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Chua JYX, Choolani M, Chee CYI, Yi H, Lalor JG, Chong YS, Shorey S. A Mobile App-Based Intervention (Parentbot-a Digital Healthcare Assistant) for Parents: Secondary Analysis of a Randomized Controlled Trial. J Med Internet Res 2025; 27:e64882. [PMID: 40245395 PMCID: PMC12046274 DOI: 10.2196/64882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 02/16/2025] [Accepted: 03/12/2025] [Indexed: 04/19/2025] Open
Abstract
BACKGROUND Mobile app-based interventions are viable methods of delivering perinatal care support to parents. A mobile app-based intervention entitled Parentbot-a Digital Healthcare Assistant (PDA) was developed and evaluated via a randomized controlled trial. PDA aimed to provide informational, socioemotional, and psychological support to parents across the perinatal period. As developing such interventions is resource intensive, it is important to evaluate participants' use and the components that are appreciated by them. OBJECTIVE This study aims to examine the (1) relationship between participants' characteristics and PDA use, (2) relationship between PDA use and parenting outcomes, and (3) relationship between participants' characteristics and the time taken to respond to the surveys (survey response timing). METHODS This study is the secondary analysis of a randomized controlled trial. A convenient sample of 118 heterosexual couples (236 participants: n=118, 50% mothers and n=118, 50% fathers) from a public tertiary hospital in Singapore were recruited. Data were collected from November 2022 to August 2023. Descriptive statistics were used to summarize the parents' characteristics and study variables. Linear mixed models were used to examine the effect of (1) participants' sociodemographic characteristics on PDA use metrics, (2) use metrics on parenting outcomes, and (3) participants' sociodemographic characteristics on the survey response timing. The Pearson correlation was also used to examine the linear relationships between the PDA use metrics and parenting outcomes. RESULTS The following parental characteristics were found to be associated with PDA use: antenatal course attendance, gender, religion, ethnicity, and the number of children. After adjusting for baseline values and sociodemographic covariates, only the viewing of educational materials was statistically significantly associated with improvements in parents' anxiety (β=-0.48, 95% CI -0.94 to -0.009; P=.046), parent-child bonding (β=-0.10, 95% CI -0.19 to -0.01; P=.03), social support (β=0.31, 95% CI 0.08-0.54; P=.01), and parenting satisfaction (β=0.57, 95% CI 0.07-1.07; P=.03) at 1 month post partum. Moreover, parents' age, ethnicity, grouping, and number of children were found to be related to the survey response timing. CONCLUSIONS As the viewing of PDA's educational materials was linked to improvements in parents' perinatal well-being, the provision of educational resources should be prioritized in future app-based parenting interventions. Because the use of other PDA features, such as poster activities, forum posts, and reflection and gratitude exercises, had a limited effect in improving parents' well-being, future interventions could explore alternative activities to better engage parents. Future mobile app-based parenting interventions could conduct similar evaluations on app use and the effectiveness of specific features to validate the findings of this study.
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Affiliation(s)
- Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Cornelia Yin Ing Chee
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Yap Seng Chong
- Institute for Human Development and Potential, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics & Gynaecology, National University Health System, Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Firrahmawati L, Wasityastuti W, Kandarina BJI, Marti E, Chandra LA, Sulistianingsih A. The efficacy of collaborative psychological interventions in reducing anxiety levels in pregnant women: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2025; 25:431. [PMID: 40217171 PMCID: PMC11992786 DOI: 10.1186/s12884-025-07523-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 03/25/2025] [Indexed: 04/14/2025] Open
Abstract
BACKGROUND Anxiety during pregnancy can be harmful to both mother and baby, with anxiety rates remaining high despite psychological intervention efforts. This study aimed to evaluate the effectiveness of collaborative and single psychological interventions in reducing anxiety compared with standard antenatal care. METHODS A literature search was conducted in four databases (Scopus, Cochrane Library, PubMed, and ScienceDirect) for relevant studies published from 2016 to January 2024. The population in this review is pregnant women with anxiety who received psychological interventions either from a single health worker or involving collaboration. Psychological interventions were compared with standard antenatal care with maternal anxiety outcome scores to measure the efficacy of pre-post psychological intervention methods, with measurements taken only during pregnancy. The study designs included the use of the Randomized Controlled Trials method. This study restricted articles to languages other than English and used a review design and pharmacological interventions. Two independent reviewers performed data extraction and quality assessment using RoB 2. Statistical analysis was conducted using R-Studio. Data analysis was performed using meta-count packages with a random effect model. RESULTS There were 14 eligible articles identified from the initial 3,346 records, with 1 article excluded from the meta-analysis. Psychological interventions were effective in reducing anxiety compared with standard care (Standardised Mean Difference (SMD) - 0.64, 95% CI - 0.98--0.31). Analysis by type of intervention group showed differences between the two groups in mindfulness interventions (SMD - 0.55, 95% CI - 0.8--0.31), motivational interviewing (SMD - 0.70, 95% CI - 1.08--0.33), and supportive counseling (SMD - 0.73, 95% CI - 1.19-0.28). There were no differences between the Cognitive Behavioral Therapy (SMD - 0.80, 95% CI (- 1.80-0.19)) and Thinking Healthy Program intervention groups (SMD - 0.35, 95% CI - 0.81-0.11). Analysis of interventions conducted by a multidisciplinary team (collaborative) showed higher efficacy (SMD - 0.88, 95% CI - 1.60--0.15) compared with a single professional (noncollaborative) (SMD - 0.47, 95% CI - 0.72--0.22). CONCLUSIONS Collaborative interventions show better efficacy than a single intervention, with psychological therapy being more effective in reducing anxiety rather than standard antenatal care. Future research should improve the cooperative approach and examine its long-term effects on maternal and newborn outcomes. TRIAL REGISTRATION This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration code CRD42024497417.
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Affiliation(s)
- Lely Firrahmawati
- Doctoral Program in Medicine and Health Science, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Midwifery Study Programme, Faculty of Health Sciences, Universitas 'Aisyiyah Surakarta, Surakarta, Indonesia
| | - Widya Wasityastuti
- Department of Physiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Bernadette Josephine Istiti Kandarina
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Eva Marti
- Nursing Study Programme, Panti Rapih College of Health, Yogyakarta, Indonesia
| | - Lukman Ade Chandra
- Department of Pharmacology and Therapy, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Apri Sulistianingsih
- Midwifery Study Programme, Faculty of Health Sciences, Universitas Muhammadiyah Pringsewu, Lampung, Indonesia
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Inderstrodt J, Stumpff JC, Smollen RC, Sridhar S, El-Azab SA, Ojo O, Bowns B, Haggstrom DA. Informatics Interventions for Maternal Morbidity: Scoping Review. Interact J Med Res 2025; 14:e64826. [PMID: 40132184 PMCID: PMC11979538 DOI: 10.2196/64826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 12/20/2024] [Accepted: 01/21/2025] [Indexed: 03/27/2025] Open
Abstract
BACKGROUND Women have been entering pregnancy less healthy than previous generations, placing them at increased risk for pregnancy complications. One approach to ensuring effective monitoring and treatment of at-risk women is designing technology-based interventions that prevent maternal morbidities and treat perinatal conditions. OBJECTIVE This scoping review evaluates what informatics interventions have been designed and tested to prevent and treat maternal morbidity. METHODS MEDLINE, Embase, and Cochrane Library were searched to identify relevant studies. The inclusion criteria were studies that tested a medical or clinical informatics intervention; enrolled adult women; and addressed preeclampsia, gestational diabetes mellitus (GDM), preterm birth, Centers for Disease Control and Prevention-defined severe maternal morbidity, or perinatal mental health conditions. Demographic, population, and intervention data were extracted to characterize the technologies, conditions, and populations addressed. RESULTS A total of 80 studies were identified that met the inclusion criteria. Many of the studies tested for multiple conditions. Of these, 73% (60/82) of the technologies were tested for either GDM or perinatal mental health conditions, and 15% (12/82) were tested for preeclampsia. For technologies, 32% (28/87) of the technologies tested were smartphone or tablet applications, 26% (23/87) were telehealth interventions, and 14% (12/87) were remote monitoring technologies. Of the many outcomes measured by the studies, almost half (69/140, 49%) were patient physical or mental health outcomes. CONCLUSIONS Per this scoping review, most informatics interventions address three conditions: GDM, preeclampsia, and mental health. There may be opportunities to treat other potentially lethal conditions like postpartum hemorrhage using proven technologies such as mobile apps. Ample gaps in the literature exist concerning the use of informatics technologies aimed at maternal morbidity. There may be opportunities to use informatics for lesser-targeted conditions and populations.
