Jurnal Ners

Vol. 14, No. 3, Special Issue 2019 This is an Open Access article distributed
under the terms of the Creative Commons
http://dx.doi.org/10.20473/jn.v14i3(si).17149 Attribution 4.0 International License

Systematic Review

Strategy Intervention to Prevent and Reduce Postpartum Depression: A Systematic

Review

M. Elyas Arif Budiman, Supiah Ningsih Juita Sari, Winda Kusumawardani and Dhona Sutopo
Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia

ABSTRACT ARTICLE HISTORY

Background: Postpartum depression is a non-psychotic depressive Received: Dec 26, 2019
disorder with the criteria for diagnosis being that it can start early at four Accepted: Dec 31, 2019
weeks postpartum. This can occur in the first year postpartum. Postpartum
depression can result in deep sorrow and even the risk of suicide. KEYWORDS
post-partum depression; nursing
Method: The sources of the articles used were from a search of the Scopus,
intervention; psychology; post-
PubMed and Proquest databases with the keywords “postpartum partum
depression, nursing intervention, psychology and postpartum”. The
search was restricted articles ranging from 2014 until 2018. After the CONTACT
articles were obtained, then the articles were reviewed until the stage of M. Elyas Arif Budiman
making a systematic review.  m.elyas.arif.budiman-
2018@fkp.unair.ac.id
Result: The systematic review resulted in 15 of 19 choices of interventions  Faculty of Nursing, Universitas
that can be used to prevent and reduce the symptoms of postpartum Airlangga, Surabaya, Indonesia
depression. The results found that an internet cognitive behavior therapy
intervention is very significant in terms of preventing and reducing the
symptoms of postpartum depression. Nursing interventions are packaged in
a variety of programs proven to reduce the postpartum depression
variables and actions needed to prevent and reduce the symptoms
of postpartum depression significantly.
Conclusion: Based on the results of the analysis of the 15 journals from the
results of the study, internet cognitive behavior therapy intervention is
recommended to prevent and reduce postpartum depression. This
intervention can be developed practically and easily.

Cite this as: Budiman, M. E. A, Sari, S. N. J, Kusumawardani, W & Sutopo, D. (2019). Strategy Intervention to Prevent and
Reduce Postpartum Depression: A Systematic Review. Jurnal Ners, 14(3si), 292-297.
doi:http://dx.doi.org/10.20473/jn.v14i3(si).17149

INTRODUCTION Post-partum mood disorders such as postpartum

depression are estimated to affect 10-20% of women
Depression is a mental health disorder characterized and it is a serious health problem for both the
by moods that are depressed or where they lose mothers and their children (Prevatt, Lowder, &
interest in their activities, causing a significant Desmarais, 2018). An average of 50% of post-partum
decrease in their quality of everyday life. Depression depression in women lasts for 6 months where the
can start from mild or moderate and range up to onset of the feeling of post-partum occurs in about
severe depression with or without psychotic features. 50% to 80% of women within 1 to 5 days after
Depression conditions are very commonly found in delivery. The onset of postpartum depression from 2
primary care settings where the incidence of weeks up to 12 months after occurs around 10-15%
depression that is most commonly found is post- in postpartum women(W.Stuart, 2013). The impact of
partum depression (W.Stuart, 2013). Post-partum post-partum depression can be severe, one of which
depression is a non-psychotic depressive disorder is suicide, which is a major cause of maternal death in
with the criteria for diagnosis starting at four weeks the first year after childbirth. It is an indication that
post-partum. This can occur in the first year after post-partum depression can have a negative impact
giving birth (Martha Raile Alligood, 2014). on children's cognitive, socio-emotional and
behavioral development. In addition, postpartum

