The effect of perinatal interventions on parent anxiety, infant socio‐emotional development and parent‐infant relationship outcomes: A systematic review

Abstract

Background Infants of parents with perinatal anxiety are at elevated likelihood of experiencing disruption in the parent‐infant relationship, as well as difficulties with socio‐emotional functioning in later development. Interventions delivered in the perinatal period have the potential to protect the early dyadic relationship and support infants’ ongoing development and socio‐emotional outcomes. This review primarily aimed to examine the efficacy of perinatal interventions on parent anxiety, infant socio‐emotional development/temperament, and parent‐infant relationship outcomes. Secondarily, the review sought to understand how interventions focused principally on one member of the dyad affected the outcomes of the other, and which intervention components were common to successful interventions. Method Five electronic databases as well as manual search procedures were used to identify randomised controlled trials according to a PICO eligibility criteria framework. Risk of bias assessments were undertaken, and a narrative synthesis was conducted. The review was pre‐registered on PROSPERO (CRD42021254799). Results Twelve studies were analysed in total, including five interventions focused on the adult, and seven interventions focused on the infant, or the infant’s relationship with their parent. Interventions incorporating cognitive behavioural strategies for affective disorders showed reductions in parent anxiety (N = 3), and interventions focusing on altering distorted maternal internal representations showed positive change in parent‐child dyadic interactions, and infant outcomes (N = 2). Evidence that interventions focused on one partner of the dyad led to improved outcomes for the other partner was limited. However, evidence was of mixed methodological quality. Conclusions It is important to integrate both parents and infants into treatment programmes for perinatal anxiety. Implications for clinical practice and future intervention trials are discussed.

Annual Research Review. ‘There, the dance is - at the still point of the turning world’: dynamic systems perspectives on co-regulation and dysregulation during early development

“…These have generally focused on increasing child-caregiver contingency (even though observational studies, as described above, have suggested that anxiety can be characterised as a mix of excessive contingency in some circumstances and insufficient in others). Interventions that target caregiver-child interactions have been shown to lead to changes in adult anxiety symptoms as well as changes in interactional style (C. G. Smith et al, 2022b). Findings are in line with transactional models of intervention that highlight the importance of integrating both caregivers and children into treatment programmes, on the basis that socio-emotional difficulties in one partner tend to exacerbate difficulties in the other.…”

“…individual observations, several months apart), and using a technique such as dynamic structural equation modelling, include genetic risk as a covariate by examining specific alleles that contribute to polygenic risk scores for anxiety but which are not shared between children and caregivers (Birmaher et al, 2022). Other approaches are to study special populations, such as caregivers raising genetically unrelated children (Harold et al, 2013), and interventions that specifically target child-caregiver behaviours to examine the long-term development of symptoms in the child (C. G. Smith et al, 2022a).…”

“…Intervention scientists have increasingly questioned whether perinatal interventions focused exclusively on only one member of the caregiver-child dyad are sufficient (e.g., Stein et al, 2018). A small number of intervention studies have targeted caregiver-child interaction in the context of perinatal anxiety (C. G. Smith et al, 2022b). These have generally focused on increasing child-caregiver contingency (even though observational studies, as described above, have suggested that anxiety can be characterised as a mix of excessive contingency in some circumstances and insufficient in others).…”

Annual Research Review: ‘There, the dance is – at the still point of the turning world’ – dynamic systems perspectives on coregulation and dysregulation during early development

“…Important theoretical and practical insights into causal mechanisms can also come from intervention studies that target caregiver–child interaction—although clinical interventions tend to be relatively broad brush‐stroke (e.g. targeting aspects of the caregiver mental health symptoms on their own, as well as the caregiver–child interaction; Smith et al., 2022). This means that, when an intervention is effective, it can be hard to impute to underlying mechanisms.…”

“…Another would be to measure caregiver–child interaction repeatedly across multiple time points and, using a technique such as dynamic structural equation modelling, include genetic risk as a covariate by examining specific alleles that contribute to polygenic risk scores for anxiety but which are not shared between children and caregivers (Birmaher et al., 2022). Other approaches are to study special populations, such as caregivers raising genetically unrelated children (Harold et al., 2013), and interventions that specifically target child–caregiver behaviours to examine the long‐term development of symptoms in the child (Smith et al., 2022).…”