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Affiliation(s)
- Jill Inderstrodt
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, United States
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Julia C Stumpff
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Rebecca C Smollen
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - Shreya Sridhar
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sarah A El-Azab
- Department of Health Policy and Management, University of Michigan, Ann Arbor, MI, United States
| | - Opeyemi Ojo
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - Brendan Bowns
- Department of Prevention, Corktown Health, Detroit, MI, United States
| | - David A Haggstrom
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, United States
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
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Stephan J, Gehrmann J, Sinha M, Stullich A, Gabel F, Richter M. A Scoping Review of Prevention Classification in Mental Health: Examining the Application of Caplan's and Gordon's Prevention Frameworks (2018-2024). JOURNAL OF PREVENTION (2022) 2025:10.1007/s10935-025-00834-1. [PMID: 40113659 DOI: 10.1007/s10935-025-00834-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2025] [Indexed: 03/22/2025]
Abstract
Mental health prevention is a global priority owing to the increasing burden of mental disorders exacerbated by global crises such as the COVID-19 pandemic, climate change, economic instability, and armed conflicts. These crises have heightened the need for effective preventive strategies addressing mental health across different life stages and populations. To structure and classify such strategies, Caplan's and Gordon's frameworks have been widely used, with one focusing on disease progression and the other on population risk. Although both frameworks are frequently used in mental health prevention, their application in clinical trials remains unexplored. This review addresses this gap by examining how Caplan's and Gordon's frameworks have been applied in mental health prevention, identifying research gaps, and exploring their potential for their combined application to enhance prevention strategies. A scoping review was conducted following PRISMA-ScR guidelines. Studies were selected based on predefined criteria and the data were synthesized. The search spanned PubMed, Scopus, APA PsycArticles, and PubPsych, covering peer-reviewed clinical trials, including randomized controlled trials, published between 2018 and 2024 in English or German. Eligible studies classified interventions based on Caplan's framework, which focuses on disease stage (primary, secondary, tertiary), or Gordon's framework, which categorizes prevention by population risk (universal, selective, indicated). Studies had to focus on mental health prevention, include populations relevant to mental health and well-being, and report mental health or well-being outcomes. Of the 40 included studies, six applied Caplan's framework, 30 applied Gordon's framework and three used a modified classification based on Gordon's approach. One study applied both frameworks, highlighting that their complementary use is rare. Studies were conducted in 19 countries, with the highest number from Germany (n = 8), the USA (n = 8), and the Netherlands (n = 6), across four continents (Asia, n = 5; Australia, n = 5; Europe, n = 22; North America, n = 8). Gordon's framework was applied more frequently, particularly in universal (n = 15) and indicated prevention (n = 12), while Caplan's framework was used mainly in primary prevention (n = 4). Depression (n = 25), anxiety (n = 21), stress (n = 8), and general mental health (n = 8) were the most frequently assessed outcomes. The studies targeted diverse populations, including children (n = 7), adolescents (n = 8), children and adolescents (n = 1) parents and their children or adolescents (n = 2), university students (n = 6), working adults (n = 7), older adults (n = 1), and adults without specifying (n = 8). This review highlights the underutilized potential of integrating Caplan's and Gordon's frameworks in mental health interventions. Two application examples illustrate how these frameworks can be combined to structure prevention strategies more effectively. Future research should explore combining these frameworks to enhance prevention strategies and address the emerging global health challenges.
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Affiliation(s)
- Johannes Stephan
- Department Health and Sport Sciences, Chair of Social Determinants of Health, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
| | - Jan Gehrmann
- Department Health and Sport Sciences, Chair of Social Determinants of Health, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department Clinical Medicine, TUM School of Medicine and Health, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany
| | - Monika Sinha
- Department Prevention and Rehabilitation, RehaPro Implementation Consultant for Cooperation and Joint Projects, German Pension Insurance (Bund), Berlin, Germany
| | - Ananda Stullich
- Department Health and Sport Sciences, Chair of Social Determinants of Health, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Frank Gabel
- Unit Rehabilitation Strategy and Social Medical Service, Department Rehabilitation Strategy and Medical Rehabilitation Facilities, German Pension Insurance Central Germany, Halle, Germany
| | - Matthias Richter
- Department Health and Sport Sciences, Chair of Social Determinants of Health, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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Surkan PJ, Park S, Sheng Z, Zaidi A, Atif N, Osborne LM, Rahman A, Malik A. Effects of a Prenatal Anxiety Randomized Controlled Trial Intervention on Infant Development in Pakistan. Acad Pediatr 2025; 25:102551. [PMID: 39097000 PMCID: PMC11833752 DOI: 10.1016/j.acap.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVE Given that infant development is influenced by caregiver mental health, we tested whether an intervention to reduce antenatal anxiety could affect infant development. A secondary aim was to test depressive symptoms, maternal responsiveness, and maternal infant bonding as mediators of this relationship. METHODS Between 2020 and 2022, pregnant women participated in a randomized controlled trial of the Happy Mother-Healthy Baby (HMHB) program based on cognitive behavioral therapy. We collected data on child development from 202 intervention and 198 control participants in a public hospital in Pakistan. Child development was measured using the Ages and Stages Questionnaires-Version 3 at six weeks postpartum. Using intent-to-treat analyses, we examined whether the intervention was associated with performance on the five ASQ-3 domains. Causal mediation analysis was used to assess depressive symptoms, bonding, and maternal-infant responsiveness as mediators. RESULTS Socio-demographic characteristics were evenly distributed between study arms. Intervention arm infants showed a 2.1-point increase (95% CI: 0.12, 4.17) in communication scores compared to controls. Though not achieving statistical significance, intervention infants also showed a 2.0-point increase (95% CI: -0.06, 4.09) in gross motor development performance. Bonding, depression, and responsiveness were mediators between the intervention and infant communication (Bindirect=1.94 (95% CI: 0.86, 3.25) depression; Bindirect= 0.57 (95% CI: 0.09, 1.16) bonding; Bindirect= 0.53 (95% CI: 0.01, 1.21) and responsiveness (Bindirect= 1.94 (95% CI: 0.86, 3.25)). Bonding, responsiveness, and depression mediated 25%, 23%, and 87% of the total association, respectively. CONCLUSIONS HMHB positively affected infant communication at six-week follow-up. Larger studies with longer follow-up are needed to confirm and extend these findings. TRIAL REGISTRATION ClinicalTrials.gov NCT03880032; https://clinicaltrials.gov/ct2/show/NCT03880032.
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Affiliation(s)
- Pamela J Surkan
- Department of International Health (PJ Surkan, S Park, and Z Sheng), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Soim Park
- Department of International Health (PJ Surkan, S Park, and Z Sheng), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ziyue Sheng
- Department of International Health (PJ Surkan, S Park, and Z Sheng), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ahmed Zaidi
- Human Development Research Foundation (A Zaidi and N Atif), Gujar Khan, Pakistan
| | - Najia Atif
- Human Development Research Foundation (A Zaidi and N Atif), Gujar Khan, Pakistan
| | - Lauren M Osborne
- Department of Obstetrics & Gynecology (LM Osborne), Weill Cornell Medical College, New York, NY
| | - Atif Rahman
- Institute of Population Health (A Rahman), University of Liverpool, Liverpool, United Kingdom
| | - Abid Malik
- Department of Public Mental Health (A Malik), Health Services Academy, Chak Shahzad, Islamabad, Pakistan
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Prabhu S, George LS, Guruvare S, Noronha JA, Jose TT, Nayak BS, George A, Mayya S. Effectiveness of psychosocial education program on postnatal depression, stress, and perceived maternal parenting self-efficacy among pregnant women in South India. PATIENT EDUCATION AND COUNSELING 2025; 130:108458. [PMID: 39413719 DOI: 10.1016/j.pec.2024.108458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 08/21/2024] [Accepted: 09/26/2024] [Indexed: 10/18/2024]
Abstract
OBJECTIVE This study aimed to evaluate the effect of a psychosocial education program on postnatal depression (PND), perceived stress, (PSS), and perceived maternal parenting self-efficacy (PMPSE). METHODS A randomized controlled trial design was used with stratified block randomization. The sample size consisted of 128 pregnant women. The women in the experimental group were provided with a psychosocial education program along with standard care, and the control group received standard care with an information pamphlet. Post-test assessments (PND, PSS, and PMPSE) were performed at 1 week, 6 weeks, and 12 weeks after delivery in both groups. RESULTS The result of the effect of the intervention on outcome variables on repeated measures ANOVA revealed that there was a positive statistically significant reduction in scores of postnatal depression [F (1, 119) = 18.832, p = 0 < 0.001] and perceived stress [F (1,119) = 22.488, p = < 0.001] and no statistically significant change in perceived maternal parenting self-efficacy in the experimental group [F (1,119) = 0.036, p = 0.850]. CONCLUSION The psychosocial education program was found to be effective in reducing postnatal depression and stress related to pregnancy and childbirth to enable a smooth transition to motherhood. PRACTICE IMPLICATIONS Given the benefits the program provides to women, this psychosocial education program could be incorporated into routine antenatal care for pregnant women.
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Affiliation(s)
- Savitha Prabhu
- Department of Psychiatric (Mental Health) Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Linu Sara George
- Department of Fundamentals of Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India.
| | - Shyamala Guruvare
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Judith Angelita Noronha
- Department of Obstetrics and Gynecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Tessy Treesa Jose
- Department of Psychiatric (Mental Health) Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Baby S Nayak
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Anice George
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Shreemathi Mayya
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Hasani M, Maleki A, Mohebbi P, Ebrahimi L. The effectiveness of the SATIR approach on parent-child attachment among adolescent mothers: a before-after study. J Matern Fetal Neonatal Med 2024; 37:2415376. [PMID: 39419611 DOI: 10.1080/14767058.2024.2415376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 09/27/2024] [Accepted: 10/07/2024] [Indexed: 10/19/2024]
Abstract
BACKGROUND Mother-child attachment is influenced by various factors, particularly social norms. It's crucial to consider the impact of cultural contexts and societal expectations on parent-child attachment. OBJECTIVE The study investigated the influence of counseling based on SATIR's theory on parent-child attachment in Iranian adolescent mothers. METHODS The study adopts a before-after design. It involves 33 adolescent mothers and their husbands. They received 6 sessions of counseling based on SATIR's approach. Data were collected using the Maternal Postnatal Attachment Scale (MPAS) in the pretest, post-test, and 6 weeks after the end of the counseling sessions. Data were analyzed using descriptive statistics and repeated measures ANOVA at a 95% confidence level. RESULTS The mean total score of the MPAS was 68.75 ± 7.7 in the pretest, 75.17 ± 6.44 in the post-test, and 77.75 ± 6.12 in the follow-up period which has increased over time (p = 0.001). The repeated measures ANOVA demonstrated the effectiveness of the intervention in enhancing overall attachment scores (59%) and the subscales of 'quality of attachment' by 56%, 'absence of hostility' by 21%, and 'pleasure in interaction' by 27%. CONCLUSION The study shows that using the SATIR approach effectively improves mother-child attachment in adolescent mothers after giving birth. Also, involving spouses in postpartum counseling programs seems to be a helpful strategy, indicating it should be taken into account by professionals in this area.
