Universal prevention of distress aimed at pregnant women: a systematic review and meta-analysis of psychological interventions.
Anxiety
/ prevention & control
Depression
/ prevention & control
Female
Humans
Mothers
/ psychology
Pregnancy
Pregnancy Complications
/ prevention & control
Psychological Distress
Psychosocial Intervention
/ methods
Randomized Controlled Trials as Topic
Stress, Psychological
/ prevention & control
Treatment Outcome
Maternal distress
Pregnant women
Psychological interventions
Universal prevention
Journal
BMC pregnancy and childbirth
ISSN: 1471-2393
Titre abrégé: BMC Pregnancy Childbirth
Pays: England
ID NLM: 100967799
Informations de publication
Date de publication:
01 Apr 2021
01 Apr 2021
Historique:
received:
10
11
2020
accepted:
24
03
2021
entrez:
2
4
2021
pubmed:
3
4
2021
medline:
22
5
2021
Statut:
epublish
Résumé
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. We included 12 universal prevention studies in the meta-analysis, incorporating a total of 2559 pregnant women. 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 = .50), and on stress (d = .52). The effect on anxiety (d = .30) was smaller. The effects were not associated with intervention timing, intervention type, intervention delivery mode, timing of post-test, and methodological quality. The number of studies including partner and/or infant outcomes was too low to assess their effectiveness. This meta-analysis suggests that universal prevention during pregnancy is effective on decreasing symptoms of maternal distress compared to routine care, at least with regard to depression. While promising, the results with regard to anxiety and stress are based on a considerably lower number of studies, and should thus be interpreted with caution. More research is needed on preventing other types of maternal distress beyond depression. Furthermore, there is a lack of research with regard to paternal distress. Also, given the large variety in interventions, more research is needed on which elements of universal prevention work. Finally, as maternal distress symptoms can affect infant development, it is important to investigate whether the positive effects of the preventive interventions extend from mother to infant. International prospective register of systematic reviews (PROSPERO) registration number: CRD42018098861.
Sections du résumé
BACKGROUND
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
METHODS
We included 12 universal prevention studies in the meta-analysis, incorporating a total of 2559 pregnant women.
RESULTS
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 = .50), and on stress (d = .52). The effect on anxiety (d = .30) was smaller. The effects were not associated with intervention timing, intervention type, intervention delivery mode, timing of post-test, and methodological quality. The number of studies including partner and/or infant outcomes was too low to assess their effectiveness.
CONCLUSIONS
CONCLUSIONS
This meta-analysis suggests that universal prevention during pregnancy is effective on decreasing symptoms of maternal distress compared to routine care, at least with regard to depression. While promising, the results with regard to anxiety and stress are based on a considerably lower number of studies, and should thus be interpreted with caution. More research is needed on preventing other types of maternal distress beyond depression. Furthermore, there is a lack of research with regard to paternal distress. Also, given the large variety in interventions, more research is needed on which elements of universal prevention work. Finally, as maternal distress symptoms can affect infant development, it is important to investigate whether the positive effects of the preventive interventions extend from mother to infant.
SYSTEMATIC REVIEW REGISTRATION NUMBER
UNASSIGNED
International prospective register of systematic reviews (PROSPERO) registration number: CRD42018098861.
