Prevention of common mental disorders among women in the perinatal period: a critical mixed-methods review and meta-analysis (original) (raw)
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BMC Pregnancy and Childbirth
Background There is sufficient meta-analytic evidence that antenatal interventions for women at risk (selective prevention) or for women with severe psychological symptoms (indicated prevention) are effective in reducing postpartum distress. However, women without risk or severe psychological symptoms might also experience distress. This meta-analysis focused on the effectiveness of preventive psychological interventions offered to universal populations of pregnant women on symptoms of depression, anxiety, and general stress. Paternal and infant outcomes were also included. Method We included 12 universal prevention studies in the meta-analysis, incorporating a total of 2559 pregnant women. Results Overall, ten studies included depression as an outcome measure, five studies included stress, and four studies anxiety. There was a moderate effect of preventive interventions implemented during pregnancy on the combined measure of maternal distress (d = .52), on depressive symptoms (d = ...
Journal of Affective Disorders, 2011
Background: There have been few antenatal interventions aimed at preparing women for the transition to parenthood and previous attempts to intervene antenatally to prevent postnatal depression and anxiety have had limited impact. Methods: We evaluated the effectiveness of an antenatal intervention which targeted risk factors for poor postnatal adjustment, with the dual aim of reducing both postnatal symptoms of depression/anxiety and parenting difficulties (a nine-unit self-guided workbook with weekly telephone support). Based on an initial feasibility study (n = 200) which confirmed a low level of help-seeking among distressed women during pregnancy, an additional community networking component was developed aimed at increasing social support and access to health professionals to facilitate treatment of current antenatal depression/anxiety, if present. In the evaluation of a second version of the intervention, pregnant women (n = 143) were randomly allocated to receive either the intervention or routine care. Results: Following the antenatal intervention there were significantly fewer cases scoring above threshold for mild-to-severe depression/anxiety symptoms postnatally compared to routine care, along with a trend towards reduced parenting stress. The community networking component appeared helpful and women with higher baseline depression scores showed higher levels of help-seeking in both intervention and routine care groups. Limitations: It was not possible to evaluate the efficacy of individual program components separately. Conclusions: The findings provide support for the effectiveness of the Towards Parenthood intervention both as a preparation for parenthood program and in reducing symptoms of postnatal depression/anxiety.
Psychosocial and psychological interventions for treating antenatal depression
Cochrane database of systematic reviews (Online), 2007
Objective To assess the effects of psychosocial and psychological interventions compared with usual antepartum, intrapartum, or postpartum care on the risk of postnatal depression. Data sources Medline, Embase, CINAHL, Cochrane central register of controlled trials, Cochrane pregnancy and childbirth group trials register, Cochrane depression, anxiety, and neurosis trials register, secondary references and review articles, and experts in the field. Study selection All published and unpublished randomised controlled trials of preventive psychosocial or psychological interventions in which the primary or secondary aim was a reduction in the risk of postnatal depression. All trials recruited pregnant women or new mothers less than six weeks postpartum. Eligible studies were abstracted, assessed for methodological quality, and pooled with relative risk for categorical data and weighted mean difference for continuous data. Results Fifteen trials with 7697 women were included. Although there was no overall statistically significant effect on the prevention of postnatal depression in the meta-analysis of all types of interventions (15 trials, n = 7697; relative risk 0.81, 95% confidence interval 0.65 to 1.02), these results suggest a potential reduction in postnatal depression. The only intervention to have a clear preventive effect was intensive postpartum support provided by a health professional (0.68, 0.55 to 0.84). Identifying women "at risk" assisted in the prevention of postnatal depression (0.67, 0.51 to 0.89). Interventions with only a postnatal component were more beneficial (0.76, 0.58 to 0.98) than interventions that incorporated an antenatal component. In addition, individually based interventions were more effective (0.76, 0.59 to 1.00) than group based interventions (1.03, 0.65 to 1.63). Conclusions Diverse psychosocial or psychological interventions do not significantly reduce the number of women who develop postnatal depression. The most promising intervention is the provision of intensive, professionally based postpartum support.
Antenatal prevention of postnatal depression
Archives of Women's Mental Health, 1999
Twenty three women at risk for postpartum depression were offered ten classes in pregnancy and postpartum, focusing on parenting and coping strategies. Twenty one controls attended standard six antenatal classes. Postpartum there were no differences in depression scores, however, anxiety was less at six weeks postpartum in the intervention group. Over time both groups had reduced numbers and reduced satisfaction with supports, but this was greater in the control group. With respect to the marital relationship, this was also less satisfactory postpartum in the control group. The intervention group was well attended and participants satisfied with the alternative antenatal class format; larger studies for all first time mothers are recommended.