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Affiliation(s)
- Masoumeh Hasani
- Department of Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Azam Maleki
- Social Determinants of Health Research Center, Health and Metabolic Diseases Research Institute, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Parvin Mohebbi
- Department of Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Loghman Ebrahimi
- Department of Psychology, Faculty of Humanities, University of Zanjan, Zanjan, Iran
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Sawyer A, Simpson B, Reece C, Richardson V, Carbone J, John M, Linke R, Russo K, Turnbull D, Sawyer M. Protocol for an intervention for new parents experiencing moderate psychosocial adversity: pilot feasibility randomised trial. J Reprod Infant Psychol 2024:1-22. [PMID: 39158028 DOI: 10.1080/02646838.2024.2390903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 08/06/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Parents exposed to psychosocial adversities often experience challenges which, combined with the needs of a new-born infant, can be difficult to manage and increase the risk of poor outcomes for both parents and infants. Psychosocial adversity can disrupt the development of parental-foetal attachment to the baby during pregnancy, which can have a negative effect on parental care and quality of interaction during the postnatal period. This intervention is based on the proposition that enhanced parental capacity to mentalise and emotionally connect to unborn children during pregnancy, and better understanding about how to manage distressing infant behaviour (i.e., persistent crying and sleep problems) will: (i) promote the development of secure parent-infant attachment; (ii) improve antenatal bonding and postnatal parenting; and, (ii) reduce parental distress. METHOD This protocol is for a pilot randomised control trial evaluating a new intervention, which makes use of innovative technologies to support parents experiencing moderate psychosocial adversity (Australian New Zealand Clinical Trials Registry: ACTRN12622000287730). The New Technology for New Parents (NTNP) intervention provides support using antenatal ultrasound scans and 'virtual home visits' during the perinatal period. Quantitative outcomes include mentalising capacity, parental-foetal/infant attachment, and parental competence. CONCLUSION To the best of our knowledge, no study has evaluated the combined effectiveness of two novel technologies (3D/4D ultrasound scans and virtual home visits) to support parents across the antenatal and postnatal periods. This protocol, which includes the rationale for this innovative intervention, addresses a gap in services for parents experiencing moderate psychosocial adversity.
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Affiliation(s)
- Alyssa Sawyer
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Bronni Simpson
- Women's and Babies Division, Department of Obstetrics and Gynaecology, Women's and Children's Hospital, Adelaide, Australia
| | - Christy Reece
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Vanessa Richardson
- Child Protection Services, Women's and Children's Hospital, Adelaide, Australia
| | - Josephine Carbone
- Child Protection Services, Women's and Children's Hospital, Adelaide, Australia
| | - Melissa John
- Child Protection Services, Women's and Children's Hospital, Adelaide, Australia
| | - Rebecca Linke
- South Australia Medical Imaging, Women's and Children's Hospital Campus, Adelaide, Australia
| | - Kate Russo
- South Australia Medical Imaging, Women's and Children's Hospital Campus, Adelaide, Australia
- College of Clinical Sciences, Central Queensland University, Adelaide, Adelaide
| | - Deborah Turnbull
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Michael Sawyer
- School of Psychology, University of Adelaide, Adelaide, Australia
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Cho H, Kim J, Kim S, Jeong HI, Kwon M, Kim HM, Shim JS, Kim K, Baek J, Kyung Y, Choi SJ, Oh SY, Bae J, Won HH, Kim J, Ahn K. Postpartum Maternal Anxiety Affects the Development of Food Allergy Through Dietary and Gut Microbial Diversity During Early Infancy. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2024; 16:154-167. [PMID: 38528383 DOI: 10.4168/aair.2024.16.2.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/29/2023] [Accepted: 12/25/2023] [Indexed: 03/27/2024]
Abstract
PURPOSE We aimed to investigate the mediating factors between maternal anxiety and the development of food allergy (FA) in children until 2 years from birth. METHODS In this longitudinal cohort of 122 mother-child dyads from pregnancy to 24 months of age, we regularly surveyed maternal psychological states, infant feeding data, and allergic symptoms and collected stool samples at 6 months of age for microbiome analysis. Considering the temporal order of data collection, we investigated serial mediating effects and indirect effects among maternal anxiety, dietary diversity (DD), gut microbial diversity, and FA using structural equation modeling. RESULTS Among the 122 infants, 15 (12.3%) were diagnosed with FA. Increased maternal anxiety between 3 and 6 months after delivery was associated with a lower DD score. Infants with low DD at 4 months showed low gut microbial richness, which was associated with FA development. When the infants were grouped into 4 subtypes, using consensus clustering of 13 gut bacteria significantly associated with maternal anxiety and DD, Prevotella, Eubacterium, Clostridiales and Lachnospiraceae were more abundant in the group with lower FA occurrence. CONCLUSIONS Postpartum maternal anxiety, mediated by reduced DD and gut microbial diversity, may be a risk factor for the development of FA in infants during the first 2 years of life.
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Affiliation(s)
- Hyunbin Cho
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Jiwon Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sukyung Kim
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong, Korea
| | - Hye-In Jeong
- Department of Pediatrics, Eulji University Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Mijeong Kwon
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Mi Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Sun Shim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Jihyun Baek
- Department of Psychology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yechan Kyung
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaewoong Bae
- R&D Institute, BioEleven Co., Ltd., Seoul, Korea
| | - Hong-Hee Won
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea.
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea
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10
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Ansaari N, Rajan SK, Kuruveettissery S. Efficacy of in-person versus digital mental health interventions for postpartum depression: meta-analysis of randomized controlled trials. J Reprod Infant Psychol 2024:1-21. [PMID: 38221725 DOI: 10.1080/02646838.2024.2303470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
AIM This meta-analysis aimed to compare the efficacy of in-person and digital mental health interventions in addressing Postpartum Depression. METHODS Following PRISMA guidelines, the protocol for this meta-analysis was registered at the Open Science Framework (Retrieved from osf.io/wy3s4). This meta analysis included Randomized Controlled Trials (RCTs) conducted between 2013 and 2023. A comprehensive literature search identified 35 eligible RCTs from various electronic databases. Inclusion criteria focused on pregnant women over 18 years old, encompassing antenatal depression and up to two years postpartum. Diagnostic interviews or Edinburgh Postnatal Depression Scale (EPDS) were used to establish PPD. Digital interventions included telephonic, app-based, or internet-based approaches, while in-person interventions involved face-to-face sessions. RESULTS The meta-analysis revealed a moderate overall effect size of -0.69, indicating that psychological interventions are effective for PPD. Digital interventions (g = -0.86) exhibited a higher mean effect size than in-person interventions (g = -0.55). Both types of interventions displayed substantial heterogeneity (digital: I2 = 99%, in-person: I2 = 92%), suggesting variability in intervention content, delivery methods, and participant characteristics. CONCLUSION Digital mental health interventions show promise in addressing PPD symptoms, with a potentially greater effect size compared to in-person interventions. However, the high heterogeneity observed in both modalities underscores the need for further research to identify key drivers of success and tailor interventions to diverse populations. Additionally, the choice between digital and in-person interventions should consider individual needs and preferences. Ongoing research should further investigate and optimise intervention modalities to better serve pregnant women at risk of PPD.
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Affiliation(s)
- Neda Ansaari
- Department of Psychology, CHRIST (Deemed to be University), Bangalore, India
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11
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Wahyuni S, Arief YS, Triharini M, Nursalam N. Husband's Contributions to Stimulate Wife's Confidence Experiencing Role Transition: Cross-Sectional Study. SAGE Open Nurs 2024; 10:23779608241304716. [PMID: 39711850 PMCID: PMC11660063 DOI: 10.1177/23779608241304716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/28/2024] [Accepted: 11/05/2024] [Indexed: 12/24/2024] Open
Abstract
Introduction Pregnancy can cause various physical and physiological changes. It affects confidence, resulting in depression and disturbing health not only for a mother but also for her fetus. These will also determine the ability of the mother to take care of her baby after delivery. Objectives To analyze the husband's contributions to stimulate the wife's confidence in experiencing role transition. Methods This research used a quantitative method with a cross-sectional design. The research was conducted in Central Java. There were 150 respondents of pregnant mothers. The variables of this study were the husband's factors and the wife's self-confidence, which were collected by demographic questionnaire and spiritual well-being scale questionnaire (SWBS) with a total sampling technique. The data were analyzed using a multinominal regression Test. Results Husbands were 58% at the age of early adult (26-35 years old), 76% graduating from secondary school level, 61.3% working as private employees, and 70% well supporting their wives. Most respondents (48.7%) had good self-confidence shown by the relationship of all husband's characteristics covering age, education, occupation, and support with the wife's self-confidence in facing role transition and had a value of <0.05. Conclusion The husband's age in a productive period with a good husband's education and occupation level could make the husband have mature thoughts, and he can calm his wife based on correct knowledge so that the wife is not worried about facing them and feels confident. Nurses can motivate and educate husbands to always provide support to their wives in facing pregnancy.
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Affiliation(s)
- Sri Wahyuni
- Faculty of Nursing, Universitas Islam Sultan Agung, Semarang, Indonesia
| | | | - Mira Triharini
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
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12
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Xie EB, Jung JW, Kaur J, Benzies KM, Tomfohr-Madsen L, Keys E. Digital Parenting Interventions for Fathers of Infants From Conception to the Age of 12 Months: Systematic Review of Mixed Methods Studies. J Med Internet Res 2023; 25:e43219. [PMID: 37494086 PMCID: PMC10413237 DOI: 10.2196/43219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/27/2023] [Accepted: 06/06/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Digital interventions help address barriers to traditional health care services. Fathers play an important parenting role in their families, and their involvement is beneficial for family well-being. Although digital interventions are a promising avenue to facilitate father involvement during the perinatal period, most are oriented toward maternal needs and do not address the unique needs of fathers. OBJECTIVE This systematic review describes the digital interventions that exist or are currently being developed for fathers of infants from conception to 12 months postpartum. METHODS A systematic search of the MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Embase (using Ovid), and CINAHL (using EBSCO) databases was conducted to identify articles from database inception to June 2022, of which 39 met the inclusion criteria. Articles were included if they were peer-reviewed and described a digital intervention that targeted fathers of fetuses or infants aged ≤12 months. Systematic reviews, meta-analyses, and opinion pieces were excluded. Data from these studies were extracted and themed using a narrative synthesis approach. Quality appraisal of the articles was conducted using the Mixed Methods Appraisal Tool. RESULTS A total of 2816 articles were retrieved, of which 39 (1.38%) met the inclusion criteria for eligibility after removing duplicates and screening. Eligible articles included 29 different interventions across 13 countries. Most articles (22/29, 76%) described interventions that were exclusively digital. There were a variety of digital modalities, but interventions were most commonly designed to be delivered via a website or web-based portal (14/29, 48%). Just over half (21/39, 54%) of the articles described interventions designed to be delivered from pregnancy through the postpartum period. Only 26% (10/39) of the studies targeted fathers exclusively. A wide range of outcomes were included, with 54% (21/39) of the studies including a primary outcome related to intervention feasibility. Qualitative and mixed methods studies reported generally positive experiences with digital interventions and qualitative themes of the importance of providing support to partners, improving parenting confidence, and normalization of stress were identified. Of the 18 studies primarily examining efficacy outcomes, 13 (72%) reported a statistically significant intervention effect. The studies exhibited a moderate quality level overall. CONCLUSIONS New and expecting fathers use digital technologies, which could be used to help address father-specific barriers to traditional health care services. However, in contrast to the current state of digital interventions for mothers, father-focused interventions lack evaluation and evidence. Among the existing studies on digital interventions for fathers, there seem to be mixed findings regarding their feasibility, acceptability, and efficacy. There is a need for more development and standardized evaluation of interventions that target father-identified priorities. This review was limited by not assessing equity-oriented outcomes (eg, race and socioeconomic status), which should also be considered in future intervention development.