292 | pISSN: 1858-3598  eISSN: 2502-5791

 JURNAL NERS

depression can continue to have an impact on how the

mothers care for their children after the post-partum
period (Perkins, Yorke, & Fancourt, 2018).
Depressive symptoms interfere with every aspect
of a mother's functional and social interactions.
Depressed mothers may have difficulties related to
being sensitive to their baby's cues and needs, and
they feel less satisfied with their care. The assessment
of maternal postpartum mental status and maternal
adaptation are a part of the standard clinical care.
Post-partum depression screening tools, such as the
Edinburgh Post-partum Depression Scale (EPDS), are
now widely used in health clinics in many Western
countries. The symptoms of postpartum depression
usually occur from birth through to six weeks
postnatal. Maternal age, the number of pregnancies,
childbirth or the number of children born alive is not
associated with the symptoms of postnatal
depression. Mothers with depressive symptoms,
however, are less satisfied with their family life and
their dynamics when compared to mothers without
depressive symptoms (Salonen, Pridham, Brown, & Table 1. Literature Search Summary
Kaunonen, 2014).
decrease in postpartum depression after the
Mental health and emotional well-being are
intervention was measured using a depressive
important for complete health. Soul welfare is very
instrument.
necessary to be maintained or improved, one of which
The exclusion criteria in this study were if the
is through the promotion and prevention of health.
study did not report original data, if there were no
Mental health promotion, when it is intended to
non-pharmacological intervention measures, if there
improve the positive mental health in the community,
was no association with the handling of postpartum
can also support the achievement of goals and reduce
depression and if the journals were published before
the incidence of mental disorders. The prevention and
2014.
promotion strategies are the same activities and they
gave different but complementary results (W.Stuart, Literature Search Strategy
2013). There is strong research evidence that The approach used was a systematic review that
identifies depression (depression) as being overcome began with the selection of topics, and then the
through several interventions. One of the results of keywords were determined in order to search for
the research is through the activities of peer groups, journals (primary research) using English and
cognitive behavior therapy and social support. The Indonesian through several databases including
purpose of this research was to find out preventive Scopus, PubMed and Proquest. The search was
measures to overcome the problem of postpartum limited to 2014 to 2018. The English keywords used
depression. were "Depression postpartum", Nursing, Psychology,
Postpartum And "Intervention". The next step was to
MATERIALS AND METHODS identify the title of each article that was considered
close to the research desired. The title identification
Design
identified postpartum depression and postpartum
A literature search was used to identify studies
intervention respectively.
published in the last 5 years, from 2014 to 2018, in
There are 15 articles that are in accordance with
peer-reviewed journals for actions to reduce the
the inclusion criteria. The articles that did not fit the
incidence of postpartum depression.
inclusion criteria totaled 4 articles including 2 articles
Article Selection Criteria not in accordance with the type of study desired and
The inclusion criteria of the article were 1) all peer- 2 outcome articles are not as desired. Then the 19th
reviewed articles related to the action of reducing article was screened again according to the exclusion
postpartum depression with a quasi-experimental criteria. After screening, the results of the articles
approach and where the sampling method carried out were in accordance with the exclusion criteria.
was done via randomized controlled trials, 2)
Quality Study Analysis
populations in the peer-reviewed articles were all
Articles or journals that fit the criteria underwent
postpartum mothers who experienced postpartum
critical appraisal analysis in accordance with the RCT
depression based on the criteria from the
examination, 3) the measures taken in peer-reviewed research approach. The measuring instrument used
was the critical appraisal skills program (CSAP). The
articles were all non-pharmacological interventions
data that was analyzed as then extracted and
that can reduce postpartum depression and 4) if the
synthesized in accordance with the objectives.
results measured in the peer-reviewed article saw a

http://e-journal.unair.ac.id/JNERS | 293
M. E. A. BUDIMAN ET AL.

