Mental health impact on Black, Asian and Minority Ethnic populations with preterm birth: A systematic review and meta-analysis

Table 1 Key features of the studies included in the systematic review

ID	Ref.	Study type	Country	Symptoms			Outcome assessment1
1	Ballantyne et al[37]	Cross-sectional study	Canada	Depression		Stress	(1) CES-D; and (2) PSS: NICU
2	Baptista et al[48]	Cross-sectional study	Portugal	Psychological problem		Stress	(1) BSI; and (2) Daily hassles questionnaire
3	Barroso et al[38]	Cross sectional study	United States	Depression			EPD-S
4	Bener[60]	Hospital-based study (cross sectional study)	Qatar	Depression	Anxiety	Stress	(1) DASS-21; (2) DASS-21; and (3) DASS-21
5	Bouras et al[34]	Cross-sectional study	Greece	Depression	Anxiety		(1) BDI; and (2) STAI
6	Brandon et al[39]	Descriptive study	United States	Depression	Anxiety	Stress	(1) EPDS; (2) STAI-S; (3) PPQ; and (4) CHWS
7	Carson et al[49]	Cohort study	United Kingdom	Psychological problem			Modified RMI
8	Cheng et al[13]	Cohort study	United States	Depression			CES-D
9	Davis et al[57]	Cross-sectional study	Australia	Depression		Stress	(1) EPDS; and (2) DASS
10	Drewett et al[50]	Cross-sectional study	United Kingdom	Depression			EPDS
11	Edwards et al[58]	Cohort study	Australia	Depression		Parenting stress	(1) EPDS; and (2) PSI
12	Fabiyi et al[40]	Cross-sectional study	United States		(1) State anxiety; and (2) Trait anxiety		STAI
13	Gambina et al[33]	Case-control study	Italy	Depression	(1) State anxiety; and (2) Trait anxiety	Stress	(1) EPDS; (2) STAI-State and STAI-Trait; and (3) PSM
14	Gueron-Sela et al[30]	Cross-sectional study	Israel	Depression		Stress	(1) CES-D; and (2) PSS: NICU
15	Gulamani et al[24]	Cohort study	Pakistan	Depression			EPDS
16	Gungor et al[35]	Case-control study	Turkey	Depression	(1) State anxiety; (2) Trait anxiety		(1) BDI; and (2) STAI
17	Hagan et al[59]	Prospective, randomised, controlled study	Australia	Depression	Anxiety		(1) EPDS; and (2) BDI
18	Henderson et al[51]	Cross-sectional study	United Kingdom	Depression			EPDS
19	Holditch-Davis et al[44]	Cross-sectional study	United States	Depression	Anxiety	Stress	(1) CES-D; (2) STAI; and (3) PSS: NICU
20	Ionio et al[52]	Longitudinal study	Italy	Depression			Profile of mood states
21	Logsdon et al[41]	Descriptive study	United States	Depression			CES-D
22	Misund et al[53]	Longitudinal study	Norway	Psychological distress	Anxiety	Trauma-related stress	(1) GHQ likert sum and case sum; (2) STAI-X1; and (3) Impact of event scale (IES)
23	Misund et al[53]	Cohort study	Norway	Psychological distress	Anxiety	Trauma-related stress	(1) GHQ likert sum and case sum; (2) STAI-X1; and (3) IES
24	Pace et al[32]	Longitudinal, prospective, follow-up cohort study	Australia	Depression	Anxiety		(1) CES-D; and (2) Hospital anxiety and depression scale
25	Rogers et al[42]	Cohort study	United States	Depression	Anxiety		(1) EPDS; and (2) STAI
26	Sharan et al[61]	Cross-sectional study	Israel	Depression			EPDS
27	Shaw et al[43]	Cross-sectional study	United States	Depression	Anxiety	Stress	(1) BDI-II; (2) BAI; and (3) SASRQ
28	Trumello et al[54]	Longitudinal study	Italy	Depression	(1) State anxiety; and (2) Trait anxiety		(1) EPDS; and (2) STAI-State Y1 and Y2
29	Holditch-Davis et al[44]	Longitudinal study	United States	Depression	State anxiety	Stress	(1) CESD; (2) STAI; (3) PSS: NICU; and (4) PSS:PBC
30	Mautner et al[55]	Prospective, longitudinal study	Austria	Depression			EPDS
31	Gray et al[28]	Cross-sectional study	Australia	Depression		Parenting stress	(1) EPDS; and (2) PSI-SF
32	Gray et al[29]	Cross-sectional study	Australia	Depression		Parenting stress	(1) EPDS; and (2) PSI-SF
33	Howe et al[62]	Cross-sectional study	Taiwan			Parenting stress	PSI-Chinese version
34	Miles et al[45]	Longitudinal, descriptive study	United States	Depression			CES-D
35	Mew et al[46]	Correlational analysis	United States	Depression			CES-D
36	Madu and Roos[31]	Cross-sectional study	South Africa	Depression			EPDS
37	Suttora et al[36]	Descriptive study	Italy			(1) PTSD; and (2) Parenting stress	(1) PPQ-Modified version; and (2) PSI-SF
38	Korja et al[56]	Cross-sectional study	Finland	Depression			EPDS
39	Younger et al[47]	Descriptive correlational study	United States	Depression		Stress	(1) CES-D; and (2) MSI