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Affiliation(s)
| | - James Wonkyu Jung
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jasleen Kaur
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Karen M Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Lianne Tomfohr-Madsen
- Department of Educational and Counselling Psychology, and Special Education, The University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth Keys
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- School of Nursing, The University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
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13
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Saharoy R, Potdukhe A, Wanjari M, Taksande AB. Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants. Cureus 2023; 15:e41381. [PMID: 37546054 PMCID: PMC10400812 DOI: 10.7759/cureus.41381] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Postpartum depression (PPD) is a common and debilitating mental health condition affecting many mothers worldwide. This review article aims to explore the complex effects of PPD on mothers and infants, focusing on maternal care. The transition to motherhood is a critical period characterized by numerous physical, psychological, and social changes, making women vulnerable to the onset of PPD. Consequently, PPD can significantly impact a mother's ability to provide optimal care for her infant, leading to potential adverse consequences for both parties. The article synthesizes existing research literature on the topic, encompassing studies from various disciplines, including psychology, psychiatry, obstetrics, and pediatrics. It begins by providing an overview of the prevalence and risk factors associated with PPD, emphasizing the importance of early detection and intervention. The impact of PPD on maternal caregiving behaviors, such as bonding, sensitivity, and responsiveness, is then examined, highlighting the potential disruptions in the mother-infant relationship. Furthermore, the article delves into the potential consequences of impaired maternal care on infant development, including emotional, cognitive, and social domains. Several factors contributing to the complex interplay between PPD and maternal care are discussed, including hormonal changes, psychosocial stressors, and the influence of social support networks. The review also addresses the bidirectional nature of the mother-infant relationship, whereby infant characteristics and behaviors can exacerbate or mitigate the effects of PPD on maternal care. Moreover, the article explores the role of healthcare providers and the importance of implementing effective screening, assessment, and treatment strategies for PPD to promote optimal maternal-infant outcomes. By consolidating current knowledge on the topic, this review article provides valuable insights into the multifaceted effects of PPD on both mothers and infants. Recognizing the significance of maternal care and understanding the mechanisms through which PPD disrupts it can inform the development of targeted interventions to promote early detection, effective treatment, and supportive interventions for mothers experiencing PPD. Ultimately, improving maternal mental health and enhancing maternal-infant relationships can yield long-term positive effects on mothers' and infants' well-being and development.
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Affiliation(s)
- Rishika Saharoy
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashwini Potdukhe
- Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Avinash B Taksande
- Physiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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14
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Kılıçlı A, Saraçoğlu G, Çetinkaya Büyükbodur A. Stress, Anxiety, and Postpartum Depression in Parents with Premature Infants in Neonatal Intensive Care Unit. FLORENCE NIGHTINGALE JOURNAL OF NURSING 2023; 31:82-90. [PMID: 37404210 PMCID: PMC10440958 DOI: 10.5152/fnjn.2023.22219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/21/2023] [Indexed: 07/06/2023]
Abstract
AIM This study aimed to determine stress, anxiety, and postpartum depression in parents with premature infants in neonatal intensive care unit. METHOD This cross-sectional study was conducted between July 15 and November 31, 2021. The research involved 120 premature infants and their parents (120 mothers and 120 fathers). This research was carried out in Şanlıurfa Mehmet Akif İnan Training and Research Hospital, third level neonatal intensive care unit. Introductory Information Form, Parental Stress Scale: Neonatal Intensive Care Unit, Beck Anxiety Inventory, and Edinburgh Postpartum Depression Scale were used as data collection tools. RESULTS Stress, anxiety, and depression were high in parents. Stress, anxiety, and postpartum depression mean scores of mothers were significantly higher than that of fathers. A positive correlation was found between stress, anxiety, and postpartum depression in parents. Simple regression analysis revealed that stress in mothers predicted depression by 5% and stress in fathers predicted anxiety by 30%. CONCLUSION This study emphasizes that stress, anxiety, and depression are seen at high rates in parents with premature infants, and stress increases anxiety in fathers and depression in mothers.
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Affiliation(s)
- Ayşegül Kılıçlı
- Department of Nursing, Muş Alparslan University, Faculty of Health Sciences, Muş, Turkey
| | - Gülben Saraçoğlu
- Department of Mental Health and Diseases, Şanlıurfa Mehmet Akif Inan Training and Research Hospital, Şanlıurfa, Turkey
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15
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Remartínez-Hamed A, Pérez-Morente MÁ, Álvarez-Serrano MA, Martínez-García E, González-García A, García-García I, Martín-Salvador A. Levels and predictors of postpartum depression and anxiety during the first year of the COVID-19 pandemic in a confined cross-border city. CURRENT PSYCHOLOGY 2023:1-10. [PMID: 37359590 PMCID: PMC10170432 DOI: 10.1007/s12144-023-04719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/28/2023]
Abstract
Pregnancy and/or the puerperium involve social, physiological and psychological changes that make women more vulnerable to mental disorders such as anxiety and depression, even more so if these develop in stressful contexts such as the pandemic. The aim of this study is to identify factors associated with the risk of postpartum anxiety and depression during the COVID-19 pandemic. A cross-sectional study was conducted among postpartum women (n = 69) who gave birth between March 2020 and March 2021 in Melilla, a Spanish cross-border city with Morocco whose borders were closed, making it a confined city. The scales used were the State-Trait Anxiety Inventory and the Edinburgh Postnatal Depression Scale. Results reported an elevated risk of depression (85.5%) and anxiety (63.8%), with severe anxiety reaching 40.6% of cases. Predictors of postpartum depression comprised a personal history of mood disorders (β = 8.421; CI95% = 4.863/11.978) and having been diagnosed with COVID-19 during pregnancy or postpartum (β = 4.488; CI95% = 1.331/7.646). As regards anxiety, it is predicted on the basis of mood antecedents (β = 14.175; CI95% = 7.870/20.479), the fact of having been diagnosed with COVID-19 during pregnancy or postpartum (β = 8.781; CI95% = 2.970/14.592) and the fact of being a multipara (β = 5.513; CI95% = 0.706/10.321). In conclusion, special attention should be paid to women with a history of mood disorders and a positive diagnosis of COVID-19 during pregnancy or postpartum, even more so in the case of multiparous women, because of its impact on mental health during the postpartum period. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-023-04719-6.
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Affiliation(s)
- Alicia Remartínez-Hamed
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | | | - María Adelaida Álvarez-Serrano
- Department of Nursing, Faculty of Health Sciences, University of Granada, St. Cortadura del Valle S/N, 51001 Ceuta, Spain
| | - Encarnación Martínez-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Guadix High Resolution Hospital, 18500 Granada, Spain
| | - Alberto González-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | | | - Adelina Martín-Salvador
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
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16
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Jones KA, Freijah I, Brennan SE, McKenzie JE, Bright TM, Fiolet R, Kamitsis I, Reid C, Davis E, Andrews S, Muzik M, Segal L, Herrman H, Chamberlain C. Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment. Cochrane Database Syst Rev 2023; 5:CD014874. [PMID: 37146219 PMCID: PMC10162699 DOI: 10.1002/14651858.cd014874.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. OBJECTIVES To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. SEARCH METHODS In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. SELECTION CRITERIA All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models. MAIN RESULTS We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills. AUTHORS' CONCLUSIONS There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.
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Affiliation(s)
- Kimberley A Jones
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isabella Freijah
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tess M Bright
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Renee Fiolet
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Ilias Kamitsis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Elise Davis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Shawana Andrews
- Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Leonie Segal
- Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, North Terrace, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellenece in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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17
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Augustin M, Licata-Dandel M, Breeman LD, Harrer M, Bilgin A, Wolke D, Mall V, Ziegler M, Ebert DD, Friedmann A. Effects of a Mobile-Based Intervention for Parents of Children With Crying, Sleeping, and Feeding Problems: Randomized Controlled Trial. JMIR Mhealth Uhealth 2023; 11:e41804. [PMID: 36897641 PMCID: PMC10039405 DOI: 10.2196/41804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/16/2022] [Accepted: 01/13/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Excessive crying, sleeping, and feeding problems in early childhood are major stressors that can result in parents feeling socially isolated and having low self-efficacy. Affected children are a risk group for being maltreated and developing emotional and behavioral problems. Thus, the development of an innovative and interactive psychoeducational app for parents of children with crying, sleeping, and feeding problems may provide low-threshold access to scientifically based information and reduce negative outcomes in parents and children. OBJECTIVE We aimed to investigate whether following the use of a newly developed psychoeducational app, the parents of children with crying, sleeping, or feeding problems experienced less parenting stress; gained more knowledge about crying, sleeping, and feeding problems; and perceived themselves as more self-effective and as better socially supported and whether their children's symptoms decreased more than those of the parents who did not use the app. METHODS Our clinical sample consisted of 136 parents of children (aged 0-24 months) who contacted a cry baby outpatient clinic in Bavaria (Southern Germany) for an initial consultation. Using a randomized controlled design, families were randomly allocated to either an intervention group (IG; 73/136, 53.7%) or a waitlist control group (WCG; 63/136, 46.3%) during the usual waiting time until consultation. The IG was given a psychoeducational app that included evidence-based information via text and videos, a child behavior diary function, a parent chat forum and experience report, tips on relaxation, an emergency plan, and a regional directory of specialized counseling centers. Outcome variables were assessed using validated questionnaires at baseline test and posttest. Both groups were compared at posttest regarding changes in parenting stress (primary outcome) and secondary outcomes, namely knowledge about crying, sleeping, and feeding problems; perceived self-efficacy; perceived social support; and child symptoms. RESULTS The mean individual study duration was 23.41 (SD 10.42) days. The IG reported significantly lower levels of parenting stress (mean 83.18, SD 19.94) after app use compared with the WCG (mean 87.46, SD 16.67; P=.03; Cohen d=0.23). Furthermore, parents in the IG reported a higher level of knowledge about crying, sleeping, and feeding (mean 62.91, SD 4.30) than those in the WCG (mean 61.15, SD 4.46; P<.001; Cohen d=0.38). No differences at posttest were found between groups in terms of parental efficacy (P=.34; Cohen d=0.05), perceived social support (P=.66; Cohen d=0.04), and child symptoms (P=.35; Cohen d=0.10). CONCLUSIONS This study provides initial evidence of the efficacy of a psychoeducational app for parents with child crying, sleeping, and feeding problems. By reducing parental stress and increasing knowledge of children's symptoms, the app has the potential to serve as an effective secondary preventive measure. Additional large-scale studies are needed to investigate long-term benefits. TRIAL REGISTRATION German Clinical Trials Register DRKS00019001; https://drks.de/search/en/trial/DRKS00019001.
