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Effectiveness of psychotherapeutic interventions on psychological distress in women who have experienced perinatal loss: a systematic review protocol.

ABSTRACT: BACKGROUND:Perinatal loss is a traumatic and complex experience that contributes to negative maternal psychological states and adverse outcomes impacting fetal development, maternal-fetal/infant bonding, marital/partner relationships, and child cognitive, emotional, and behavioral development. These outcomes present preventable disease burden and financial liability to individuals, families, and the healthcare system. Psychological interventions have the potential to improve outcomes for women and their families after perinatal loss. A few studies have explored the effectiveness of individual psychotherapeutic interventions in reducing maternal psychological distress after perinatal loss; however, a systematic review to compare these interventions has not been conducted. The primary objective of this systematic review is to determine the effectiveness of psychotherapeutic intervention on psychological distress and perception, coping, and adjustment in women who have experienced perinatal loss. The secondary objective of this review is to examine the content and delivery methods of effective psychotherapeutic interventions. METHODS:We endeavor to search electronic databases (PsycINFO, MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, CINAHL, Social Work Abstracts, Family and Society Studies Worldwide, Family Studies Abstracts, Academic Search Premier), gray literature databases (Proquest Dissertation and Theses Global, Web of Science Conference Proceedings Citation Index, OAIster, Open-Grey, Canadian Electronic Library, Canadian Research Index), and relevant organizational websites and conduct forward and backward citation searches of included studies. Inclusion criteria will consider studies that (1) are randomized controlled trials (RCTs), quasi-experimental (e.g., before-after design), and observational (prospective cohort); (2) include women affected by perinatal loss accessing psychotherapeutic intervention or support; and (3) evaluate a mental health or related outcome. Two authors will independently screen all citations, full-text articles, and abstract data. The study methodological quality (or bias) will be appraised using an appropriate tool. The primary outcome(s) will be measurements on the severity of depressive, anxiety, grief, and post-traumatic stress symptoms. Secondary outcomes will include measurements on difficulties in perception, coping, social, or dyadic adjustment. Conducting a narrative synthesis will identify relationships within study findings, and if appropriate, a random effects meta-analysis will be performed. DISCUSSION:This systematic review will summarize the effectiveness of psychological interventions, including their content and delivery method, in reducing psychological distress and improving outcomes for women affected by perinatal loss. The evidence generated from this review can inform researchers and policymakers in expanding on related research and developing customized interventions or programs. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42019126456.

SUBMITTER: Charrois EM

PROVIDER: S-EPMC7268676 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Effectiveness of psychotherapeutic interventions on psychological distress in women who have experienced perinatal loss: a systematic review protocol.

Charrois Elyse M EM Bright Katherine S KS Wajid Abdul A Mughal Muhammad Kashif MK Hayden K Alix KA Kingston Dawn D

Systematic reviews 20200602 1

<h4>Background</h4>Perinatal loss is a traumatic and complex experience that contributes to negative maternal psychological states and adverse outcomes impacting fetal development, maternal-fetal/infant bonding, marital/partner relationships, and child cognitive, emotional, and behavioral development. These outcomes present preventable disease burden and financial liability to individuals, families, and the healthcare system. Psychological interventions have the potential to improve outcomes for ...[more]

PMID: 32487235

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Project description:BACKGROUND:Interpersonal psychotherapy (IPT) is a psychological intervention with established efficacy in the prevention and treatment of depressive disorders. Previous systematic reviews have not evaluated the effectiveness of IPT on symptoms of stress, anxiety, depression, quality of life, relationship satisfaction/quality, social supports, and an improved psychological sense of wellbeing. There is limited information regarding moderating and mediating factors that impact the effectiveness of IPT such as the timing of the intervention or the mode of delivery of IPT intervention. The overall objective of this systematic review was to evaluate the effectiveness of IPT interventions to treat perinatal (from pregnancy up to 12 months postpartum) psychological distress. METHODS:MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials (OVID), CINAHL with Full Text (Ebsco), Social Work Abstracts (Ebsco), SocINDEX with Full Text (Ebsco), Academic Search Complete (Ebsco), Family & Society Studies Worldwide (Ebsco), Family Studies Abstracts (Ebsco), and Scopus databases were searched from inception until 31 January 2019. Two researchers independently screened articles for eligibility. Of the 685 screened articles, 43 met the inclusion criteria. The search was re-run on 11 May 2020. An additional 204 articles were screened and two met the inclusion criteria, resulting in a total of 45 studies included in this review. There were 25 Randomized Controlled Trials, 10 Quasi-experimental studies, eight Open Trials, and two Single Case Studies. All included studies were critically appraised for quality. RESULTS:In most studies (n = 24, 53%), the IPT intervention was delivered individually; in 17 (38%) studies IPT was delivered in a group setting and two (4%) studies delivered the intervention as a combination of group and individual IPT. Most interventions were initiated during pregnancy (n = 27, 60%), with the remaining 18 (40%) studies initiating interventions during the postpartum period. LIMITATIONS:This review included only English-language articles and peer-reviewed literature. It excluded government reports, dissertations, conference papers, and reviews. This limited the access to grassroots or community-based recruitment and retention strategies that may have been used to target smaller or marginalized groups of perinatal women. CONCLUSIONS:IPT is an effective intervention for the prevention and treatment of psychological distress in women during their pregnancy and postpartum period. As a treatment intervention, IPT is effective in significantly reducing symptoms of depression and anxiety as well as improving social support, relationship quality/satisfaction, and adjustment. Systematic Review Registration: PROSPERO CRD42019114292.