RESULT disorders. This prevention uses health intervention

strategies as a way to reduce the symptoms of mental
Characteristics disorders. In addition, the prevention of mental
The results of the review of the research articles that disorders has the goal of reducing the incidence,
met the inclusion criteria showed there to be 15 prevalence and recurrence levels. In this study,
different types of intervention used to reduce or several interventions that have a positive effect when
prevent the occurrence of postpartum peer support it comes reducing the depressive symptoms,
depression, an internet-based intervention, especially in postpartum depression, will be
mindfulness-based cognitive therapy groups, sausage described(Prevatt et al., 2018).
support, telephone-based cognitive behavior, As a prevention strategy, the social support
psychotherapy cantered on parenthood (PCP), system means strengthening the social support aimed
adjuvant detached mindfulness and stress at increasing the protective factors and
management, sexual counseling, internet cognitive developmental methods used to protect or safeguard
behavior therapy, telephone-based peer support against the effects of potential stressful events. Social
cognitive behavior intervention and focused support can be used to design and implement actions
counseling, lifestyle-based education, home visits, in terms of primary prevention. One study explained
cognitive behavior and all of the above in combination that the social support felt by the mothers during
with systemic family therapy and expressive writing. pregnancy plays an important role as a protective
The interventions given in this study consisted of factor against postpartum depression, both directly
more than one intervention on average. The following and indirectly, reducing the negative clinical aspects
are the results of the analysis of the existing journals of birth experience (Tani, Castagna, Tani, & Castagna,
in the review. 2016).
The settings from the 15 research articles were In addition, individuals and groups can develop,
either in the community (n = 10) and in the hospital maintain, expand and use their social networks.
(n = 5). The number of samples varied from 30 Network therapy collects all important members of
respondents to a total of 760 respondents. The the family and it brings the networks of friendship
interventions given in this study ranged from together. The focus is then to strengthen the ties in
internet-based media through to support, cognitive, the network and to break the dysfunctional features
counseling, stress management and mind (W.Stuart, 2013). One network that can be applied to
management. Some in this study explained in detail break the dysfunctional pattern in the form of
the intervention procedures and how long the postpartum depression based on the results of the
intervention was given for. The measuring study is the implementation of peer group
instruments used in all of the articles consisted of the interventions. The results of this study indicate that
Edinburgh Postnatal Depression Scale, Generalized peer group programs are very effective at reducing
Anxiety Disorder-7 (GAD-7) questionnaire and the postpartum depression (Prevatt et al., 2018).
Depression Beck Depression Inventory. The However, there are several telephone-based peer
parameters used were in accordance with the group developments that are considered to be more
inclusion criteria to measure postpartum depression. effective in the development of information and
From the review of the 15 research articles technology. One study showed that telephone-based
selected, there were four research articles using a peer support is effective against postpartum
quasi-experiment, where the intervention was given depression. Another study utilizing groups in the
in the form of peer support, psychotherapy centered used intervention was a lifestyle education-based
on parenthood, internet-based intervention, training study on prenatal and postnatal depression
telephone-based peer support intervention and and paternal anxiety. The study showed significant
mindfulness-based intervention therapy group. Ten results in decreasing postpartum
studies used the RCT approach with the choice of depression(Mohammad, Charandabi, &
interventions being expressive writing, sexual Mirghafourvand, 2017).
counseling, internet cognitive behavior therapy, Interventions by utilizing information and
adjuvant detached mindfulness and stress technology are very useful at reducing postpartum
management training, telephone-based cognitive depletion. This is evidenced by a study that explains
behavior, cognitive behavioral and AIDS-focused that Internet Cognitive Behavioral Therapy
counseling, lifestyle based education, home visit, interventions can reduce postpartum depletion
cognitive behavior and combination with systemic (Milgrom et al., 2016). Internet-based development
family therapy, and social support. If viewed in terms CBT can also be applied through CBT that is phone-
of the method selection, then in accordance with the based which results in a reduction in depressive
level of evidence, the research that uses the RCT symptoms that is far greater than the standard care
method approach can be more generalized than the during the postpartum period. Both internet-based
research with the quasi-experimental design. and telephone-based studies show that prevention
Effects of Intervention in Preventing and strategies can be developed practically and that they
Reducing Postpartum Depression. can be easily made accessible to all groups (Ngai,
The prevention of mental disorders has the goal of Wong, Leung, & Chau, 2015).
reducing symptoms in people who have mental