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Affiliation(s)
- Michaela Augustin
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Maria Licata-Dandel
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- kbo-Kinderzentrum Munich, Munich, Germany
| | - Linda D Breeman
- Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
- Clinical Psychology and Psychotherapy, Institute for Psychology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Ayten Bilgin
- School of Psychology, University of Kent, Canterbury, United Kingdom
| | - Dieter Wolke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Volker Mall
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- kbo-Kinderzentrum Munich, Munich, Germany
| | | | - David Daniel Ebert
- Psychology & Digital Mental Health Care, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Anna Friedmann
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Almutairi HA, Alyousef SM, Alhamidi SA, Almoammar DN. Exploring the Healthcare Services' Contribution to Reducing Postpartum Depression. SAGE Open Nurs 2023; 9:23779608231171780. [PMID: 37181734 PMCID: PMC10170593 DOI: 10.1177/23779608231171780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction The postpartum period is accompanied by health risks that impact many women. Postpartum depression (PPD) is a mental health problem that has been neglected in maternal healthcare services. Objective The purpose of this study was to explore nurses' perceptions towards health services' contribution to lowering the incidence of PPD. Methods An interpretive phenomenological approach was adopted in a tertiary hospital in Saudi Arabia. A convenience sample of 10 postpartum nurses was interviewed face-to-face. The analysis followed Colaizzi's data analysis method. Results Seven main themes emerged on how to improve maternal health services to contribute to reducing the incidence of PPD among women: (1) maternal mental health, (2) follow-up of mental health status, (3) screening mental health status, (4) enhancing health education, (5) reducing stigma toward mental health, (6) updating resources, and (7) empowering nurses. Conclusion The integration of mental health services into maternal services that are provided to women needs to be considered in the context of Saudi Arabia. This integration will result in high-quality holistic maternal care.
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Affiliation(s)
| | - Seham Mansour Alyousef
- Community and Psychiatric Department, Nursing College, King Saud University, Riyadh, Saudi Arabia
| | - Sami Abdulrahman Alhamidi
- Department of Maternal and Child Health, Nursing College, King Saud University, Riyadh, Saudi Arabia
| | - Danah Nasser Almoammar
- Department of Psychiatric and Mental Health Care, College of Nursing, King Saud University, Riyadh, Saudi Arabia
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A Web-Based, Mindful, and Compassionate Parenting Training for Mothers Experiencing Parenting Stress: Results from a Pilot Randomized Controlled Trial of the Mindful Moment Program. Mindfulness (N Y) 2022; 13:3091-3108. [PMID: 36408119 PMCID: PMC9649016 DOI: 10.1007/s12671-022-02016-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2022] [Indexed: 11/12/2022]
Abstract
Objectives Mindful Moment is a self-guided, web-based, mindful, and compassionate parenting training for postpartum mothers who experience parenting stress. We aimed to assess Mindful Moment’s feasibility, acceptability, and usability, and to gather preliminary evidence of its effectiveness in reducing parenting stress and outcomes such as mindful parenting, self-compassion, depressive symptoms, anxious symptoms, dispositional mindfulness, mother’s perception of infant temperament, and mother-infant bonding. Methods This pilot randomized controlled trial (RCT) was a two-arm trial and followed the CONSORT 2010, CONSORT-EHEALTH, and CONSORT-SPI 2018 extension guidelines. A total of 292 Portuguese mothers were randomly assigned to the intervention group (n = 146) or to the waiting list control group (n = 146) and completed baseline (T1) and postintervention (T2) self-reported assessments. Results A total of 31 mothers (21.23%) completed the Mindful Moment intervention. Most mothers evaluated the program as good or excellent (90%), considered that Mindful Moment provided them the kind of help they expected or wanted (61%), were satisfied with the help provided by the program (74.6%), would recommend it to a friend in a similar situation (86.4%), and would use it again if needed (81.4%). Regarding the program’s preliminary effectiveness, mothers in the intervention group presented a greater decrease in parenting stress, a greater increase in dispositional mindfulness, and a greater decrease in their perception of the difficult temperament of their infants from T1 to T2. Conclusions This study provides preliminary evidence of the Mindful Moment’s effectiveness and suggests that it is a feasible and acceptable program for postpartum mothers experiencing parenting stress. Further research is needed to confirm these results in a larger RCT. Trial Registration ClinicalTrials.gov (NCT04892082).
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The Effectiveness of Interventions for the Prevention or Treatment of Paternal Perinatal Anxiety: A Systematic Review. J Clin Med 2022; 11:jcm11226617. [PMID: 36431094 PMCID: PMC9692859 DOI: 10.3390/jcm11226617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/30/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022] Open
Abstract
Background: The worldwide prevalence of paternal perinatal anxiety (PPA) ranges between 3.4% and 25.0% antenatally, and 2.4% and 51.0% postnatally. Experiencing PPA can adversely impact the individual, partners, and infants. Research concerning PPA is lagging and fragmented compared to research for new mothers. Objectives: To establish the effectiveness of prevention or treatment interventions for PPA in adults identifying as male. Data sources: We completed searches of Medline, EMBASE, PsycINFO and Web of Science from inception to 2 December 2021, as well as hand searches of references from relevant papers. Search selection and data extraction: Randomised controlled trials delivering prevention or treatment interventions and reporting anxiety outcomes for new/expectant fathers in the perinatal mental health period were included. Our review follows the PRISMA reporting guidelines. One reviewer independently screened 5170 titles/abstracts; second reviewers screened 50%. Two reviewers independently screened full text, extracted data, and conducted risk of bias assessments. Synthesis: Cochrane's collaboration tool 2 was used to assess quality. Primarily results are synthesised narratively, a post-hoc sub-group analysis was completed on four studies using the same outcome measure. Main results: Twelve of the 5170 studies fulfilled the inclusion criteria. Studies used psychoeducational or practical skills interventions. Interventions mostly involved couple-dyads and three studies assessed PPA as a primary outcome. Included interventions were prevention-based; no treatment interventions were found. Father-only interventions consistently reported a significant reduction of PPA. Conclusions: Systematic searching yielded no treatment interventions, highlighting a substantial gap in the evidence base. Within a limited and heterogenous sample, no studies targeted diagnosed PPA. Evidence suggested father-focused interventions may be effective in preventing PPA, regardless of the intervention delivery mode or intervention content. However, consistency between study design and options within the field are lacking compared to interventions available for mothers.
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Song JE, Roh EH, Kim YJ, Ahn JA. Effects of Maternal Adjustment Enhancement Program Using Mobile-Based Education for Chinese Immigrant Women in Korea: A Quasi-Experimental Study. J Transcult Nurs 2022; 33:685-694. [PMID: 35941817 DOI: 10.1177/10436596221107601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This study aimed to develop a maternal adjustment program for Chinese immigrant primiparous women in Korea and to investigate its effectiveness. METHODOLOGY Forty-five Chinese immigrant women with newborns were recruited and conveniently assigned into experimental and control groups. A maternal adjustment enhancement program was initiated to the experimental group using a mobile-based education regarding cultural intimacy for 4 weeks. RESULTS In the follow-ups, the experimental group showed significantly higher knowledge of childcare and parenting efficacy. Both the experimental and control groups showed an improvement in social support and a decrease in childcare stress without between-group differences. DISCUSSION The maternal adjustment enhancement program can be utilized as an effective approach to improve knowledge of childcare and reinforce parenting efficacy of Chinese immigrant women in Korea. Strategies to reduce language barrier and to provide education with culturally friendly manners should be utilized for successful transition to motherhood among immigrant mothers.
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Affiliation(s)
| | - Eun Ha Roh
- Ajou University, Suwon, Republic of Korea.,Global Korean Nursing Foundation, Seoul, Republic of Korea
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Tola YO, Akingbade O, Akinwaare MO, Adesuyi EO, Arowosegbe TM, Ndikom CM, Adejumo PO, Alexis O. Psychoeducation for psychological issues and birth preparedness in low- and middle-income countries: a systematic review. AJOG GLOBAL REPORTS 2022; 2:100072. [PMID: 36276790 PMCID: PMC9563193 DOI: 10.1016/j.xagr.2022.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Psychological issues usually accompany the pregnancy of first-time mothers, and psychoeducational interventions might be effective in addressing these concerns and preparing first-time mothers for childbirth and the postnatal period. OBJECTIVE This study aimed to identify, analyze, and synthesize the components and determine the effectiveness of psychoeducational interventions that are used for managing psychological issues and enhancing birth preparedness among primigravid women or couples in low- and middle-income countries. STUDY DESIGN A systematic search of 12 databases (APA PsycINFO, EmCare, Embase, MEDLINE(R), Ovid Nursing, British Nursing Index, Health & Medical Collection, ProQuest, CINAHL, Cochrane, Hinari, and PubMed) was conducted to identify relevant studies published between 1946 and October 2021. The quality of the included studies was appraised by the Joanna and Briggs Institute critical appraisal tool, and a narrative synthesis was performed to analyze data extracted from included articles. The systematic review protocol is registered with the International Prospective Register of Systematic Reviews (registration number: CRD42021237896). RESULTS The initial search yielded 8658 articles. Of note, 16 articles, including 7 randomized controlled trials and 9 nonrandomized trials, met the inclusion criteria and were selected and reviewed for quality. In addition, 31 outcomes were measured in the studies, including psychological outcomes, birth preparedness outcomes, and other outcomes. The design of the interventions included antenatal education that was delivered through lectures, role plays, trainings, and antenatal counseling. All the psychoeducational interventions had a significant effect (P<.05; Cohen's d or Hedges' g=0.2-1.9) on certain psychological outcomes, including childbirth attitude, fear of childbirth, depression, fear, and anxiety, and birth preparedness outcomes. CONCLUSION Although first-time mothers experience a range of psychological issues during pregnancy, psychoeducational interventions were beneficial in addressing their psychological concerns. It would seem that these interventions are less expensive and could be easily implemented in low- and middle-income countries. However, rigorous research, such as randomized controlled trials, is hereby warranted to standardize the interventions and outcome assessment tools.