Identifiants
pubmed: 33794828
doi: 10.1186/s12884-021-03752-2
pii: 10.1186/s12884-021-03752-2
pmc: PMC8017784
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
276Subventions
Organisme : Nederlandse Organisatie voor Wetenschappelijk Onderzoek
ID : 406.14.106
Références
Br J Psychiatry. 2017 May;210(5):315-323
pubmed: 28302701
J Adv Nurs. 2018 Feb;74(2):289-309
pubmed: 28921612
J Affect Disord. 2012 Mar;137(1-3):25-34
pubmed: 21514960
J Affect Disord. 2003 Apr;74(2):139-47
pubmed: 12706515
J Am Osteopath Assoc. 2006 Apr;106(4):193-8
pubmed: 16627773
J Affect Disord. 2016 Nov 15;205:44-59
pubmed: 27414953
Dev Psychol. 2006 Jul;42(4):627-42
pubmed: 16802896
Midwifery. 2017 Jul;50:174-183
pubmed: 28463789
Arch Womens Ment Health. 2015 Oct;18(5):681-92
pubmed: 25663309
J Affect Disord. 2011 May;130(3):385-94
pubmed: 21112641
Infant Behav Dev. 2018 May;51:24-32
pubmed: 29544195
J Fam Psychol. 2008 Apr;22(2):253-63
pubmed: 18410212
JAMA. 2019 Feb 12;321(6):580-587
pubmed: 30747971
Pediatrics. 2006 Aug;118(2):659-68
pubmed: 16882821
J Affect Disord. 2018 May;232:316-328
pubmed: 29501991
Eur Child Adolesc Psychiatry. 2019 Feb;28(2):257-280
pubmed: 29948234
Perspect Psychiatr Care. 2012 Oct;48(4):218-24
pubmed: 23005589
Am J Obstet Gynecol. 2003 May;188(5):1217-9
pubmed: 12748483
J Health Psychol. 2016 Dec;21(12):2977-2982
pubmed: 26150431
Attach Hum Dev. 2005 Dec;7(4):349-67
pubmed: 16332580
J Affect Disord. 2016 Aug;200:148-55
pubmed: 27131505
Child Dev. 2004 Nov-Dec;75(6):1774-91
pubmed: 15566379
J Affect Disord. 2008 Jan;105(1-3):35-44
pubmed: 17490753
J Affect Disord. 2004 May;80(1):65-73
pubmed: 15094259
Am J Psychiatry. 2006 Aug;163(8):1443-5
pubmed: 16877662
Women Birth. 2017 Apr;30(2):e111-e118
pubmed: 27810284
Pediatrics. 2013 Feb;131(2):e463-9
pubmed: 23296445
Psychol Med. 2019 Aug;49(11):1850-1858
pubmed: 30191779
J Affect Disord. 2016 Jan 1;189:263-8
pubmed: 26454186
J Reprod Infant Psychol. 2018 Nov;36(5):476-503
pubmed: 30293441
Lancet. 2014 Nov 15;384(9956):1800-19
pubmed: 25455250
PLoS One. 2016 May 16;11(5):e0155720
pubmed: 27182732
J Perinat Neonatal Nurs. 2014 Jul-Sep;28(3):185-95
pubmed: 25062520
BJOG. 2014 Mar;121(4):389-97
pubmed: 24397691
Clin Child Fam Psychol Rev. 2011 Mar;14(1):1-27
pubmed: 21052833
J Affect Disord. 2020 Feb 15;263:491-499
pubmed: 31757623
Arch Womens Ment Health. 2010 Feb;13(1):61-74
pubmed: 19789953
Child Dev. 1997 Aug;68(4):571-91
pubmed: 9306636
Br J Psychiatry. 1987 Jun;150:782-6
pubmed: 3651732
Dev Psychol. 2000 Nov;36(6):759-66
pubmed: 11081699
BMJ. 2011 Oct 18;343:d5928
pubmed: 22008217
J Reprod Infant Psychol. 2017 Apr;35(2):172-182
pubmed: 29517361
PLoS One. 2017 Jan 17;12(1):e0169829
pubmed: 28095505
J Affect Disord. 2015 May 15;177:7-21
pubmed: 25743368
Infant Behav Dev. 2010 Feb;33(1):1-6
pubmed: 19962196
J Abnorm Psychol. 2012 Nov;121(4):795-809
pubmed: 22288906
BMC Pregnancy Childbirth. 2014 Oct 25;14:369
pubmed: 25343848
BMC Public Health. 2010 Dec 20;10:771
pubmed: 21167078
Clin Psychol Rev. 2013 Dec;33(8):1205-17
pubmed: 24211712