294 | pISSN: 1858-3598  eISSN: 2502-5791

 JURNAL NERS

The development of CBT is not only limited to the is positive. This can improve maternal and infant
internet. The CBT program can also be applied with a health (Shamshiri et al., 2017). Although raising
combination of other interventions such as when the children is considered to be an important
results of the research that show that the integration responsibility, relatively little attention is paid to
of counseling programs focused on cognitive- believing that effective parenting is not a natural
behavioral in prenatal care can be effective at ability but that it needs to be studied. Parent-centered
improving the mental health of pregnant women psychotherapy is a promising intervention used to
(Ramezani, Khosravi, Motaghi, & Hamidzadeh, 2016). treat perinatal depression and to help the mothers to
Another study applying CBT was focused on CBT get involved in parenting. Research clearly shows that
combined with systemic family therapy. It improved involving new parents can increase the role of
depression and sleep quality in the patients with mild caregiving and it is also a process of preventing the
to moderate postpartum depression (Hou et al., occurrence of depression in postpartum mothers
2014). (Nanzer et al., 2012).
The development of interventions continues not Using an intervention to reduce postpartum
only to develop CBT. One intervention that teaches depression does not only involve feelings and
clients to focus on their experiences also teaches them cognition but it can also be a training process as a
to be aware of the sensations, thoughts and feelings form of diversion to prevent depression, one of which
experienced that can also be developed into is writing. Postpartum writing activities have also
interesting interventions combined with others. One carried out research. This study shows that
of the results of the research showed that both the expressive writing can be an early universal
Mindfulness-Based Cognitive Therapy Group intervention and its low cost is useful for preventing
Intervention and Adjunctive Treatment interventions postpartum suffering in women (Carla, Caravita,
had a clinically significant effect on the participants. Ionio, Milani, & Valtolina, 2015).
In addition, the impact of the Mindfulness-Based
Cognitive Therapy Group Intervention as well as the DISCUSSION
Adjunctive Treatment intervention is that it is
This systematic review provides evidence of the
beneficial in the acute phase and disease maintenance
effectiveness of health interventions in relation to
phase as evidenced by the symptom stability at three
preventing and reducing postpartum depression. The
months, especially with depressive symptoms
review results explain that there are 15 out of 19
(Shulman et al., 2017). Other studies also explain that
intervention options that can be used to prevent and
mindfulness can be combined with stress
reduce postpartum depression. The results of this
management training; this study shows that these
review are certainly useful for nurses, both clinical
results indicate that adjuvant detached mindfulness
nurses and community mental health nurses. The
and stress management training are effective
nurse can apply one of the health interventions as a
interventions to reduce postpartum depression
form of prevention of the incidence of postpartum
(Ahmadpanah et al., 2017).
depression. Clinical nurses can conduct quality
Mental health education can be done in any order.
interventions and have the innovations tailored to the
It can have a formal or informal structure and it can
development of information and technology in an
be addressed to individuals or groups. Health
effort to prevent and reduce the symptoms of
education can be done in various forms. An
postpartum depression. The application of health
educational program is centered on the activities that
interventions can prevent a better condition in the
can be done, one of which is counseling. Health
postpartum mothers who experience postpartum
education in the form of counseling is urgently
depression.
needed for a woman who experiences postpartum
Mental health and emotional well-being are
depression where research shows that sexual
important for the health of postpartum mothers.
counseling can help reduce stress, anxiety, and
Some studies have explained that the emotional
depression in women who suffer from sexual
health of the post-research mothers greatly
problems during the postpartum period (Zamani,
influenced the development of the children, the health
Roudsari, & Moradi, 2017).This study explains that
of the mother physically and psychologically and their
the counseling process has a positive impact on the
contribution to their welfare. However, these studies
decrease in depressions experienced by postpartum
cannot be generalized. Bias may occur. This can be
mothers. (Ahmadpanah et al., 2017)
caused by the non-homogeneous measurement
In addition to several existing interventions,
parameters as well as the non-homogeneous research
cooperation between the nurses and their families
samples. Developmental research is better and an
through home visits has also been shown to improve
easy and flexible intervention is needed. In addition,
health, well-being and independence in the face of low
extraction needs to be considered during the process
income conditions. The first experience of becoming
of assessing the inclusion and exclusion criteria.
a parent, especially for a woman who has just given
birth, is poignant (W.Stuart, 2013).The opinion of the IMPLICATION IN NURSING PRACTICE
stratum was also in accordance with the results of the
study which explained that giving postpartum home The results of the research reviewed critically in this
visits can affect postpartum depression in a way that systematic review indicate that there are viable