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Affiliation(s)
- Yetunde Oluwafunmilayo Tola
- Institute of Nursing Research, Nigeria, Osogbo, Osun State, Nigeria (Dr Tola,Mr Akingbade, Mr Adesuyi and Mrs Arowosegbe)
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China (Dr Tola and Mr Akingbade)
| | - Oluwadamilare Akingbade
- Institute of Nursing Research, Nigeria, Osogbo, Osun State, Nigeria (Dr Tola,Mr Akingbade, Mr Adesuyi and Mrs Arowosegbe)
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China (Dr Tola and Mr Akingbade)
| | | | - Emmanuel Olumide Adesuyi
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China (Dr Tola and Mr Akingbade)
- School of Nursing and Midwifery, Birmingham City University, Birmingham, United Kingdom (Mr Adesuyi)
| | - Tomiike Mabel Arowosegbe
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China (Dr Tola and Mr Akingbade)
- Afe Bablola Multi-System Hospital, Ado-Ekiti, Ekiti State, Nigeria (Mrs Arowosegbe)
| | - Chizoma Millicent Ndikom
- Department of Nursing, University of Ibadan, Oyo State, Nigeria (Ms Drs Akinwaare, Dr Ndikom and Prof. Adejumo)
| | - Prisca Olabisi Adejumo
- Department of Nursing, University of Ibadan, Oyo State, Nigeria (Ms Drs Akinwaare, Dr Ndikom and Prof. Adejumo)
| | - Obrey Alexis
- Oxford Brookes University, Oxford, United Kingdom (Dr Alexis)
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Neo HS, Tan JH, Ang WHD, Lau Y. Internet-delivered psychological interventions for reducing depressive, anxiety symptoms and fear of childbirth in pregnant women: A meta-analysis and meta-regression. J Psychosom Res 2022; 157:110790. [PMID: 35367919 DOI: 10.1016/j.jpsychores.2022.110790] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The current review aims to (1) investigate the effectiveness of Internet-based psychological intervention in reducing depressive, anxiety, and stress symptoms and fear of childbirth among pregnant women at post-intervention and follow-up; (2) compare the effects of the intervention using different psychological principles; and (3) explore potential covariates on the intervention effect. METHODS A literature search of seven databases was carried out to identify published and unpublished randomized controlled trials (RCTs) in English without any time limitation up to February 2021. Meta-analysis and meta-regression were conducted using Comprehensive Meta-analysis software. This review protocol was registered on PROSPERO (CRD42021235565). RESULTS Sixteen RCTs involving 3894 pregnant women were included from more than 23 countries. Internet-delivered psychological interventions were found to significantly (p < 0.05) reduce depressive (g = -0.16 to -0.32) and anxiety (g = -0.22 to -0.33) symptoms with small effect sizes at post-intervention and follow-up during 6 to 8 weeks postpartum compared with those in the comparator group. However, there was insufficient evidence for fear of childbirth and stress symptoms. Our subgroup analyses found that psychological interventions adopting component of cognitive behavioral therapy (g = -0.29) or mindfulness therapy (g = -0.62) showed beneficial effects to improve depressive symptoms among pregnant women. Univariate random-effect regression analyses showed that the attrition rate was a significant covariate (Z = -2.33, p = 0.02) on depressive symptoms. The certainty of main outcomes was graded from low to very low in accordance with the GRADE criteria. CONCLUSIONS Our reviews suggested that Internet-delivered psychological intervention may complement usual antenatal care in the improvement of depressive and anxiety symptoms. Future trials involving a large-scale sample are needed to improve the methodological quality.
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Affiliation(s)
- Hwee Shuen Neo
- Department of Nursing, KK Women and Children's Hospital, Singapore
| | - Jung Howe Tan
- Department of Nursing, KK Women and Children's Hospital, Singapore
| | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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The Impact of Maternal Prenatal Stress Related to the COVID-19 Pandemic during the First 1000 Days: A Historical Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084710. [PMID: 35457577 PMCID: PMC9029063 DOI: 10.3390/ijerph19084710] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic has a major impact on society, particularly affecting its vulnerable members, including pregnant women and their unborn children. Pregnant mothers reported fear of infection, fear of vertical transmission, fear of poor birth and child outcomes, social isolation, uncertainty about their partner's presence during medical appointments and delivery, increased domestic abuse, and other collateral damage, including vaccine hesitancy. Accordingly, pregnant women's known vulnerability for mental health problems has become a concern during the COVID-19 pandemic, also because of the known effects of prenatal stress for the unborn child. The current narrative review provides a historical overview of transgenerational effects of exposure to disasters during pregnancy, and the role of maternal prenatal stress. We place these effects into the perspective of the COVID-19 pandemic. Hereby, we aim to draw attention to the psychological impact of the COVID-19 pandemic on women of reproductive age (15-49 year) and its potential associated short-term and long-term consequences for the health of children who are conceived, carried, and born during this pandemic. Timely detection and intervention during the first 1000 days is essential to reduce the burden of transgenerational effects of the COVID-19 pandemic.
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van den Heuvel MI, Vacaru SV, Boekhorst MGBM, Cloin M, van Bakel H, Riem MME, de Weerth C, Beijers R. Parents of young infants report poor mental health and more insensitive parenting during the first Covid-19 lockdown. BMC Pregnancy Childbirth 2022; 22:302. [PMID: 35397538 PMCID: PMC8994419 DOI: 10.1186/s12884-022-04618-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/16/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The Covid-19 pandemic has put an unprecedented pressure on families with children. How parents were affected by the first Covid-19 lockdown during the early postpartum period, an already challenging period for many, is unknown. AIM To investigate the associations between Covid-19 related stress, mental health, and insensitive parenting practices in mothers and fathers with young infants during the first Dutch Covid-19 lockdown. METHODS The Dutch Covid-19 and Perinatal Experiences (COPE-NL) study included 681 parents of infants between 0 and 6 months (572 mothers and 109 fathers). Parents filled out online questionnaires about Covid-19 related stress, mental health (i.e. anxiety and depressive symptoms), and insensitive parenting. Hierarchical regression models were used to analyze the data. RESULTS Parents of a young infant reported high rates of Covid-19 related stress, with higher reported stress in mothers compared to fathers. Additionally, the percentages of mothers and fathers experiencing clinically meaningful mental health symptoms during the pandemic were relatively high (mothers: 39.7% anxiety, 14.5% depression; fathers: 37.6% anxiety, 6.4% depression). More Covid-19 related stress was associated with more mental health symptoms in parents and increased insensitive parenting practices in mothers. CONCLUSIONS The results emphasize the strain of the pandemic on young fathers' and mothers' mental health and its potential negative consequences for parenting. As poor parental mental health and insensitive parenting practices carry risk for worse child outcomes across the lifespan, the mental health burden of the Covid-19 pandemic might not only have affected the parents, but also the next generation.
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Affiliation(s)
| | - Stefania V Vacaru
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Myrthe G B M Boekhorst
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | | | | | - Madelon M E Riem
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
- Clinical Child & Family Studies, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Carolina de Weerth
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Roseriet Beijers
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands.
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Lau Y, Yen KY, Wong SH, Cheng JY, Cheng LJ. Effect of digital cognitive behavioral therapy on psychological symptoms among perinatal women in high income-countries: A systematic review and meta-regression. J Psychiatr Res 2022; 146:234-248. [PMID: 34774299 DOI: 10.1016/j.jpsychires.2021.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/11/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
Several reviews focused on the use of digital cognitive behavioral therapy (CBT) across different populations. This review synthesized randomized controlled trials (RCTs) that evaluated the effectiveness of digital CBT on psychological symptoms (depression, anxiety, and stress symptoms). An extensive search was conducted in 10 databases from inception until August 29, 2021. A meta-analysis using a random-effects model was performed using Hedges' g. The potential sources of heterogeneity were explored through subgroup analyses and meta-regression analysis. A total of 18 RCTs in 2514 perinatal women were identified from over 23 countries. The sample size ranged from 25 to 910. Meta-analyses showed that digital CBT significantly reduced depression (g = -0.56, 95% CI: -0.85, -0.27, I2 = 84.81%, p < 0.001), anxiety (g = -0.30, 95% CI: -0.44, -0.17, I2 = 0%, p < 0.001), and stress (g = -0.75, 95% CI: -0.95, -0.56, I2 = 0%, p < 0.001) symptoms at post-intervention and stress symptoms at follow-up (g = -0.52, 95% CI: -0.93, -0.11, I2 = 0%, p = 0.01) compared with those in the control group. Subgroup analyses highlighted that the intervention was effective when CBT was combined with other therapeutic components which delivered via a mobile application. Preferable features of intervention should be more than eight sessions and conducted for than 6 weeks among postnatal women. Multivariable meta-regression showed that age was a significant covariate on depression symptoms. The sample size in the selected RCTs was small, and the overall quality of the evidence was very low. Digital CBT is a potential intervention for alleviating psychological outcomes in perinatal women. This review suggests the essential features to optimize the intervention effect. Further well-designed RCTs with large sample sizes are necessary.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Kai Yoong Yen
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Sai Ho Wong
- Alexandra Hospital, National University Health System, Singapore.
