Comparative Effectiveness of Non-Pharmacological Interventions for Postpartum Depression and Anxiety: A Network Meta-Analysis

BACKGROUND: Postpartum depression (PPD), a prevalent perinatal mood disorder characterized by persistent depressive and anxiety symptoms, significantly impacts maternal-infant health. The COVID-19 pandemic has further increased the global burden of PPD, emphasizing the need for effective and accessible interventions. Although non-pharmacological interventions are widely used, their comparative efficacy remains uncertain. METHODS: We searched the Cochrane Library, Web of Science, EMBASE, PubMed, Scopus, CNKI, VIP Database, and Wanfang Database (inception to September 1, 2024) for randomized controlled trials (RCTs). Interventions included acupuncture (ACU), exercise (EXE), psychotherapy (PSY), exercise combined with psychotherapy (ECP), and music therapy (MT). Primary (depression) and secondary (anxiety) outcomes were pooled using mean differences (MD) with 95% credible intervals (CrI). Risk of bias was assessed via Cochrane RoB2. (PROSPERO: CRD42020166801). RESULTS: Thirty-five RCTs were included (n=4047). Meta-analyses for depressive symptoms (5 interventions, n=4047) showed a statistically significant improvement in the non-pharmacological intervention group compared with the control group (standard care, no intervention, or placebo et al), particularly for the ECP (95% CrI -2.3 to -0.85), followed by ACU (95% CrI -1.8 to -0.44) and EXE (95% CrI -1.7 to -0.48). Similarly, for anxiety symptoms (5 interventions, n=863), the overall effect of the non-pharmacological interventions was superior to that of the control group, with ECP again being the most effective modality (95% CrI -2.3 to -0.18), followed by EXE (95% CrI -2.0 to -0.0021) and ACU (95% CrI -0.96 to -0.052). CONCLUSION: This study demonstrates the promise of non-pharmacological interventions, particularly exercise, acupuncture, and ECP, for alleviating PPD symptoms, positioning ECP as a potential first-line intervention for mild to moderate cases.