more psychologically-oriented element
into routine pregnancy and post-pregnancy healthcare could significantly impact the adjustment
and well-being of mother and child. Chinese women are especially at risk for marital and familial
conflicts over disagreements on baby care, gender preferences, and postpartum rituals.
Researchers concluded that IPT-oriented programs would help mothers transition into their new
roles and develop better interpersonal and coping skills.
POSTPARTUM DEPRESSION AND INTERPERSONAL PSYCHOTHERAPY
12
References
Carter, W., Grigoriadis, S., & Ross, L. E. (2010). Relationship distress and depression in
postpartum women: literature review and introduction of a conjoint interpersonal
psychotherapy intervention. Archives of Women's Mental Health, 13(3), 279-284.
doi:10.1007/s00737-009-0136-8
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