The Effect of Mindfulness-Based Interventions on Stress, Depression and Anxiety During the Perinatal Period in Women Without Pre-existing Stress, Depressive or Anxiety Disorders: a Systematic Review and Meta-analysis of Controlled Trials

Abstract

Objectives The objective of this systematic review and meta-analysis was to examine controlled trial evidence for the effectiveness of mindfulness-based interventions on stress, anxiety and depression in the perinatal period in women without pre-existing mental health issues. Methods Six databases were searched for studies exploring the effects of mindfulness-based interventions on mental health outcomes of women during the perinatal period. Quality of both controlled trial meeting inclusion criteria were assessed using a tool specifically designed for meta-analyses of mindfulness-based interventions. Effect sizes were extracted for measures of mindfulness, depression, stress and anxiety outcomes. Effects were pooled in separate meta-analyses for all outcomes except anxiety which lacked sufficient studies. Results Twelve studies were analysed. Pooled effects suggest that mindfulness-based interventions cause small but clear increases in mindfulness and reductions in depression in women without pre-existing disorders. Effects of mindfulness-based interventions on other outcomes were unclear and confounded by heterogeneity. Conclusions Available controlled trial evidence suggests that mindfulness-based interventions improve mindfulness and decrease symptoms of depression during pregnancy in women without pre-existing mental health issues and might be a useful approach to prevent or attenuate the development of depression in the perinatal period.

The Efficacy of Digital Cognitive–Behavioral Interventions in Supporting the Psychological Adjustment and Sleep Quality of Pregnant Women with Sub-Clinical Symptoms: A Systematic Review and Meta-Analysis

“…These results are in line with the findings of a meta-analysis that investigated the efficacy of in-person mindfulness-based interventions (MBIs) on pregnant women, which reported no effect of the MBIs on depression, anxiety, or stress symptoms [ 44 ]. These same results, on the other hand, contrast with the above-mentioned meta-analysis reporting the efficacy of CBTs [ 41 ], as well as with a recent meta-analysis showing the efficacy of in-person MBIs on perinatal women with sub-clinical symptoms [ 46 ]. The latter, in particular, showed a significant intervention effect on pregnant women’s sub-clinical depression symptoms [ 46 ].…”

“…These same results, on the other hand, contrast with the above-mentioned meta-analysis reporting the efficacy of CBTs [ 41 ], as well as with a recent meta-analysis showing the efficacy of in-person MBIs on perinatal women with sub-clinical symptoms [ 46 ]. The latter, in particular, showed a significant intervention effect on pregnant women’s sub-clinical depression symptoms [ 46 ].…”

“…Distinguishing between CBTs and third-generation CBTs, it is worth noting that as just mentioned, while the former seems effective in supporting perinatal women’s mood disturbances, the results are unclear for third-generation CBTs [ 44 , 45 , 46 ]. Indeed, the small number of reviews and meta-analyses carried out in this regard, which were focused on in-person mindfulness-based interventions (MBIs), showed that these interventions were not superior to the control conditions in reducing depression, anxiety, or stress symptoms [ 44 , 45 ].…”

“…Indeed, the small number of reviews and meta-analyses carried out in this regard, which were focused on in-person mindfulness-based interventions (MBIs), showed that these interventions were not superior to the control conditions in reducing depression, anxiety, or stress symptoms [ 44 , 45 ]. Furthermore, in a recent meta-analysis, albeit where the authors reported a small effect on depression symptoms during pregnancy [ 46 ], the efficacy of MBIs on stress symptoms was unclear and that on anxiety symptoms could not be assessed due to a lack of studies. Regarding digital interventions, to our current knowledge no review study has been conducted to investigate the efficacy of digital third-generation CBTs deployed during the perinatal period.…”

“…In addition, among the studies that placed attention on pregnancy, the involved women presented either clinically relevant psychological symptoms or mental disorders, such as major depression [ 52 , 53 ], or were instead recruited from the general population regardless of their symptomatology level [ 41 , 42 , 54 ]. The only available study that solely included women with sub-clinical symptoms and no prior mental disorder considered the broader perinatal period and investigated the efficacy of in-person MBIs [ 46 ]. Therefore, being mindful of the above and with a specific interest in prevention, the present meta-analysis is aimed at providing further and more specific information useful to the development of digital interventions and applications within a cognitive–behavioral approach, which can favor and support the well-being and mental health of pregnant women from the general population showing sub-clinical symptoms.…”