¹Outcome assessment scales: Edinburgh Postnatal Depression Scale; State-Trait Anxiety Inventory; Hospital Anxiety and Depression Scale; Centre for Epidemiological Studies Depression; Beck’s Depression Inventory; Profile of Mood States; Parent Stress Index; Professional Personality Questionnaire; Perceived Stress Measure. EPDS: Edinburgh Postnatal Depression Scale; STAI: State-Trait Anxiety Inventory; HADS-A: Hospital Anxiety and Depression Scale; CES-D: Centre for Epidemiological Studies Depression; BDI: Beck’s Depression Inventory; POMS: Profile of Mood States; PSI: Parent Stress Index; PPQ: Professional Personality Questionnaire; PSM: Perceived Stress Measure.

Table 2 The quality assessment outcomes using the Newcastle-Ottawa Scale

ID	Ref.	Study type	Country	Symptoms			Outcome assessment	NOS score
1	Ballantyne et al[37]	Cross-sectional study	Canada	Depression		Stress	(1) CES-D; and (2) PSS: NICU	****** (6)
2	Baptista et al[48]	Cross-sectional study	Portugal	Psychological problem		Stress	(1) BSI; and (2) Daily hassles questionnaire	***** (5)
3	Barroso et al[38]	Cross sectional study	United States	Depression			EPD-S	****** (6)
4	Bener[60]	Hospital-based study (Cross sectional study)	Qatar	Depression	Anxiety	Stress	(1) DASS-21; (2) DASS-21; and (3) DASS-21	***** (5)
5	Bouras et al[34]	Cross-sectional study	Greece	Depression	Anxiety		(1) BDI; and (2) STAI	****** (6)
6	Brandon et al[39]	descriptive study	United States	Depression	Anxiety	Stress	(1) EPDS; (2) STAI-S; (3) PPQ; and (4) CHWS	******* (7)
7	Carson et al[49]	Cohort study	United Kingdom	Psychological problem			Modified RMI	***** (5)
8	Cheng et al[13]	Cohort study	United States	Depression			CES-D	***** (5)
9	Davis et al[57]	Cross-sectional study	Australia	Depression		Stress	(1) EPDS; and (2) DASS	***** (5)
10	Drewett et al[50]	Cross-sectional study	United Kingdom	Depression			EPDS	***** (5)
11	Edwards et al[58]	Cohort study	Australia	Depression		Parenting stress	(1) EPDS; and (2) PSI	***** (5)
12	Fabiyi et al[40]	Cross-sectional study	United States		(1) State anxiety; and (2) Trait anxiety		STAI	****** (6)
13	Gambina et al[33]	Case-control study	Italy	Depression	(1) State anxiety; and (2) Trait anxiety	Stress	(1) EPDS; (2) STAI-State and STAI-Trait; and (3) PSM	****** (6)
14	Gueron-Sela et al[30]	Cross-sectional study	Israel	Depression		Stress	(1) CES-D; and (2) PSS: NICU	******* (7)
15	Gulamani et al[24]	Cohort study	Pakistan	Depression			EPDS	**** (4)
16	Gungor et al[35]	Case-control study	Turkey	Depression	(1) State anxiety; (2) Trait anxiety		(1) BDI; and (2) STAI	****** (6)
17	Hagan et al[59]	Prospective,randomised, controlled study	Australia	Depression	Anxiety		(1) EPDS; and (2) BDI	****** (6)
18	Henderson et al[51]	Cross-sectional study	United Kingdom	Depression			EPDS	******* (7)
19	Holditch-Davis et al[44]	Cross-sectional study	United States	Depression	Anxiety	Stress	(1) CES-D; (2) STAI; and (3) PSS: NICU	****** (6)
20	Ionio et al[52]	Longitudinal study	Italy	Depression			Profile of mood states	***** (5)
21	Logsdon et al[41]	Descriptive study	United States	Depression			CES-D	****** (6)
22	Misund et al[53]	Longitudinal study	Norway	Psychological distress	Anxiety	Trauma-related stress	(1) GHQ likert sum and case sum; (2) STAI-X1; and (3) Impact of Event Scale (IES)	****** (6)
23	Misund et al[53]	Cohort study	Norway	Psychological distress	Anxiety	Trauma-related stress	(1) GHQ likert sum and case sum; (2) STAI-X1; and (3) IES	***** (5)
24	Pace et al[32]	Longitudinal, prospective, follow-up cohort study	Australia	Depression	Anxiety		(1) CES-D; and (2) Hospital anxiety and depression scale	****** (6)
25	Rogers et al[42]	Cohort study	US	Depression	Anxiety		(1) EPDS; and (2) STAI	***** (5)
26	Sharan et al[61]	Cross-sectional study	Israel	Depression			EPDS	****** (6)
27	Shaw et al[43]	Cross-sectional study	US	Depression	Anxiety	Stress	(1) BDI-II; (2) BAI; and (3) SASRQ	****** (6)
28	Trumello et al[54]	Longitudinal study	Italy	Depression	1) State anxiety2) Trait anxiety		(1) EPDS; and (2) STAI-State Y1 and Y2	******* (7)
29	Holditch-Davis et al[44]	Longitudinal study	US	Depression	1) State anxiety	Stress	(1) CESD; (2) STAI; (3) PSS: NICU; and (4) PSS:PBC	****** (6)
30	Mautner et al[55]	Prospective, longitudinal study	Austria	Depression			EPDS	****** (6)
31	Gray et al[28]	Cross-sectional study	Australia	Depression		Parenting stress	(1) EPDS; and (2) PSI-SF	****** (6)
32	Gray et al[29]	Cross-sectional study	Australia	Depression		Parenting stress	(1) EPDS; and (2) PSI-SF	****** (6)
33	Howe et al[62]	Cross-sectional study	Taiwan			Parenting stress	PSI-Chinese version	****** (6)
34	Miles et al[45]	Longitudial, descriptive study	United States	Depression			CES-D	***** (5)
35	Mew et al[46]	Correlational analysis	United States	Depression			CES-D	***** (5)
36	Madu and Roos[31]	Cross-sectional study	South Africa	Depression			EPDS	****** (6)
37	Suttora et al[36]	Decriptive study	Italy			(1) PTSD; and (2) Parenting stress	(1) PPQ-Modified version; and (2) PSI-SF	***** (5)
38	Korja et al[56]	Cross-sectional study	Finland	Depression			EPDS	****** (6)
39	Younger et al[47]	Decriptive correlational study	United States	Depression		Stress	(1) CES-D; and (2) MSI	****** (6)