Project description:BackgroundThere is sufficient meta-analytic evidence that antenatal interventions for women at risk (selective prevention) or for women with severe psychological symptoms (indicated prevention) are effective in reducing postpartum distress. However, women without risk or severe psychological symptoms might also experience distress. This meta-analysis focused on the effectiveness of preventive psychological interventions offered to universal populations of pregnant women on symptoms of depression, anxiety, and general stress. Paternal and infant outcomes were also included.MethodWe included 12 universal prevention studies in the meta-analysis, incorporating a total of 2559 pregnant women.ResultsOverall, ten studies included depression as an outcome measure, five studies included stress, and four studies anxiety. There was a moderate effect of preventive interventions implemented during pregnancy on the combined measure of maternal distress (d = .52), on depressive symptoms (d = .50), and on stress (d = .52). The effect on anxiety (d = .30) was smaller. The effects were not associated with intervention timing, intervention type, intervention delivery mode, timing of post-test, and methodological quality. The number of studies including partner and/or infant outcomes was too low to assess their effectiveness.ConclusionsThis meta-analysis suggests that universal prevention during pregnancy is effective on decreasing symptoms of maternal distress compared to routine care, at least with regard to depression. While promising, the results with regard to anxiety and stress are based on a considerably lower number of studies, and should thus be interpreted with caution. More research is needed on preventing other types of maternal distress beyond depression. Furthermore, there is a lack of research with regard to paternal distress. Also, given the large variety in interventions, more research is needed on which elements of universal prevention work. Finally, as maternal distress symptoms can affect infant development, it is important to investigate whether the positive effects of the preventive interventions extend from mother to infant.Systematic review registration numberInternational prospective register of systematic reviews (PROSPERO) registration number: CRD42018098861.

Project description:IntroductionWomen who are migrants and who are pregnant or postpartum are at high risk of poorer perinatal outcomes compared with host country populations due to experiencing numerous additional stressors including social exclusion and language barriers. High-income countries (HICs) host many migrants, including forced migrants who may face additional challenges in the peripartum period. Although HICs' maternity care systems are often well developed, they are not routinely tailored to the needs of migrant women. The primary objective will be to determine what interventions exist to improve perinatal outcomes for migrant women in HICs. The secondary objective will be to explore the effectiveness of these interventions by exploring the impact on perinatal outcomes. The main outcomes of interest will be rates of preterm birth, birth weight, and number of antenatal or postnatal appointments attended.Methods and analysisThis protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols guidelines. EMBASE, EMCARE, MEDLINE and PsycINFO, CENTRAL, Scopus, CINAHL Plus, and Web of Science, as well as grey literature sources will be searched from inception up to December 2022. We will include randomised controlled trials, quasi-experimental and interventional studies of interventions, which aim to improve perinatal outcomes in any HIC. There will be no language restrictions. We will exclude studies presenting only qualitative outcomes and those including mixed populations of migrant and non-migrant women. Screening and data extraction will be completed by two independent reviewers and risk of bias will be assessed using the Quality Assessment Tool for Quantitative Studies. If a collection of suitably comparable outcomes is retrieved, we will perform meta-analysis applying a random effects model. Presentation of results will comply with guidelines in the Cochrane Handbook of Systematic Reviews of Interventions and the PRISMA statement.Ethics and disseminationEthical approval is not required. Results will be submitted for peer-reviewed publication and presented at national and international conferences. The findings will inform the work of the Lancet Migration European Hub.Prospero registration numberCRD42022380678.

Project description:ObjectiveAs patients and family caregivers are increasingly viewed as a dyadic whole, growing studies have emerged that identify ways to improve the two parties' emotional distress. However, the specific effectiveness, quality, and optimal intervention details of these studies are unclear. Our objective is to synthesize the effectiveness of existing dyadic interventions for improving the psychological distress of cancer patient-caregiver dyads and identify potential moderators that influence intervention effectiveness.MethodsPubMed, Cochrane Library, Web of Science, CINHAL, Embase, and Clinical Trials were searched to identify all randomized controlled trials from inception until June 2021. Two reviewers performed the process independently. The Cochrane Risk of Bias tool was used for quality assessment. We calculated effect sizes (Hedges' adjusted g) by standard mean difference. Potential moderators influencing the intervention effects were explored.ResultsWe included 28 articles, of which 12 were available for meta-analysis. In total, 4784 participants were included, who were primarily middle-aged (M = 58 years old), with the highest proportion reporting a diagnosis of "mixed cancer" (30%). Patients' anxiety (g = -0.31; 95% CI: -0.51 to -0.12; P = 0.001; I 2 = 17%) and cancer-related distress (g = -0.32; 95% CI: -0.46 to -0.18; P < 0.0001; I 2 = 0%) were statistically significantly improved from baseline to post-intervention. Interventionist, delivery type, duration, and frequency were potential moderators for psychosocial interventions on negative emotions.ConclusionsFace-to-face, relatively shorter interventions led by psychologists in moderator analysis seem to have better performance. Cancer dyad-based interventions were efficacious in improving the emotional distress of both parties in the dyad, but the effect was more apparent in patients than in family caregivers. However, the long-term effects were modest for both groups.

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Effectiveness of psychotherapeutic interventions on psychological distress in women who have experienced perinatal loss: a systematic review protocol.

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Effectiveness of psychotherapeutic interventions on psychological distress in women who have experienced perinatal loss: a systematic review protocol.

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