Women with PPD complain of depressive mood, insomnia, frequent crying, lack of appetite and motivation, fatigue, and multiple somatic symptoms, inability to cope, low self-esteem, and suicidal ideation. The reported prevalence of PPD is variable, with rates ranging from 5 to 25%, depending on the measures used. According to a meta-analysis of 59 studies, the prevalence rate of depression was 14% by diagnostic interview, which is similar to the value of 12% obtained by self-reporting measurements.1
Although the majority of PPD are spontaneously recovered within the first few months after birth,2
more than half of women with PPD continue to experience episodes of depression beyond the first postpartum year. Women with prolonged PPD are likely to have insecurely attached to their infants, and reported more negative perceptions of their infants.3
Observational research shows that infants and children of depressed mothers compared to children of non-depressed mothers are fussier, receive lower scores on measures of intellectual and motor development, and have more difficult temperaments and less secure attachments to their mothers. Infants and children of depressed mothers also react more negatively to stress show delayed development of self-regulatory strategies, and exhibit poorer academic performance, fewer social competencies, lower levels of self-esteem, and higher levels of behavioral problems.4
Consequently, point prevalence rates of psychiatric disorders among children of depressed parents have been estimated to be 2 - 5 times above normal at 41 - 77%.5,6
In addition, PPD has been linked to elevated rates of depression in spouses,7
and 50 - 70% of depressed women report that they experience marital problems and conflict. Therefore, left untreated, PPD causes not only considerable distress to women inflicted with this disorder but also yields more serious consequences of marital relationships and child-caring capacity. After birth relapse, the occurrence of depression and its recurrence are common.8
Although it is widely known that a substantial number of women are suffering from PPD, most of them seldom seek professional help.
The most common risk factors cited for PPD include depressed mood during pregnancy, lack of partner support, and low self-esteem.9,10
Especially, more than half of the women previously depressed in the postpartum period are at risk of developing depression again. Given the recurrent nature of depression, the antenatal period offers a window of opportunity during which a preventative approach to this serious condition can be instituted to high risk women during routine visits to the obstetric clinics. There have been 6 randomized controlled trials examining the effectiveness of antenatal group intervention aimed at preventing PPD in high risk women. The majority of the studies used psycho-educational group intervention delivered by non-specialist mental health professionals and found the intervention to be overall ineffective.11,12
The lack of positive effects suggests that presenting psycho-educational intervention in a group format by non-specialist mental health professionals may not be an optimal preventive strategy. It is of interest to note that positive outcomes were reported by 1 study using a validated structural intervention (IPT) delivered by a clinical psychologist in contrast to psycho-educational group intervention.13
In a recently published study, the CBT group intervention delivered by a clinical psychologist was found to be effective in reducing depressive symptoms in a perinatal period, however they failed to produce superior outcomes compared to "non-specific" booklet control condition.10
Given that CBT in a standard form is administered by clinical psychologists over 16 sessions, the poor outcome in this study might be attributable to the fact that they used a briefer CBT, focusing more on the behavioral rather than cognitive components of CBT.13
These findings suggest that specific intervention at a full dosage delivered by a specialist is necessary to bring about changes in depressive symptoms and behaviors to achieve the prevention of PPD.
Currently, 50 - 70% of depressed pregnant women reported that they had experienced marital problems and conflicts.1
These studies suggest that marital therapy or therapy dealing with marital conflict would be effective in preventing PPD. Some studies have reported that the level of depressive symptoms predicts later marital distress of depressed people as well as their partners, and depressive episodes prior to marriage may bring about increased risk of subsequent marital discord.14,15
Therefore, intervention seems to be desperately needed for improving marital relationships. For buffering negative events related to marital discord and alleviating depression, 5 types of positive and supportive behaviors of the partner are potentially important: spending quality time together, listening positively, acquiring support and boosting self-esteem and building intimacy. Once depressed women perceive the positive and supportive behavior from their spouse, the level of depression seems to decrease over time. Accordingly, marital intervention for depressive women has a strong foundation upon which to build. Until recently, studies have shown that preventive intervention is not sufficiently effective for reducing PPD. However, it would be possible that a full dosage intervention with specific dyadic component added to traditional CBT and delivered by a specialist can bring changes in depressive symptoms and behaviors to prevent PPD.
In this study, we maintained the basic tenet of cognitive-behavioral treatment and used the techniques of CBT for depression but focused on marital conflicts when dealing with negative thought and used behavioral techniques to improve marital relationships.16-18
The aim of this study was to investigate whether our CBT intervention was effective in improving depressive symptoms and marital relationships of pregnant depressive women and also in preventing PPD.