Lever Taylor Billie, Cavanagh Kate, Strauss Clara
Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom.
School of Psychology, University of Sussex, Brighton, United Kingdom.
PLoS One. 2016 May 16;11(5):e0155720. doi: 10.1371/journal.pone.0155720. eCollection 2016.
Perinatal mental health difficulties are associated with adverse consequences for parents and infants. However, the potential risks associated with the use of psychotropic medication for pregnant and breastfeeding women and the preferences expressed by women for non-pharmacological interventions mean it is important to ensure that effective psychological interventions are available. It has been argued that mindfulness-based interventions may offer a novel approach to treating perinatal mental health difficulties, but relatively little is known about their effectiveness with perinatal populations. This paper therefore presents a systematic review and meta-analysis of the effectiveness of mindfulness-based interventions for reducing depression, anxiety and stress and improving mindfulness skills in the perinatal period. A systematic review identified seventeen studies of mindfulness-based interventions in the perinatal period, including both controlled trials (n = 9) and pre-post uncontrolled studies (n = 8). Eight of these studies also included qualitative data. Hedge's g was used to assess uncontrolled and controlled effect sizes in separate meta-analyses, and a narrative synthesis of qualitative data was produced. Pre- to post-analyses showed significant reductions in depression, anxiety and stress and significant increases in mindfulness skills post intervention, each with small to medium effect sizes. Completion of the mindfulness-based interventions was reasonable with around three quarters of participants meeting study-defined criteria for engagement or completion where this was recorded. Qualitative data suggested that participants viewed mindfulness interventions positively. However, between-group analyses failed to find any significant post-intervention benefits for depression, anxiety or stress of mindfulness-based interventions in comparison to control conditions: effect sizes were negligible and it was conspicuous that intervention group participants did not appear to improve significantly more than controls in their mindfulness skills. The interventions offered often deviated from traditional mindfulness-based cognitive therapy or mindfulness-based stress reduction programmes, and there was also a tendency for studies to focus on healthy rather than clinical populations, and on antenatal rather than postnatal populations. It is argued that these and other limitations with the included studies and their interventions may have been partly responsible for the lack of significant between-group effects. The implications of the findings and recommendations for future research are discussed.
围产期心理健康问题会给父母和婴儿带来不良后果。然而，孕妇和哺乳期妇女使用精神药物存在潜在风险，且女性对非药物干预的偏好意味着确保有有效的心理干预措施至关重要。有人认为，基于正念的干预措施可能为治疗围产期心理健康问题提供一种新方法，但对于其在围产期人群中的有效性了解相对较少。因此，本文对基于正念的干预措施在围产期减轻抑郁、焦虑和压力以及提高正念技能的有效性进行了系统评价和荟萃分析。一项系统评价确定了17项围产期基于正念的干预措施研究，包括对照试验（n = 9）和前后无对照研究（n = 8）。其中8项研究还包括定性数据。在单独的荟萃分析中，使用赫奇斯g值来评估无对照和有对照的效应大小，并对定性数据进行了叙述性综合分析。干预前后分析显示，干预后抑郁、焦虑和压力显著降低，正念技能显著提高，每项的效应大小为小到中等。基于正念的干预措施的完成情况合理，约四分之三的参与者达到了研究定义的参与或完成标准（若有记录）。定性数据表明参与者对正念干预持积极看法。然而组间分析未能发现与对照条件相比，基于正念的干预措施在干预后对抑郁、焦虑或压力有任何显著益处：效应大小可忽略不计，且明显的是干预组参与者在正念技能方面似乎没有比对照组有更显著的改善。所提供的干预措施往往偏离了传统的基于正念的认知疗法或基于正念的减压计划，而且研究还倾向于关注健康人群而非临床人群，以及产前人群而非产后人群。有人认为，纳入研究及其干预措施存在的这些和其他局限性可能部分导致了组间效应不显著。本文讨论了研究结果的意义以及对未来研究的建议。
