Barlow J, Coren E
Health Services Research Unit, University of Oxford, Institute of Health Sciences, Old Road, Oxford, UK, OX3 7LF.
Cochrane Database Syst Rev. 2000(4):CD002020. doi: 10.1002/14651858.CD002020.
The prevalence of mental health problems in women is 1:3 and such problems tend to be persistent. There is evidence from a range of studies to suggest that a number of factors relating to maternal psychosocial health can have a significant effect on the mother-infant relationship, and that this can have consequences for the psychological health of the child. It is now thought that parenting programmes may have an important role to play in the improvement of maternal psychosocial health.
The objective of this review is to address whether group-based parenting programmes are effective in improving maternal psychosocial health including anxiety, depression and self-esteem.
A range of biomedical, social science, educational and general reference electronic databases were searched including MEDLINE, EMBASE CINAHL, PsychLIT, ERIC, ASSIA, Sociofile and the Social Science Citation Index. Other sources of information included the Cochrane Library (SPECTR, CENTRAL), and the National Research Register (NRR).
Only randomised controlled trials were included in which participants had been randomly allocated to an experimental and a control group, the latter being either a waiting-list, no-treatment or a placebo control group. Studies had to include at least one group-based parenting programme, and one standardised instrument measuring maternal psychosocial health.
A systematic critical appraisal of all included studies was undertaken using the Journal of the American Medical Association (JAMA) published criteria. The data were summarised using effect sizes but were not combined in a meta-analysis due to the small number of studies within each group and the presence of significant heterogeneity.
A total of 22 studies were included in the review but only 17 provided sufficient data to calculate effect sizes. These 17 studies reported on a total of 59 outcomes including depression, anxiety, stress, self-esteem, social competence, social support, guilt, mood, automatic thoughts, dyadic adjustment, psychiatric morbidity, irrationality, anger and aggression, mood, attitude, personality, and beliefs. Approximately 22% of the outcomes measured suggested significant differences favouring the intervention group. A further 40% showed differences favouring the intervention group but which failed to achieve conventional levels of statistical significance, in some cases due to the small numbers that were used. Approximately 38% of outcomes suggested no evidence of effectiveness.
REVIEWER'S CONCLUSIONS: It is suggested that parenting programmes can make a significant contribution to the improvement of psychosocial health in mothers. While the critical appraisal suggests some variability in the quality of the included studies, it is concluded that there is sufficient evidence to support their use with diverse groups of parents. However, it is also suggested that some caution should be exercised before the results are generalised to parents irrespective of the level of pathology present, and that further research is still required.
女性心理健康问题的患病率为1:3，且此类问题往往具有持续性。一系列研究的证据表明，许多与孕产妇心理社会健康相关的因素会对母婴关系产生重大影响，进而可能影响儿童的心理健康。目前认为，育儿项目可能在改善孕产妇心理社会健康方面发挥重要作用。
本综述的目的是探讨基于小组的育儿项目是否能有效改善孕产妇的心理社会健康，包括焦虑、抑郁和自尊。
检索了一系列生物医学、社会科学、教育和综合参考电子数据库，包括MEDLINE、EMBASE、CINAHL、PsychLIT、ERIC、ASSIA、Sociofile和社会科学引文索引。其他信息来源包括Cochrane图书馆（SPECTR、CENTRAL）和国家研究注册库（NRR）。
仅纳入随机对照试验，其中参与者被随机分配到实验组和对照组，后者为等待名单、无治疗或安慰剂对照组。研究必须包括至少一个基于小组的育儿项目，以及一种测量孕产妇心理社会健康的标准化工具。
使用美国医学会杂志（JAMA）发表的标准对所有纳入研究进行系统的批判性评价。数据采用效应量进行汇总，但由于每组研究数量较少且存在显著异质性，未进行荟萃分析。
本综述共纳入22项研究，但只有17项提供了足够的数据来计算效应量。这17项研究共报告了59项结果，包括抑郁、焦虑、压力、自尊、社交能力、社会支持、内疚、情绪、自动思维、二元调整、精神疾病发病率、非理性、愤怒和攻击性、情绪、态度、个性和信念。约22%的测量结果显示干预组有显著差异。另有40%的结果显示干预组有差异，但未达到传统的统计学显著性水平，在某些情况下是由于样本量较小。约38%的结果表明没有有效性证据。
建议育儿项目可为改善母亲的心理社会健康做出重大贡献。虽然批判性评价表明纳入研究的质量存在一定差异，但得出的结论是，有足够的证据支持在不同的父母群体中使用这些项目。然而，也建议在将结果推广到任何病理水平的父母之前应谨慎行事，并且仍需要进一步的研究。
