Efficacy of Psychological Treatments for Perinatal Depression and Anxiety: A Systematic Review and Network Meta-Analysis

Background: Perinatal depression and anxiety affect approximately one in five women globally and represent a pressing concern for social workers in maternal and child health, home visiting, and community-based mental health settings. While multiple psychological treatments exist for these conditions, no prior synthesis has simultaneously compared their short- and long-term efficacy using network meta-analytic methods that account for differences in evidence certainty. This study compared the short- and long-term efficacy of psychological treatments for clinically significant perinatal depression and anxiety across randomized controlled trials (RCTs).

Methods: PubMed, Embase, MEDLINE, and PsycINFO were searched from January 1990 to January 2025. Eligible RCTs enrolled pregnant or postpartum women (up to 12 months postpartum) with clinically significant depression or anxiety symptoms. Seventy-eight RCTs involving 11,345 participants were included. Primary outcomes were post-intervention symptom severity; secondary outcomes were symptoms at the longest follow-up (3–12 months). A Bayesian network meta-analysis estimated standardized mean differences (SMD) with 95% credible intervals (CrI). Evidence certainty was evaluated using the CINeMA framework. Between-study heterogeneity was explored using meta-regression examining participant age, country income level, and study risk of bias.

Results: Cognitive behavioral therapy (CBT) demonstrated consistent efficacy for post-intervention perinatal depression (SMD: −0.55, 95% CrI [−0.77, −0.33]; moderate certainty) and anxiety (−0.54, [−1.00, −0.06]; moderate certainty), with sustained effects for depression at follow-up. Interpersonal psychotherapy (IPT; −0.65, [−1.09, −0.20]; low certainty) and mindfulness-based intervention (MBI; −2.02, [−2.65, −1.42]; low certainty) also outperformed treatment as usual for short-term depression. Behavioral therapy (BT) showed short-term superiority for anxiety and was the only treatment with a sustained anxiety effect at follow-up. Treatment effects were attenuated in lower-income country settings and in higher risk-of-bias trials, indicating that effect estimates from high-income, methodologically rigorous trials may not generalize uniformly across practice contexts.

Conclusions and Implications: CBT is the most consistently supported psychological treatment for perinatal depression and anxiety and should be prioritized in perinatal mental health services where social workers play a coordinating or direct practice role. IPT, MBI, and BT show preliminary promise but require confirmation through rigorous trials with extended follow-up before being adopted as primary interventions. The moderating role of country income level is a critical caution for international social work: efficacy evidence generated in high-income settings should not be applied without local adaptation and evaluation. Social work educators should incorporate perinatal mental health competencies and familiarity with psychological treatment evidence into clinical training.