Department of Psychosomatic Medicine, University of Leipzig, Leipzig, Germany.
Psychother Psychosom. 2013;82(6):372-81. doi: 10.1159/000348713. Epub 2013 Sep 20.
The loss of a child during pregnancy causes significant psychological distress for many women and their partners, and may lead to long-lasting psychiatric disorders. Internet-based interventions using exposure techniques and cognitive restructuring have proved effective for posttraumatic stress disorder (PTSD) and prolonged grief. This study compared the effects of an Internet-based intervention for parents after prenatal loss with a waiting list condition (WLC).
The Impact of Event Scale - Revised assessed symptoms of PTSD; the Inventory of Complicated Grief and the Brief Symptom Inventory assessed depression, anxiety, and general mental health. The 228 participants (92% female) were randomly allocated to a treatment group (TG; n = 115) or a WLC group (n = 113). The TG received a 5-week cognitive behavioral intervention including (1) self-confrontation, (2) cognitive restructuring, and (3) social sharing.
The TG showed significantly reduced symptoms of posttraumatic stress, prolonged grief, depression, and anxiety relative to the WLC control group. Intention-to-treat analysis revealed treatment effects of between d = 0.84 and d = 1.02 for posttraumatic stress and prolonged grief from pre- to posttreatment time points. Further significant improvement in all symptoms of PTSD and prolonged grief was found from the posttreatment evaluation to the 12-month follow-up. The attrition rate of 14% was relatively low.
The Internet-based intervention proved to be a feasible and cost-effective treatment, reducing symptoms of posttraumatic stress, grief, depression, anxiety, and general mental health after pregnancy loss. Low-threshold e-health interventions should be further evaluated and implemented routinely to improve psychological support after pregnancy loss.
妊娠期间失去孩子会给许多妇女及其伴侣带来严重的心理困扰，并可能导致长期的精神障碍。基于互联网的干预措施，使用暴露技术和认知重构，已被证明对创伤后应激障碍（PTSD）和延长的悲伤有效。本研究比较了基于互联网的产前损失后父母干预与等待名单条件（WLC）的效果。
修订后的事件影响量表（IES-R）评估 PTSD 症状；复杂悲伤清单和简明症状清单评估抑郁、焦虑和一般心理健康。228 名参与者（92%为女性）被随机分配到治疗组（TG；n=115）或 WLC 组（n=113）。TG 接受了为期 5 周的认知行为干预，包括（1）自我对抗，（2）认知重构，和（3）社会分享。
TG 组的创伤后应激、延长悲伤、抑郁和焦虑症状较 WLC 对照组显著减轻。意向治疗分析显示，从治疗前到治疗后时间点，创伤后应激和延长悲伤的治疗效果为 d=0.84 至 d=1.02。从治疗后评估到 12 个月随访，所有 PTSD 和延长悲伤症状均有显著改善。14%的退出率相对较低。
基于互联网的干预被证明是一种可行且具有成本效益的治疗方法，可减少妊娠后创伤后应激、悲伤、抑郁、焦虑和一般心理健康的症状。低门槛的电子健康干预措施应进一步评估并常规实施，以改善妊娠后心理支持。