Perinatal anxiety and depression: issues, outcomes and interventions
2008
The transition to parenthood, especially with the first child, is stressful physiologically, psychologically and socially. As with all developmental stages, the opportunity exists to grow and mature, but there is always the attendant threat of things going wrong, with physical or psychological disability as temporary or permanent outcome. Psychologically resilient people will use the challenges of this transition to review and appropriately modify their coping strategies and their relationships with others, even if all does not go according to plan.
Psychological treatment of perinatal depression: a meta-analysis
Psychological Medicine
Background Depression during pregnancy and after the birth of a child is highly prevalent and an important public health problem. Psychological interventions are the first-line treatment and, although a considerable number of randomized trials have been conducted, no recent comprehensive meta-analysis has evaluated treatment effects. Methods We used an existing database of randomized controlled trials of psychotherapies for adult depression and included studies aimed at perinatal depression. Random effects models were used in all analyses. We examined the effects of the interventions in the short and long term, and also examined secondary outcomes. Results Forty-three studies with 49 comparisons and 6270 participants between an intervention and control group were included. The overall effect size was g = 0.67 [95% confidence interval (CI) 0.45~0.89; numbers needed-to-be-treated = 4.39] with high heterogeneity (I2 = 80%; 95% CI 75~85). This effect size remained largely unchanged and ...
Healthy Moms and Babies Preventive Psychological Intervention Application: A Study Protocol
International Journal of Environmental Research and Public Health
Depression is the most common psychological disorder during the perinatal period, and its negative effects extend to mothers, babies, their family and society. Scientific evidence points to the urgency of designing preventive interventions and concludes that the gestational period is the most appropriate time to implement these interventions. However, many pregnant women do not seek professional help due to a lack of knowledge about the importance of mental health, its impact, and the available intervention options, as well as a lack of time and financial resources. E-health interventions can be an efficient, cost-effective, and accessible resource for preventing postpartum depression that can circumvent the barriers that pregnant women face. This randomized clinical trial will examine the efficacy of Healthy Moms and Babies, an app aimed at preventing postpartum depressive symptomatology. The second objective of this study is to analyze the effectiveness of the tool in preventing a...
Journal of Child and Family Studies, 2018
Prenatal mental illness is a significant public health issue with intergenerational consequences. Caring for Body and Mind in Pregnancy (CBMP) is an Australian, 8week mindful parenting program. The primary aim of this study was to investigate the effectiveness of CBMP in reducing pregnant women's levels of depression, anxiety, perinatal depression, perinatal anxiety and stress. The sample consisted of 109 pregnant women at-risk for perinatal depression and anxiety. The mean age of the sample was 33.52 years (SD = 4.90), ranging from 21 to 45 years. A within group, pre-post research design was used to examine whether CBMP improves participants' scores on outcome measures. Wilcoxon Signed Rank test results indicated that CBMP significantly reduced depression, anxiety, perinatal depression, perinatal anxiety and general stress scores, while significantly increasing self-compassion and mindfulness with moderate to strong effect sizes. The double mediation hypothesis was supported with selfcompassion t (71) = −2.23, p < 03, b2 = −1.96, SE = 88, 95% CI = −3.71, −.20, having a stronger influence in reducing perinatal depression than mindfulness t (71) = −2.68, p < .01, b3 = −.07, SE = .03, 95% CI = −.13, −.02. Further research, using a randomized controlled design with appropriate control conditions, is needed to establish the effectiveness of CBMP in reducing psychological distress amongst pregnant women at risk of developing depression, anxiety or stress.
Frontiers in Psychiatry, 2022
Background: Women in low-and middle-income countries (LMICs) are disproportionally affected by perinatal depression and anxiety and lack access to mental health care. Integrating perinatal mental health care into routine maternal care is recommended to address gaps in access to mental health care in such under-resourced settings. Understanding the effectiveness of interventions that integrate perinatal mental health care into routine maternal care in LMICs is critical to inform ongoing intervention development, implementation, and scale-up. This systematic review aims to assess the effectiveness of interventions that integrate perinatal mental health care into routine maternal care to improve maternal mental health and infant health outcomes in LMICs. Method: In accordance with the PRISMA guidelines, an electronic database search was conducted seeking publications of controlled trials examining interventions that aimed to integrate perinatal mental health care into routine maternal care in LMICs. Abstracts and full text articles were independently reviewed by two authors for inclusion utilizing Covidence Review Software. Data was extracted and narrative synthesis was conducted. Findings: Twenty studies met eligibility criteria from the initial search results of 2,382 unique citations. There was substantial heterogeneity between the study samples, intervention designs, and outcome assessments. Less than half of the studies focused on women with active depression or anxiety. Most studies (85%) implemented single intervention designs involving psychological, psychosocial, psychoeducational, or adjuvant emotion/stress management. There were few interventions utilizing multicomponent approaches, pharmacotherapy, or referral to mental health specialists. Outcome measures and assessment timing were highly variable. Eighteen studies demonstrated significantly greater improvement on depression and/or anxiety measures in the intervention group(s) as compared to control.