| | - Jing Ying Cheng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Mannocci A, Ciavardini S, Mattioli F, Massimi A, D’Egidio V, Lia L, Scaglietta F, Giannini A, Antico R, Dorelli B, Svelato A, Orfeo L, Benedetti Panici P, Ragusa A, La Torre G, Group HAPPYMAMA. HAPPY MAMA Project (Part 2)-Maternal Distress and Self-Efficacy: A Pilot Randomized Controlled Field Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1461. [PMID: 35162482 PMCID: PMC8835492 DOI: 10.3390/ijerph19031461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION The aim of the pilot randomized controlled field trial is to assess if a midwifery intervention is able to increase the maternal self-efficacy and reduce the stress level during the first six months after birth. METHODS The study was conducted in two different hospitals in Rome, Italy, involving women delivering at or beyond term, aged >18 years old and with normal APGAR scores of the infant. The participants were randomly divided into two groups: "Individual Intervention Group" (they received home midwifery assistance for one month after birth, I) and the "Control Group" (C). A self-administered questionnaire was administered four times: at the baseline about one week after the hospital delivery (T0), after the intervention about one month after the delivery (T1), and at three months (T2) and at six months after birth (T3). The questionnaire included different validated scales needed to assess maternal perceived self-efficacy (KPCS), parental stress scale stress (PSS) and maternal depressive risk symptoms (EPDS). RESULTS The study population counted 51 mothers: 28 women in the "C" group and 23 women in the "I" group. The PSS score was statistically higher in the "C" than "I" group at T1 (p = 0.024); whereas the KPCS score was statistically higher in the "I" (p = 0.039) group; EPDS score did not show significant difference between the two groups in the follow-up period. An inverse significant correlation between KPCS and PSS was found during the study window time (p < 0.0001). CONCLUSIONS These results potentially give the opportunity to explore this area of focus further, in order to better address maternal individual needs for the successful transition to motherhood. More research in this area is required.
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Affiliation(s)
- Alice Mannocci
- Faculty of Economics, Mercatorum University, 00186 Rome, Italy
| | - Sara Ciavardini
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy; (S.C.); (F.M.); (A.M.); (V.D.); (L.L.); (F.S.); (R.A.); (B.D.); (G.L.T.); (H.M.G.)
| | - Federica Mattioli
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy; (S.C.); (F.M.); (A.M.); (V.D.); (L.L.); (F.S.); (R.A.); (B.D.); (G.L.T.); (H.M.G.)
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy; (S.C.); (F.M.); (A.M.); (V.D.); (L.L.); (F.S.); (R.A.); (B.D.); (G.L.T.); (H.M.G.)
| | - Valeria D’Egidio
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy; (S.C.); (F.M.); (A.M.); (V.D.); (L.L.); (F.S.); (R.A.); (B.D.); (G.L.T.); (H.M.G.)
| | - Lorenza Lia
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy; (S.C.); (F.M.); (A.M.); (V.D.); (L.L.); (F.S.); (R.A.); (B.D.); (G.L.T.); (H.M.G.)
| | - Franca Scaglietta
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy; (S.C.); (F.M.); (A.M.); (V.D.); (L.L.); (F.S.); (R.A.); (B.D.); (G.L.T.); (H.M.G.)
| | - Andrea Giannini
- Department of Maternal and Child Health and Urological Sciences, Umberto I Teaching Hospital, Sapienza University, 00185 Rome, Italy; (A.G.); (P.B.P.)
| | - Roberta Antico
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy; (S.C.); (F.M.); (A.M.); (V.D.); (L.L.); (F.S.); (R.A.); (B.D.); (G.L.T.); (H.M.G.)
- Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli Hospital, 00186 Rome, Italy; (A.S.); (A.R.)
| | - Barbara Dorelli
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy; (S.C.); (F.M.); (A.M.); (V.D.); (L.L.); (F.S.); (R.A.); (B.D.); (G.L.T.); (H.M.G.)
| | - Alessandro Svelato
- Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli Hospital, 00186 Rome, Italy; (A.S.); (A.R.)
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, “San Giovanni Calibita” Fatebenefratelli, 00186 Rome, Italy;
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Umberto I Teaching Hospital, Sapienza University, 00185 Rome, Italy; (A.G.); (P.B.P.)
| | - Antonio Ragusa
- Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli Hospital, 00186 Rome, Italy; (A.S.); (A.R.)
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy; (S.C.); (F.M.); (A.M.); (V.D.); (L.L.); (F.S.); (R.A.); (B.D.); (G.L.T.); (H.M.G.)
| | - HAPPY MAMA Group
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy; (S.C.); (F.M.); (A.M.); (V.D.); (L.L.); (F.S.); (R.A.); (B.D.); (G.L.T.); (H.M.G.)
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Rodrigues AL, Ericksen J, Watson B, Gemmill AW, Milgrom J. Interventions for Perinatal Depression and Anxiety in Fathers: A Mini-Review. Front Psychol 2022; 12:744921. [PMID: 35126228 PMCID: PMC8810528 DOI: 10.3389/fpsyg.2021.744921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives Up to 10% of fathers experience perinatal depression, often accompanied by anxiety, with a detrimental impact on the emotional and behavioural development of infants. Yet, few evidence-based interventions specifically for paternal perinatal depression or anxiety exist, and few depressed or anxious fathers engage with support. This mini-review aims to build on the evidence base set by other recent systematic reviews by synthesising more recently available studies on interventions for paternal perinatal depression and anxiety. Secondarily, we also aimed to identify useful information on key implementation strategies, if any, that increase the engagement of men. Methods We drew upon three major previous systematic reviews and performed an updated search of PubMed/Medline; Psycinfo; Cochrane Database; Embase and Cinahl. The search was limited to trials, feasibility studies or pilot studies of interventions published between 2015 and 2020 that reported on fathers' perinatal mental health. We included psychological, educational, psychosocial, paternal, couple-focused, or group therapies, delivered face-to-face, via telephone and/or online that reported on either paternal depression, anxiety or both. Results Eleven studies satisfied search criteria (5 of which were not included in previous reviews). The majority were randomised controlled trials. Most interventions incorporated counselling, therapy or psychoeducation and took an indirect approach to perinatal mental health through antenatal or postnatal education and were couple-focused. No studies reported a presence of diagnosed depression or anxiety at baseline, although five studies reported a positive effect on sub-threshold symptoms. Discussion There was some evidence that these approaches may be useful in the initial engagement of fathers with perinatal supports and improve depression and anxiety scores. No studies targeted the explicit treatment of clinically depressed or anxious men, and this remains the most substantial gap in the peer-reviewed evidence base. Our results highlight the need to deliver perinatal interventions specifically designed for men and evaluate them in populations with clinical levels of depressive and anxious symptomatology.
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Affiliation(s)
- Andre L. Rodrigues
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC, Australia
| | - Jennifer Ericksen
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC, Australia
| | - Brittany Watson
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC, Australia
| | - Alan W. Gemmill
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC, Australia
| | - Jeannette Milgrom
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC, Australia
- University of Melbourne School of Psychological Sciences, Parkville, VIC, Australia
- *Correspondence: Jeannette Milgrom
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Bellomo A, Severo M, Petito A, Nappi L, Iuso S, Altamura M, Marconcini A, Giannaccari E, Maruotti G, Palma GL, Vicino M, Perrone A, Tufariello AM, Sannicandro V, Milano E, Arcidiacono G, Di Salvatore M, Caroli A, Di Pinto I, Ventriglio A. Perinatal depression screening and prevention: Descriptive findings from a multicentric program in the South of Italy. Front Psychiatry 2022; 13:962948. [PMID: 35990082 PMCID: PMC9389401 DOI: 10.3389/fpsyt.2022.962948] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Perinatal depression (PD) is a cluster of clinical depressive symptoms occurring globally during pregnancy or after childbirth, with a prevalence of 11.9%. Risk factors for PD among pregnant women may include personality traits of neuroticism, low personal resilience, higher anxiety, avoidance in close relationships, as well as dysfunctional coping strategies. METHODS We report on descriptive findings of a screening/prevention program aimed to detect depressive symptoms and associated risk factors in a large sample of women (N = 1,664) accessing the gynecological departments of the Regione Puglia (South of Italy) from July to November 2020. Pregnant women were assessed in their third trimester of pregnancy (T0), after childbirth (T1), and those at risk for PD within 1 year from delivery (T2-T4); The Edinburgh Postnatal Depression Scale (EPDS) has been employed for the screening of PD over time as well as other standardized measures for neuroticism, resilience, coping strategies, and quality of life. RESULTS Of 1,664, n = 1,541 were tested at T1, and 131 scored ≥ 12 at EPDS (14.6 ± 2.95), showing a higher risk for PD. They were followed over time at 1, 6, and 12 months after childbirth (T2-T4), and 15 of them scored ≥ 12 (EPDS) at T4. Women with a higher risk of PD also reported higher levels of neuroticism, lower levels of personal resilience, more anxiety and avoidance in close relationships, higher employment of dysfunctional coping strategies (e.g., denial, self-blame, etc.), and lower quality of life (0.0008 < all p < 0.0001). CONCLUSION This study confirmed the benefit of screening programs for the early detection of PD among pregnant women. We may suggest a set of risk factors to be considered in the clinical assessment of PD risk as well as the promotion of similar programs to improve depressive outcomes and pathways to care for PD on the basis of a more accurate assessment and referral.
