Effects of a Brief Electronic Mindfulness-Based Intervention on Relieving Prenatal Depression and Anxiety in Hospitalized High-Risk Pregnant Women: Exploratory Pilot Study

Abstract

Background Peripartum depression and anxiety disorders are highly prevalent and are correlated with adverse maternal and neonatal outcomes. Antenatal care in Germany does not yet include structured screening and effective low-threshold treatment options for women facing peripartum depression and anxiety disorders. Mindfulness-based interventions (MBIs) are increasingly becoming a focus of interest for the management of such patients. Studies have shown a decrease in pregnancy-related stress and anxiety in expectant mothers following mindfulness programs. Objective The aim of this study was to explore the clinical effectiveness of a 1-week electronic course of mindfulness on prenatal depression and anxiety in hospitalized, high-risk pregnant women. We hypothesized that participating in a 1-week electronic MBI (eMBI) could alleviate symptoms of depression and anxiety during the hospital stay. Methods A prospective pilot study with an explorative study design was conducted from January to May 2019 in a sample of 68 women hospitalized due to high-risk pregnancies. After enrolling into the study, the participants were given access to an eMBI app on how to deal with stress, anxiety, and symptoms of depression. Psychometric parameters were assessed via electronic questionnaires comprising the Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI-S), and abridged version of the Pregnancy-Related Anxiety Questionnaire (PRAQ-R). Results We observed a high prevalence of peripartum depression and anxiety among hospitalized high-risk pregnant women: 39% (26/67) of the study participants in the first assessment and 41% (16/39) of the participants in the second assessment achieved EPDS scores above the cutoff value for minor/major depression. The number of participants with anxiety levels above the cutoff value (66% [45/68] of the participants in the first assessment and 67% [26/39] of the participants in the second assessment) was significantly more than that of the participants with anxiety levels below the cutoff value, as measured with the STAI-S. After completing the 1-week electronic course on mindfulness, the participants showed a significant reduction in the mean state anxiety levels (P<.03). Regarding pregnancy-related anxiety, participants who completed more than 50% of the 1-week course showed lower scores in PRAQ-R in the second assessment (P<.05). No significant changes in the EPDS scores were found after completing the intervention. Conclusions Peripartum anxiety and depression represent a relevant health issue in hospitalized pregnant patients. Short-term eMBIs could have the potential to reduce anxiety levels and pregnancy-related anxiety. However, we observed that compliance to eMBI seems to be related to lower symptoms of pregnancy-related stress among high-risk patients. eMBIs represent accessible mental health resources at reduced costs and can be adapted for hospitalized patients during pregnancy.

Systematic Review on the Efficacy of Interventions for Fear of Childbirth, Anxiety and Fear in Pregnant Women

“…Zhang et al, 2019), while Beattie et al (2017) did not show a positive effect of mindfulness-based interventions on perceived stress and Duncan et al (2017) did not show a positive result on pain catastrophizing. This result does not seem to be affected by the weak ratings of the studies from Goetz et al (2020), Sobhani et al (2019 and Warriner et al (2018).…”

“…The included studies show mixed results regarding mindfulness-based interventions and their positive effect on anxiety/fear and stress. While several authors found positive influences (Goetz et al, 2020;Krusche et al, 2018;Price et al, 2019;Sobhani et al, 2019;Warriner et al, 2018;Yang et al, 2019;Zarenejad et al, 2020;Zemestani, 2019;J.-Y. Zhang et al, 2019), two studies did not show positive effects of mindfulness-based interventions on perceived stress (Beattie et al, 2017) or on pain catastrophizing (Duncan et al, 2017).…”

“…Some studies focused on "state/trait anxiety during pregnancy" (Abbasi et al, 2020;Ekrami et al, 2019;Fontein-Kuipers et al, 2016;Goetz et al, 2020;Hamilton et al, 2020;Parsa et al, 2016;Rajeswari & SanjeevaReddy, 2020;Salehi et al, 2016;Sanaati et al, 2017;Toosi et al, 2017;J.-Y. Zhang et al, 2019), while others focused only on "state anxiety during pregnancy (Esfandiari et al, 2020;Legrand et al, 2017;Mirtabar et al, 2020;Sheikh-Azadi et al, 2016;Uçar & Golbasi, 2019).…”

“…Some studies had "pregnancy related anxiety as an outcome" (Aksoy Derya et al, 2021;Bazrafshan et al, 2020;Goetz et al, 2020;Karamoozian & Askarizadeh, 2015;Khojasteh et al, 2016;Zarenejad et al, 2020) and others focused on "anxiety during pregnancy" (Akbarian et al, 2018;Alipour et al, 2020;Aslami et al, 2016;Beevi et al, 2016;Hajmohamadi et al, 2018;Heller et al, 2020;Mohammadi & Parandin, 2019;Montazeri et al, 2020;Sobhani et al, 2019;Sridhar et al, 2020;van der Zwan et al, 2019;Yazdanimehr et al, 2016;Zemestani, 2019).…”

“…Interventions were delivered in two forms: Via the internet respectively online or digital (Aksoy Derya et al, 2021;Fontein-Kuipers et al, 2016;Heller et al, 2020;Klabbers et al, 2019;Krusche et al, 2018;Larsson et al, in press;Loughnan, Sie, et al, 2019;Nieminen et al, 2016;Price et al, 2019;Rondung et al, 2018;Shahsavan et al, 2020;Yang et al, 2019) or offline respectively face to face. Online "mindfulness based interventions" seem to be effective online/digital (Goetz et al, 2020;Krusche et al, 2018;Price et al, 2019;Yang et al, 2019). For the offline "mindfulness-based interventions" results are inconsistent: Several studies find a positive effect (Sobhani et al, 2019;Warriner et al, 2018;Yazdanimehr et al, 2016;Zarenejad et al, 2020;Zemestani, 2019;J.-Y.…”