Systematic review and meta‐analysis of non‐pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women

Evans, Kerry; Morrell, C Jane; Spiby, Helen

doi:10.1111/jan.13456

Cited by 31 publications

(50 citation statements)

References 74 publications

(201 reference statements)

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“…Both indicated as well as selective prevention interventions have been proven to be effective in preventing depression [ 53 – 57 ]. However, much is unknown about the effectiveness of preventive interventions on other forms of distress beyond depression, such as anxiety and general stress [ 56 , 58 ]. Furthermore, much less is known about universally applicable interventions that target all pregnant women, without pre-existing symptomatology or risk factors [ 56 , 58 ].…”

Section: Universal Selected and Indicated Prevention Of Parental Dismentioning

confidence: 99%

Effectiveness of a psycho-educational intervention for expecting parents to prevent postpartum parenting stress, depression and anxiety: a randomized controlled trial

Missler

Straten

Denissen

et al. 2020

BMC Pregnancy Childbirth

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Background The first months postpartum can be challenging for parents, leading to elevated symptoms of parenting stress, depression and anxiety. In turn, distressed parents are at higher risk for providing suboptimal quality of caregiving. As psychoeducational interventions can be effective in reducing psychological distress, the goal of this randomized controlled trial was to examine the effectiveness of low-intensity universal psychoeducational program to prevent postpartum parenting stress, and to enhance parental well-being and caregiving quality. Method Between 26 and 34 weeks of pregnancy, 138 pregnant women and 96 partners were randomized to the intervention or a waitlist control group. The intervention consisted of a booklet, a video, a home visit, and a telephone call. Information was provided on (1) sensitive responsiveness, adapting to the parental role, and attending to own needs; (2) crying patterns; (3) feeding (arrangements); and (4) sleeping (arrangements). The primary outcome was parenting stress postpartum. Secondary outcomes were additional measures of distress (depression and anxiety), parental well-being, and caregiving quality. Results Both groups showed a rise in distress after birth. No between-group differences were observed on parenting stress, nor on the secondary outcomes. The intervention was rated as useful and of added value by the parents. Conclusion This study offered no evidence that our universal prevention program was effective in decreasing parental distress or in increasing caregiving quality. However, parents found aspects of the intervention useful. More research is needed, including a longer period of follow-up as well as observational measures of parents’ responsiveness. Trial registration This trial has been registered on 15 September 2016 in the Netherlands National Trial Register, ID: NTR6065, https://www.trialregister.nl/trial/5782.

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Section: Universal Selected and Indicated Prevention Of Parental Dismentioning

confidence: 99%

Effectiveness of a psycho-educational intervention for expecting parents to prevent postpartum parenting stress, depression and anxiety: a randomized controlled trial

Missler

Straten

Denissen

et al. 2020

BMC Pregnancy Childbirth

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“…Descriptive statistics were used to describe pre/post intervention quantitative data from self-report measures using measures of mean and variance including con dence intervals (95% CI) and standard deviation (SD). Qualitative interviews were transcribed prior to conducting template analysis (King 2004) An a priori coding template was developed which was informed by themes identi ed in the literature review (Evans et al 2017(Evans et al , 2019. Transcripts were then read through and new themes which arose were incorporated into the initial template.…”

Section: Discussionmentioning

confidence: 99%

“…Psychological interventions developed speci cally for pregnant women with mental health concerns have demonstrated promising results but have not been rigorously evaluated in large studies (Lavender 2016). Recent systematic reviews found insu cient evidence to draw overall conclusions regarding the bene t of interventions for pregnant women with anxiety (Evans et al 2017(Evans et al , 2019. For this study, the intervention development followed the MRC framework for complex interventions, theoretical and modelling phases (Craig et al 2008).…”

mentioning

confidence: 99%

Supporting Women With Mild to Moderate Anxiety in Pregnancy: a Feasibility Study of a Midwife Facilitated Intervention

Evans¹,

Morrell

Spiby

2020

Preprint

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Aim: The aim of the study was to determine the acceptability and feasibility of an intervention to support women with mild to moderate anxiety in pregnancy.Design: The intervention development and feasibility testing followed the MRC guidelines for complex interventions. A feasibility study was conducted between April - May 2016.Methods: Qualitative and quantitative data were collected to assess the acceptability and feasibility of the intervention. The intervention was delivered in three components: pre-group individual meeting with the midwife; group sessions; guided self-help resources. The intervention was facilitated by midwives and co-facilitated by midwifery support workersResults: Eight women with self-reported symptoms of mild to moderate anxiety participated in the study. Women reported an improvement in anxiety symptoms and felt they had benefitted from participation. Accessing social support from other women in similar circumstances had helped women to feel less isolated and facilitated open and honest discussions. Women valued the involvement of the midwife facilitator to support their wellbeing and provide specific advice about their pregnancies.Conclusions: The intervention design appeared to be acceptable and beneficial for this group of women. This study highlights the potential for midwives to facilitate supportive interventions to enhance the current provision of emotional support for women with anxiety symptoms in pregnancy and address the current gap in services. The intervention is potentially feasible for introduction into current clinical practice with minimal additional resources.

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“…It was considered that the therapeutic intervention components (mind body and cognitive behavioural approaches) could be delivered through supported use of self-help resources. Guided self-help has been reported as an effective intervention for depression and anxiety in general populations (Seekles et al 2011) and has been used as a stand-alone intervention or alongside group interventions for pregnant women with anxiety, stress and depression (Evans et al 2017). Potential self-help resources were identi ed evaluated using IAPT criteria (IAPT 2010) .…”

Section: Additional Considerations and Motivations Informing The Intementioning

confidence: 99%

Developing a Complex Intervention to Support Pregnant Women with Mild to Moderate Anxiety: Application of the Medical Research Council Framework

Evans

Spiby

Morrell

2020

Preprint

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Abstract Aim: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy.Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators. Discussion: The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care.Conclusion: The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.

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Systematic review and meta‐analysis of non‐pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women

Abstract: There was insufficient evidence from which to draw overall conclusions regarding the benefit of interventions. Results were predominantly based on small samples. Many papers provided an inadequate description of methods which prevented a full assessment of methodological quality.

Cited by 31 publications

References 74 publications

Effectiveness of a psycho-educational intervention for expecting parents to prevent postpartum parenting stress, depression and anxiety: a randomized controlled trial

Effectiveness of a psycho-educational intervention for expecting parents to prevent postpartum parenting stress, depression and anxiety: a randomized controlled trial

Supporting Women With Mild to Moderate Anxiety in Pregnancy: a Feasibility Study of a Midwife Facilitated Intervention

Developing a Complex Intervention to Support Pregnant Women with Mild to Moderate Anxiety: Application of the Medical Research Council Framework

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