http://e-journal.unair.ac.id/JNERS | 295
M. E. A. BUDIMAN ET AL.

strategies to prevent and reduce the symptoms of therapy in combination with systemic family
postpartum depression in the prevention / control of therapy improves mild to moderate postpartum
the occurrence of postpartum depression. Although depression. 47–52.
not all studies produce significant values in all of the https://doi.org/10.1590/1516-4446-2013-1170
measured parameters, this conclusion can be taken in Martha Raile Alligood. (2014). Pakar Teori
the majority. Mental nurses can optimize the health
Keperawatan. In Pakar Teori Keperawatan (Ke-
intervention programs by modifying the method of
8, p. 224). Singapura: ELSEVIER.
giving the intervention, including the media used, as
well as the other parties involved in the intervention Milgrom, J., Danaher, B. G., Gemmill, A. W., Holt,
process. C., Holt, J., Seeley, J. R., … Ericksen, J. (2016).
Based on the results of an analysis of 15 journals, Internet Cognitive Behavioral Therapy for
the results of the research on internet-based Women With Postnatal Depression : A
interventions, telephone-based cognitive behavior, Randomized Controlled Trial of
internet cognitive behavior therapy and telephone- MumMoodBooster Corresponding Author : 18,
based peer support intervention are recommended to 1–18. https://doi.org/10.2196/jmir.4993
be applied by mental nurses as interventions to Mohammad, S., Charandabi, A., &
prevent and reduce postpartum depression. These Mirghafourvand, M. (2017). The Effect of Life
interventions have several advantages, including 1) Style Based Education on the Fathers ’ Anxiety
the method of providing the intervention is relayed and Depression During Pregnancy and
and involves both information and technology media,
Postpartum Periods : A Randomized Controlled
2) it involves groups and behaviors in managing
interventions, 3) the media used are very varied and Trial. Community Mental Health Journal, 53(4),
informative which are easily accessible to the people 482–489. https://doi.org/10.1007/s10597-017-
affected by technological developments and 4) there 0103-1
is a flexible application in accordance with the Nanzer, N., Rossignol, A. S., Righetti-veltema, M.,
postpartum needs. Knauer, D., Manzano, J., & Espasa, F. P. (2012).
Effects of a brief psychoanalytic intervention for
CONCLUSION perinatal depression. 259–268.
The results of a systematic review of 15 research https://doi.org/10.1007/s00737-012-0285-z
journals were related to the application of the latest Ngai, F., Wong, P. W., Leung, K., & Chau, P.
nursing interventions to prevent and reduce the (2015). The Effect of Telephone-Based
symptoms of postpartum depression. The Cognitive-Behavioral Therapy on Postnatal
implementation of nursing interventions should be Depression : A Randomized Controlled Trial.
facilitated by nurses who have a good understanding 294–303. https://doi.org/10.1159/000430449
of the intervention and depression management. In Perkins, R., Yorke, S., & Fancourt, D. (2018). How
preventing and reducing the symptoms of group singing facilitates recovery from the
postpartum depression in the form of nursing symptoms of postnatal depression: A
interventions packaged into various programs, the comparative qualitative study. BMC Psychology,
interventions can be proven to significantly reduce
6(1), 1–12. https://doi.org/10.1186/s40359-018-
the variables of postpartum depression. Internet
0253-0
cognitive behavior therapy and telephone-based peer
support interventions are the methods Prevatt, B. S., Lowder, E. M., & Desmarais, S. L.
recommended. It should also be considered whether (2018). Peer-support intervention for postpartum
the results of this research are flexible or not. depression: Participant satisfaction and program
effectiveness. Midwifery, 64(May), 38–47.
REFERENCES https://doi.org/10.1016/j.midw.2018.05.009
Ramezani, S., Khosravi, A., Motaghi, Z., &
Ahmadpanah, M., Nazaribadie, M., Aghaei, E.,
Hamidzadeh, A. (2016). The effect of cognitive-
Ghaleiha, A., Akhondi, A., Bajoghli, H., …
behavioural and solution- focused counselling
Brand, S. (2017). Influence of adjuvant detached
on prevention of postpartum depression in
mindfulness and stress management training
nulliparous pregnant women. Journal of
compared to pharmacologic treatment in
Reproductive and Infant Psychology,
primiparae with postpartum depression.
6838(January 2017), 1–11.
https://doi.org/10.1007/s00737-017-0753-6
https://doi.org/10.1080/02646838.2016.126647
Carla, S., Caravita, S., Ionio, C., Milani, L., &
0
Valtolina, G. G. (2015). The effects of expressive
Salonen, A. H., Pridham, K. F., Brown, R. L., &
writing on postpartum depression and
Kaunonen, M. (2014). Impact of an internet-
posttraumatic stress symptoms 1. 856–882.
based intervention on Finnish mothers’
https://doi.org/10.2466/02.13.PR0.117c29z3
perceptions of parenting satisfaction, infant
Hou, Y., Hu, P., Zhang, Y., Lu, Q., Wang, D., Yin,
centrality and depressive symptoms during the
L., & Chen, Y. (2014). Cognitive behavioral

