It is estimated that 20% of women who have just given birth suffer from postpartum depression (PPD), and as many as one in three has depressive symptoms that affect them despite falling short of the criteria for major depressive disorder.

PPD is not the same as the syndrome popularly called “baby blues,” which affects many women in the days after childbirth and typically lasts 2 weeks or less. Such women commonly experience mood swings, crying spells, anxiety, and/or difficulty sleeping. PPD, a form of major depression, is far more severe, long-lasting, and is associated, among other things, with an increased risk of suicidal ideas and behavior. It can begin before childbirth or up to 1 year after, explaining why depression associated with pregnancy and childbirth is sometimes called “perinatal.”

It is a worrying fact that of women who qualify diagnostically for PPD, only about 1 in 10 receives evidence-based treatment from a mental health professional.

To address the unmet psychiatric needs of depressed women in the period just after giving birth, a team of researchers led by 2015 BBRF Young Investigator Ryan J. Van Lieshout, M.D., Ph.D., of McMaster University in Ontario, Canada, conducted a randomized clinical trial early in the COVID pandemic. They wanted to know if a 1-day interactive workshop, delivered via Zoom and based on Cognitive Behavioral Therapy (CBT), when added to “treatment as usual,” could help reduce symptoms of women with PPD.

They compared the results of this intervention to those in women who received only “treatment as usual.”

Of 403 women with PPD who participated in the trial, conducted between April and October of 2020, 22% were taking an antidepressant when the trial began, and 41% had received some form of counseling in their lives. Some of the participants responded to advertisements online, while others were referred by doctors.  The typical mom was about 32 years old and had given birth about 5 months before the trial began.

Half the study participants were assigned to continue with any treatment they had been receiving, while the other half continued any prior treatment but also participated in a 7-hour CBT workshop delivered in a single day. To accommodate the 161 participants who ultimately received the CBT workshop, it was given 10 times over the course of the trial, with some of the workshops led by Dr. Van Lieshout (a psychiatrist), and others by trained graduate students and psychotherapists. That was part of the experiment, too—to see if facilitators with different levels of training could successfully lead the CBT sessions and help patients reduce their PPD symptoms.

The interactive Zoom-mediated workshop, conducted from 9am to 4pm, consisted of 4 parts. In the first, PPD was broadly discussed, with a focus on modifiable cognitive risk factors (negative thoughts, “maladaptive” core beliefs). The second part focused on cognitive skills, including cognitive restructuring. The third was devoted to behavioral skills such as problem-solving, behavioral activation, and assertiveness. The fourth covered goal-setting and action-planning.  All participants received a workshop manual before attending.

Those with PPD who attended a workshop, after they responded to various questionnaires 12 weeks later, were found to be more likely to have had a clinically significant decrease in a standard measure of PPD symptoms—a decline, on average of about one-third.  Those same women also had a significant positive change in anxiety scores, the team reported. Finally, mothers who attended the workshop “also reported improvements in bonding with their child,” as well as reductions in infant-focused anxiety and increases in positive affect in their children.

The size of the positive impact, the team said, was “similar to those seen in some randomized controlled trials of full courses of CBT for perinatal depression and other online psychotherapies.” Head-to-head trials will be needed to more definitively assess the relative effectiveness of 1-day interventions compared with more lengthy treatments, the team acknowledged. “Regardless,” they added, “these workshops would help large numbers of women.”  In part, this is because they are brief and therefore easy to deploy; also, because they appear to be deliverable online, and to groups as large as 30 participants at a time. Another plus, the team said, is that the workshops “could potentially be taught to nonexpert” facilitators, thus greatly increasing their reach.  

While 6% of workshop participants said they preferred alternative delivery methods such as half-day sessions, 96% of those who received the workshop remained online for its duration; 87% said they were very satisfied with it; and 89% said they would refer a friend.

 “The COVID-19 pandemic has profoundly changed the way mothers with infants access mental health care,” the team noted. PPD treatment guidelines advise a “stepped approach, where the least expensive and intrusive interventions are offered first.” Given their easy deployment online to potentially sizeable groups of individuals suffering PPD symptoms, the workshops “could represent a significant component” of future public health strategy, they concluded.