Research review 032
Randomised study
Short answer
A structured therapy programme led by specially trained public health nurses produced greater improvement in depressive symptoms after birth than usual treatment alone. The difference was still present at six months. The result concerns this specific programme. It does not mean that all talking support from a nurse has the same effect.
What did the researchers investigate?
The researchers examined whether group-based cognitive behavioural therapy could be delivered through a local healthcare service. This form of therapy works with the relationships between thoughts, feelings and actions. Treatment lasted nine weeks and followed a planned programme.
Participants were randomly assigned to group therapy in addition to usual treatment or to usual treatment alone. Random allocation makes the groups more comparable at the start. Researchers examined changes in symptoms and how many people achieved an improvement large enough to matter to patients.
What did they find?
Group therapy was examined as an addition to usual treatment
After treatment, 63.3% in the therapy group had a reduction of at least four points on the EPDS, compared with 33.3% receiving usual treatment. That corresponds to approximately 30 more people achieving such an improvement per hundred in this comparison. The EPDS is a questionnaire about depressive symptoms. Four points was the study's threshold for an improvement that might matter to patients; it does not automatically mean depression had resolved. These proportions concern participants with available follow-up data and must be considered alongside attrition.
Improvement remained visible at the six-month follow-up. This provides some information about duration, but does not demonstrate that everyone recovered or that no one developed new difficulties. The figure of 141 is the number of people in the trial, not the number who improved.
How certain can we be?
Participants knew which care they received. The therapy group also had more contact and support than the comparison group. The study therefore cannot completely distinguish the effect of the therapy method itself from the effect of additional follow-up and belonging to a group.
No formal assessment was made of how closely therapists followed the method. There was also more loss to follow-up at six months. If people with particular experiences were more likely to stop responding, the longer-term picture could be distorted. Planned follow-up at twelve and 18 months was not completed because of resource limitations.
Who do the findings apply to?
The study included 141 mothers in Ontario, Canada. They had a child under one year of age and elevated scores on a depression questionnaire. Such a questionnaire measures symptoms. It is not, on its own, equivalent to a full diagnostic assessment.
Most participants were White, married and highly educated. The study was conducted in one defined service setting. The results therefore do not necessarily describe how the programme would work for people who speak other languages, have less support at home or face different barriers to attending a group.
What might this mean in everyday life?
The study points to a possible way of making treatment more accessible. For services wishing to test the model, training, a clearly defined treatment programme and support for group leaders are central. The study does not justify replacing specialist care with unstructured talking support or assuming everyone needs the same treatment.
What do we still need to know?
The programme should be tested in more healthcare settings and language groups, with longer follow-up. Researchers also need to investigate why some people stop participating. If people who drop out have more severe symptoms, the results among respondents may paint an overly positive picture.
We need to know what training and supervision group leaders require and how much time the programme takes. People who cannot or do not wish to attend a group must also have access to help. Research should examine how an equally effective alternative could be designed.
Sources
The publication covered by this review
Van Lieshout RJ, Layton H, Savoy CD, Haber E, Feller A, Biscaro A, Bieling PJ, Ferro MA. Public Health Nurse-delivered Group Cognitive Behavioural Therapy for Postpartum Depression: A Randomized Controlled Trial. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2022.
Other studies and professional sources mentioned in the text
Background source: Enduring effects of brief interpersonal therapy on depression from pregnancy through 1-year postpartum: A randomized clinical trial. 2026. Read the publication.
Background source: Clinical effectiveness of the Circle of Security-Parenting group intervention for birthing parents in perinatal mental health services in England (COSI): a pragmatic, multicentre, assessor-masked, randomised controlled trial. 2025. Read the publication.
Previous reference on the card
Nursing intervention for mental health after birth. Systematic review. Previous source.
Last reviewed: 30 October 2026.
Source basis: The publication's full text.
Editorial update, 1 November 2026: Language, explanations and references were reviewed. The source-review date is stated above.