Effects of stepped care on depression outcomes in perinatal women: a systematic review and meta-analysis

To evaluate the effects of stepped care (SC) on perinatal depression and to provide the first systematic description of the core components and delivery models. Six electronic databases, including PubMed, Web of Science, Embase, Cochrane, Scopus, and Ovid were searched from inception to July 2025. Randomized controlled trials (RCTs), quasi-experimental studies, and pilot studies of SC interventions on depression outcomes in perinatal women were included. Risk of Bias 2 and the Risk of Bias in Non-randomized Studies tools were used to rate the risk of bias in RCT and non-RCT studies, respectively. Meta-analysis and narrative synthesis were conducted based on data availability. Within-group standardized mean differences (SMDs) in depression scores were the primary outcomes, with positive SMDs indicating reductions in depressive symptoms. Seven studies composed of five RCTs and two pre-post studies were included. The duration of SC ranged from pregnancy to postpartum, involving continuous depression monitoring, psychotherapy, and antidepressant treatment. Interventions were delivered individually (n = 5) or in groups (n = 2), all delivered face-to-face (n = 7), with three studies also incorporating telephone formats (n = 3). All interventions were delivered by multidisciplinary teams (n = 7). The pooled analysis of pre-post changes within the intervention groups suggested that SC had large effects on reducing depression during pregnancy (SMD = 1.17, 95% CI:0.85 to 1.49; 2 studies; 91 participants), within the first 3 months postpartum (SMD = 1.71, 95% CI:1.26 to 2.15; 4 studies; 822 participants), at 6–9 months postpartum(SMD = 1.46, 95% CI:0.75 to 2.16; 6 studies; 861 participants), and during long-term follow-up (≥ 12 months postpartum) (SMD = 1.80, 95% CI:1.51 to 2.09; 2 studies; 274 participants). Narrative synthesis of the evidence suggested a potential beneficial effect on treatment engagement. The findings of this systematic review and meta-analysis suggest that SC has potential to reduce perinatal depression. However, the included studies exhibited considerable heterogeneity, suggesting the need for future research using high-quality RCTs.