Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB, Canada.
Depress Anxiety. 2017 Oct;34(10):928-966. doi: 10.1002/da.22687. Epub 2017 Sep 29.
Antenatal and postpartum depression are very common and have significant consequences for mothers and their children. This review examines which antenatal depression (AD) and postpartum depression (PPD) treatment interventions are most efficacious in improving parenting and/or child development. CINAHL, Scopus, Cochrane Systematic Reviews, Cochrane Controlled Trials, Medline (OVID), Embase (OVID), PsychINFO, PsycARTICLES, AMED, and reference lists were searched. Randomized controlled trials (RCTs) and quasi-experimental studies assessing the effect of AD, PPD, or both treatment interventions on parenting and/or child development were included. Meta-analysis was conducted using random effects when possible. Thirty-six trials (within 40 articles) met criteria for review. Interventions include interpersonal psychotherapy (IPT), cognitive behavioural therapy (CBT), peer support, maternal-child interaction guidance, and other interventions, such as massage. For AD, IPT, CBT, and massage produced large effects on parenting (e.g. adjustment and attention toward infant) and child development (e.g. behaviour). For PPD, maternal-child interaction guidance and psychotherapeutic group support produced large effects on parenting (e.g. sense of competence) and child development (e.g. cortisol). However, meta-analysis revealed nonsignificant effects of IPT on maternal-child attachment and CBT on parenting stress. Promising findings exist for IPT, CBT, maternal-child interaction guidance, massage, and psychotherapeutic group support for specific parenting and/or child development outcomes. Additional RCTs using measures already employed in the literature are required to conduct necessary meta-analysis and fully elucidate treatment effects.
产前和产后抑郁症非常常见,对母亲及其子女有重大影响。本综述考察了哪些产前抑郁症 (AD) 和产后抑郁症 (PPD) 治疗干预措施在改善育儿和/或儿童发育方面最有效。检索了 CINAHL、Scopus、Cochrane 系统评价、Cochrane 对照试验、Medline (OVID)、Embase (OVID)、PsychINFO、PsycARTICLES、AMED 和参考文献列表。纳入了评估 AD、PPD 或两者治疗干预对育儿和/或儿童发育影响的随机对照试验 (RCT) 和准实验研究。当可能时,使用随机效应进行荟萃分析。有 36 项试验 (40 篇文章内) 符合审查标准。干预措施包括人际心理治疗 (IPT)、认知行为疗法 (CBT)、同伴支持、母婴互动指导和其他干预措施,如按摩。对于 AD,IPT、CBT 和按摩对育儿 (例如对婴儿的调整和关注) 和儿童发育 (例如行为) 产生了很大的影响。对于 PPD,母婴互动指导和心理治疗团体支持对育儿 (例如胜任感) 和儿童发育 (例如皮质醇) 产生了很大的影响。然而,荟萃分析显示 IPT 对母婴依恋和 CBT 对育儿压力没有显著影响。IPT、CBT、母婴互动指导、按摩和心理治疗团体支持在特定的育儿和/或儿童发育结果方面有有希望的发现。需要更多的 RCT 来使用文献中已经使用的措施进行必要的荟萃分析,并充分阐明治疗效果。