Efficacy of non-pharmacological interventions for the prevention of antenatal depression: A systematic review and network meta-analysis

Background: Preventing the occurrence of prenatal depression is one of the most important possibilities for reducing the disease burden of maternal depression. The preventive effects of various non-pharmacological interventions on prenatal depression remain insufficiently understood. Aims: To assess the efficacy of different non-pharmacological measures in preventing prenatal depression via a network analysis. Method: We conducted a systematic review and network meta-analysis to examine the most effective nonpharmacological interventions for preventing prenatal depression in randomised controlled trials (RCTs). We searched databases including PubMed, Cochrane Library, Web of Science, EMBASE, CNKI, Wanfang, CBM, and VIP from their inception to July 18, 2024, for RCTs. The Cochrane and PRISMA guidelines were used. Network meta-analysis was conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol has been registered in PROSPERO (CRD42024594188). Results: We included 20 RCTs involving 3,051 participants. The results indicated that, compared to usual care, yoga was the most effective in preventing prenatal depression (SMD = -2.72; 95% CI, -4.39 to -1.05); CINeMA: Low certainty, followed by cognitive behavioral therapy (SMD = -1.92; 95% CI, -3.78 to -0.06); CINeMA: Low certainty. The surface under the cumulative ranking curve (SUCRA) value indicated that yoga has the highest likelihood of being the best intervention for preventing prenatal depression (89.1%). Conclusions: Yoga was the most effective in preventing prenatal depression, followed by cognitive behavioral therapy. Due to the low quality of evidence, further well-designed trials are needed to confirm these findings.