*: Quality of the included cross-sectional studies was measured using the modified Newcastle-Ottawa Measurement Scale specific for Cross-sectional studies. We rated the quality of the studies (good, fair and poor) by allocating each domain with stars in this manner: A good quality score was awarded 3 or 4 stars in selection, 1 or 2 in comparability, and 2 or 3 stars in outcomes; A fair quality score was awarded 2 stars in selection, 1 or 2 stars in comparability, and 2 or 3 stars in outcomes; A poor quality score was allocated 0 or 1 star(s) in selection, 0 stars in comparability, and 0 or 1 star(s) in outcomes domain in line with the Newcastle-Ottawa Scale guidelines. NOS: Newcastle-Ottawa Scale; EPDS: Edinburgh Postnatal Depression Scale; STAI: State-Trait Anxiety Inventory; HADS-A: Hospital Anxiety and Depression Scale; CES-D: Centre for Epidemiological Studies Depression; BDI: Beck’s Depression Inventory; POMS: Profile of Mood States; PSI: Parent Stress Index; PPQ: Professional Personality Questionnaire; PSM: Perceived Stress Measure.

Table 3 Risk of Bias using the Newcastle-Ottawa Scale

	Selection (S)				Comparability (C)		Exposure/outcome E/O			Sub total assessment			Conclusion
	1	2	3	4	1a	1b	1	2	3	S1	C2	E/O2
Ballantyne et al[37]	*	*	No	*	*	*	No	*	*	Good	Good	Good	Good
Baptista et al[48]	*	*	No	*	*	*	*	*	*	Good	Good	Good	Good
Barroso et al[38]	*	*	*	*	*	*	*	No	*	Good	Good	Good	Good
Bener[60]	*	No	*	*	*	*	*	*	*	Good	Good	Good	Good
Bouras et al[34]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Brandon et al[39]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Carson et al[49]	*	No	*	*	*	*	*	*	*	Good	Good	Good	Good
Cheng et al[13]	*	*	No	*	No	*	*	*	*	Good	Good	Good	Good
Davis et al[57]	*	*	No	No	*	*	*	*	*	Fair	Good	Good	Good
Drewett et al[50]	*	*	*	*	No	*	*	*	*	Good	Good	Good	Good
Edwards et al[58]	*	No	No	*	No	*	*	*	*	Fair	Good	Good	Fair
Fabiyi et al[40]	*	No	*	No	No	*	*	*	*	Fair	Fair	Good	Fair
Gambina et al[33]	*	No	*	*	*	*	*	*	*	Good	Good	Good	Good
Gueron-Sela et al[30]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Gulamani et al[24]	*	No	*	*	*	*	*	*	*	Good	Good	Good	Good
Gungor et al[35]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Hagan et al[59]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Henderson et al[51]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Holditch-Davis et al[44]	*	*	No	*	No	*	*	*	*	Good	Good	Good	Good
Ionio et al[52]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Logsdon et al[41]	*	No	No	*	No	*	*	*	*	Fair	Fair	Good	Fair
Misund et al[53]	No	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Misund et al[53]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Pace et al[32]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Rogers et al[42]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Sharan et al[61]	No	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Shaw et al[43]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Trumello et al[54]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Holditch-Davis et al[44]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Mautner et al[55]	*	No	*	*	*	*	*	*	*	Good	Good	Good	Good