296 | pISSN: 1858-3598  eISSN: 2502-5791

 JURNAL NERS

postpartum year. Midwifery, 30(1), 112–122. Tani, F., Castagna, V., Tani, F., & Castagna, V.
https://doi.org/10.1016/j.midw.2013.02.009 (2016). Maternal social support , quality of birth
Shamshiri, H., Milani, Amiri, P., Mohsey, M., experience , and post-partum depression in
Davoudi, E., Monfared1, … Salmani4, F. primiparous women Maternal social support ,
(2017). Effect of Health Care as the “ Home quality of birth experience , and post-partum.
Visiting ” on Postpartum Depression : A 7058(May).
Controlled Clinical Trial. 1–6. https://doi.org/10.1080/14767058.2016.118298
https://doi.org/10.4103/2008-7802.204003 0
Shulman, B., Dueck, R., Ryan, D., Breau, G., W.Stuart, G. (2013). Psychiatric (10, Ed.). St.Lois,
Sadowski, I., & Misri, S. (2017). Author ’ s Missouri: ELSEVIER.
Accepted Manuscript. Journal of Affective Zamani, M., Roudsari, R. L., & Moradi, M. (2017).
Disorders. Effect of Sexual Counseling on Stress , Anxiety ,
https://doi.org/10.1016/j.jad.2017.12.065 and Depression in Women during Postpartum
Period. (098 51), 16–26.
https://doi.org/10.22038/ebcj.2017.24244.1525

http://e-journal.unair.ac.id/JNERS | 297