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Affiliation(s)
- Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Melania Severo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Annamaria Petito
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Salvatore Iuso
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | | | - Giuseppe Maruotti
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Mario Vicino
- Unit of Gynecology, Di Venere Hospital, Bari, Italy
| | | | - Anna Maria Tufariello
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Valeria Sannicandro
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Eleonora Milano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giulia Arcidiacono
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Melanie Di Salvatore
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | - Isabella Di Pinto
- Dipartimento Promozione Della Salute e del Benessere Animale, Regione Puglia, Bari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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30
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Kavanagh DJ, Connolly J, Fisher J, Halford WK, Hamilton K, Hides L, Milgrom J, Rowe H, Scuffham PA, White KM, Wittkowski A, Appleton S, Sanders D. The Baby Steps Web Program for the Well-Being of New Parents: Randomized Controlled Trial. J Med Internet Res 2021; 23:e23659. [PMID: 34842534 PMCID: PMC8665385 DOI: 10.2196/23659] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/25/2021] [Accepted: 08/02/2021] [Indexed: 01/20/2023] Open
Abstract
Background New parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents. Objective This study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information (Baby Care) and information plus an interactive program (Baby Steps Wellbeing) were compared from the third trimester baseline to 3 and 6 months subsequently. Methods The study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks’ gestation), using web-based registration. Most (337/388, 86.8%) were obtained from prenatal hospital classes. Couples’ randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50% couples scored high if either mother >7, father >5). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes; relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples. Results Selection criteria were met by 63.9% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6%), tertiary educated (324/496, 65.3%), employed full time (407/496, 82%), and born in Australia (337/496, 67.9%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9% (18/248) of men, and 16.1% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92% ≥50). Only 37.3% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6%) than fathers (52/248, 20.9%; P<.001). The EPDS, quality of life, and social support did not show differential improvements between programs, but Baby Steps Wellbeing gave a greater linear increase in self-efficacy for support provision (P=.01; Cohen d=0.26) and lower reduction in relationship satisfaction (P=.03; Cohen d=0.20) than Baby Care alone. Mothers had greater linear benefits in parenting self-efficacy over time than fathers after receiving Baby Steps Wellbeing rather than Baby Care (P=.01; Cohen d=0.51). However, the inclusion of program type in analyses on parenting self-efficacy and relationship satisfaction did not improve model fit above analyses with only parent gender and time. Conclusions Three secondary outcomes showed differential benefits from Baby Steps Wellbeing, but for one (parenting self-efficacy), the effect only occurred for mothers, perhaps reflecting their greater program use. Increased engagement will be needed for more definitive testing of the potential benefits of Baby StepsWellbeing for perinatal adjustment. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12614001256662; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367277
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Affiliation(s)
- David John Kavanagh
- Centre for Children's Health Research, Queensland University of Technology, South Brisbane Qld, Australia.,School of Psychology and Counselling, Queensland University of Technology, South Brisbane Qld, Australia
| | - Jennifer Connolly
- Centre for Children's Health Research, Queensland University of Technology, South Brisbane Qld, Australia.,School of Psychology and Counselling, Queensland University of Technology, South Brisbane Qld, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - W Kim Halford
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Leanne Hides
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Jeannette Milgrom
- Perinatal and Infant Research Institute, Austin Health, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Heather Rowe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Katherine M White
- School of Psychology and Counselling, Queensland University of Technology, South Brisbane Qld, Australia
| | - Anja Wittkowski
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Shelley Appleton
- Centre for Children's Health Research, Queensland University of Technology, South Brisbane Qld, Australia.,School of Psychology and Counselling, Queensland University of Technology, South Brisbane Qld, Australia
| | - Davina Sanders
- Centre for Children's Health Research, Queensland University of Technology, South Brisbane Qld, Australia.,School of Psychology and Counselling, Queensland University of Technology, South Brisbane Qld, Australia
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Wong J, Foussat AC, Ting S, Acerbi E, van Elburg RM, Mei Chien C. A Chatbot to Engage Parents of Preterm and Term Infants on Parental Stress, Parental Sleep, and Infant Feeding: Usability and Feasibility Study. JMIR Pediatr Parent 2021; 4:e30169. [PMID: 34544679 PMCID: PMC8579217 DOI: 10.2196/30169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/19/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Parents commonly experience anxiety, worry, and psychological distress in caring for newborn infants, particularly those born preterm. Web-based therapist services may offer greater accessibility and timely psychological support for parents but are nevertheless labor intensive due to their interactive nature. Chatbots that simulate humanlike conversations show promise for such interactive applications. OBJECTIVE The aim of this study is to explore the usability and feasibility of chatbot technology for gathering real-life conversation data on stress, sleep, and infant feeding from parents with newborn infants and to investigate differences between the experiences of parents with preterm and term infants. METHODS Parents aged ≥21 years with infants aged ≤6 months were enrolled from November 2018 to March 2019. Three chatbot scripts (stress, sleep, feeding) were developed to capture conversations with parents via their mobile devices. Parents completed a chatbot usability questionnaire upon study completion. Responses to closed-ended questions and manually coded open-ended responses were summarized descriptively. Open-ended responses were analyzed using the latent Dirichlet allocation method to uncover semantic topics. RESULTS Of 45 enrolled participants (20 preterm, 25 term), 26 completed the study. Parents rated the chatbot as "easy" to use (mean 4.08, SD 0.74; 1=very difficult, 5=very easy) and were "satisfied" (mean 3.81, SD 0.90; 1=very dissatisfied, 5 very satisfied). Of 45 enrolled parents, those with preterm infants reported emotional stress more frequently than did parents of term infants (33 vs 24 occasions). Parents generally reported satisfactory sleep quality. The preterm group reported feeding problems more frequently than did the term group (8 vs 2 occasions). In stress domain conversations, topics linked to "discomfort" and "tiredness" were more prevalent in preterm group conversations, whereas the topic of "positive feelings" occurred more frequently in the term group conversations. Interestingly, feeding-related topics dominated the content of sleep domain conversations, suggesting that frequent or irregular feeding may affect parents' ability to get adequate sleep or rest. CONCLUSIONS The chatbot was successfully used to collect real-time conversation data on stress, sleep, and infant feeding from a group of 45 parents. In their chatbot conversations, term group parents frequently expressed positive emotions, whereas preterm group parents frequently expressed physical discomfort and tiredness, as well as emotional stress. Overall, parents who completed the study gave positive feedback on their user experience with the chatbot as a tool to express their thoughts and concerns. TRIAL REGISTRATION ClinicalTrials.gov NCT03630679; https://clinicaltrials.gov/ct2/show/NCT03630679.
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Affiliation(s)
- Jill Wong
- Precision Nutrition D-lab, Danone Nutricia Research, Singapore, Singapore
| | - Agathe C Foussat
- Precision Nutrition D-lab, Danone Nutricia Research, Singapore, Singapore
| | - Steven Ting
- Precision Nutrition D-lab, Danone Nutricia Research, Singapore, Singapore.,Cytel Singapore Private Limited, Singapore, Singapore
| | - Enzo Acerbi
- Precision Nutrition D-lab, Danone Nutricia Research, Singapore, Singapore.,NLYTICS Pte. Ltd., Singapore, Singapore
| | - Ruurd M van Elburg
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands.,Nutrition4Health, Hilversum, Netherlands
| | - Chua Mei Chien
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Graduate School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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32
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Reid C, McKenzie JE, Brennan SE, Bennetts SK, Clark Y, Mensah F, Hokke S, Ralph N, Brown SJ, Gee G, Nicholson JM, Chamberlain C. Interventions during pregnancy or up to two years after birth for parents who are experiencing complex trauma or have experienced maltreatment in their childhood (or both) to improve parenting capacity or socio-emotional well-being. Hippokratia 2021. [DOI: 10.1002/14651858.cd014874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carol Reid
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Shannon K Bennetts
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- Murdoch Children's Research Institute; Parkville Australia
| | - Yvonne Clark
- South Australian Health and Medical Research Institute; Adelaide Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute; Parkville Australia
- Department of Paediatrics; University of Melbourne; Parkville Australia
| | - Stacey Hokke
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Naomi Ralph
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- Central Queensland University; Townsville Australia
| | - Stephanie J Brown
- Murdoch Children's Research Institute; Parkville Australia
- Department of Paediatrics; University of Melbourne; Parkville Australia
- South Australian Health and Medical Research Council; Adelaide Australia
| | - Graham Gee
- Murdoch Children's Research Institute; Parkville Australia
- Melbourne School of Psychological Sciences; University of Melbourne; Melbourne Australia
| | - Jan M Nicholson
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Catherine Chamberlain
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity; Murdoch University; Perth Australia
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Lau Y, Cheng JY, Wong SH, Yen KY, Cheng LJ. Effectiveness of digital psychotherapeutic intervention among perinatal women: A systematic review and meta-analysis of randomized controlled trials. World J Psychiatry 2021; 11:133-152. [PMID: 33889538 PMCID: PMC8040152 DOI: 10.5498/wjp.v11.i4.133] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/11/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The perinatal period is a challenging time of substantial emotional, physiological, social, and relational changes. Depression, anxiety, and stress symptoms are common, and co-exist in the perinatal period. Digital technology continues to grow at an unprecedented pace with wide application, including psychotherapeutic intervention. A growing number of meta-analyses supported the application of digital psychotherapeutic intervention across different populations, but relatively few meta- and meta-regression analyses have concentrated on perinatal women. AIM To evaluate the effectiveness of digital psychotherapeutic intervention on improving psychological outcomes among perinatal women and identify its essential features. METHODS Randomized controlled trials (RCTs) were obtained from eight databases, including Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, Scopus, PsycINFO, PubMed, Web of Science, and ProQuest Dissertation and Theses from inception up until November 24, 2020. Comprehensive Meta-analysis 3.0 software was used to conduct meta- and meta-regression analyses. The Cochrane risk-of-bias tool and the Grading of the Recommendation, Assessment, Development, and Evaluation system were adopted to assess the individual and overall qualities of the evidence, respectively. RESULTS A total of 25 RCTs that included 3239 women were identified. Meta-analyses revealed that intervention significantly improved depression (Hedges's g = 0.49), anxiety (g = 0.25), and stress (g = 0.47) symptoms compared to the control. Subgroup analyses demonstrated that a website platform with ≥ eight therapist-guided sessions using the theoretical principle of cognitive behavioral therapy was more effective than other treatments in improving depression symptoms in postnatal women. Meta-regression analyses observed that the age of perinatal women and the type of psychotherapy also had statistically significant effects on depression symptoms. Egger's regression asymmetry tests suggested that no publication biases occurred, but the overall quality of the evidence was very low. CONCLUSION This review suggests that digital psychotherapeutic intervention may be a potential solution to reduce psychological problems in perinatal women. Further high-quality RCTs with large sample sizes are needed.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Jing-Ying Cheng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Sai-Ho Wong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Kai-Yoong Yen
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Ling-Jie Cheng
- Nursing Research Unit, Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore 768828, Singapore
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