Gray et al[28]	*	*	No	*	No	*	*	*	*	Good	Good	Good	Good
Gray et al[29]	*	*	No	*	No	*	*	*	*	Good	Good	Good	Good
Howe et al[62]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Miles et al[45]	*	No	No	*	No	*	*	*	*	Fair	Good	Good	Fair
Mew et al[46]	*	No	No	*	No	*	*	No	*	Fair	Fair	Good	Fair
Madu and Roos[31]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Suttora et al[36]	*	*	*	*	*	*	*	*	*	Good	Good	Good	Good
Korja et al[56]	*	*	No	*	No	*	*	*	*	Good	Good	Good	Good
Younger et al[47]	*	No	No	*	No	*	*	*	*	Fair	Good	Good	Good

¹Domain scored: 0-1 (Poor); 2 (Fair); 3+ (Good).

²Domain scored: 0 (Poor); 1 (Fair); 2+ (Good).

*: Domain acceptable.

Table 4 Characteristics of the 12 studies included within the meta-analysis for depression

ID	Ref.	Study type	Country	Sample size	Outcome assessment
1	Brandon et al[39]	Descriptive study	United States	60	EPDS
2	Bouras et al[34]	Cross-sectional study	Greece	200	BDI
3	Cheng et al[13]	Cohort study	United States	5350	CES-D
4	Drewett et al[50]	Cross-sectional study	United Kingdom	10838	EPDS
5	Gambina et al[33]	Case-control study	Italy	84	EPDS
6	Gray et al[28,29]	Cross-sectional study	Australia	217	EPDS
7	Gueron-Sela et al[30]	Cross-sectional study	Israel	103 (Bedouin); 230 (Jewish)	CES-D
8	Gungor et al[35]	Case-control study	Turkey	299	BDI
9	Ionio et al[52]	Longitudinal study	Italy	50	Profile of mood states
10	Madu and Roos[31]	Cross-sectional study	South Africa	100	EPDS
11	Mautner et al[55]	Prospective, longitudinal study	Australia	61	EPDS
12	Pace et al[32]	Longitudinal, prospective cohort study	Australia	230	CES-D

EPDS: Edinburgh Postnatal Depression Scale; BDI: Beck’s Depression Inventory; CES-D: Centre for Epidemiological Studies Depression.

Table 5 Characteristics of the 5 studies included within the meta-analysis for anxiety

ID	Ref.	Study type	Country	Sample size	Outcome assessment
1	Brandon et al[39]	Descriptive study	United States	60	STAI-S
2	Bouras et al[34]	Cross-sectional study	Greece	200	STAI-T; STAI-S
3	Gambina et al[33]	Case-control study	Italy	84	STAI-T; STAI-S
4	Gungor et al[35]	Case-control study	Turkey	299	STAI-T; STAI-S
5	Pace et al[32]	Longitudinal, prospective cohort study	Australia	230	HADS-A

STAI: State-Trait Anxiety Inventory.

Table 6 Characteristics of the 5 studies included within the meta-analysis for stress

ID	Ref.	Study type	Country	Sample size	Outcome assessment
1	Brandon et al[39]	Descriptive study	United States	60	PPQ
2	Gambina et al[33]	Case-control study	Italy	84	PSM
3	Gray et al[28,29]	Cross-sectional study	Australia	217	PSI-SF
4	Howe et al[62]	Cross-sectional study	Taiwan	420	PSI-Chinese version
5	Suttora et al[36]	Descriptive study	Italy	243	PSI-SF

PPQ: Professional Personality Questionnaire; PSM: Perceived Stress Measure; PSI: Parent Stress Index.

Table 7 The thematic synthesis

Themes	Population group
	Women who had a preterm birth
Depression	++++++++++++++++++++++++++++++++
Stress	+++++++++++
Anxiety	+++++++++++
Parenting stress	+++++
State anxiety	+++++
Trait anxiety	++++
Psychological distress	++
Trauma-related stress	++
Psychological problem	++
Post-traumatic stress disorder	+