Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa.
Peninsula Technology Assessment Group, University of Exeter, Exeter, UK.
Reprod Health. 2020 May 14;17(1):65. doi: 10.1186/s12978-020-00913-y.
Pregnancy and parenthood are known to be high-risk times for mental health. However, less is known about the mental health of pregnant adolescents or adolescent parents. Despite the substantial literature on the risks associated with adolescent pregnancy, there is limited evidence on best practices for preventing poor mental health in this vulnerable group. This systematic review therefore aimed to identify whether psychosocial interventions can effectively promote positive mental health and prevent mental health conditions in pregnant and parenting adolescents.
We used the standardized systematic review methodology based on the process outlined in the World Health Organization's Handbook for Guidelines Development. This review focused on randomized controlled trials of preventive psychosocial interventions to promote the mental health of pregnant and parenting adolescents, as compared to treatment as usual. We searched PubMed/Medline, PsycINFO, ERIC, EMBASE and ASSIA databases, as well as reference lists of relevant articles, grey literature, and consultation with experts in the field. GRADE was used to assess the quality of evidence.
We included 17 eligible studies (n = 3245 participants). Interventions had small to moderate, beneficial effects on positive mental health (SMD = 0.35, very low quality evidence), and moderate beneficial effects on school attendance (SMD = 0.64, high quality evidence). There was limited evidence for the effectiveness of psychosocial interventions on mental health disorders including depression and anxiety, substance use, risky sexual and reproductive health behaviors, adherence to antenatal and postnatal care, and parenting skills. There were no available data for outcomes on self-harm and suicide; aggressive, disruptive, and oppositional behaviors; or exposure to intimate partner violence. Only two studies included adolescent fathers. No studies were based in low- or middle-income countries.
Despite the encouraging findings in terms of effects on positive mental health and school attendance outcomes, there is a critical evidence gap related to the effectiveness of psychosocial interventions for improving mental health, preventing disorders, self-harm, and other risk behaviors among pregnant and parenting adolescents. There is an urgent need to adapt and design new psychosocial interventions that can be pilot-tested and scaled with pregnant adolescents and adolescent parents and their extended networks, particularly in low-income settings.
怀孕和为人父母被认为是心理健康的高危时期。然而，人们对怀孕青少年或青少年父母的心理健康了解较少。尽管有大量关于青少年怀孕相关风险的文献，但关于在这一弱势群体中预防心理健康不良的最佳实践方法的证据有限。因此，本系统评价旨在确定心理社会干预是否能有效促进怀孕和为人父母的青少年的心理健康，并预防其心理健康问题。
我们使用基于世界卫生组织指南制定手册中概述的标准化系统评价方法。本评价侧重于比较常规治疗的情况下，预防心理社会干预对促进怀孕和为人父母的青少年心理健康的随机对照试验。我们检索了 PubMed/Medline、PsycINFO、ERIC、EMBASE 和 ASSIA 数据库，以及相关文章的参考文献列表、灰色文献，并咨询了该领域的专家。使用 GRADE 评估证据质量。
我们纳入了 17 项符合条件的研究（n=3245 名参与者）。干预措施对积极心理健康（SMD=0.35，极低质量证据）和上学出勤率（SMD=0.64，高质量证据）有小到中度的有益影响。心理社会干预对抑郁和焦虑、物质使用、危险的性和生殖健康行为、产前和产后护理的依从性以及育儿技能等心理健康障碍的有效性的证据有限。没有关于自残和自杀、攻击、破坏和对立行为或亲密伴侣暴力暴露的结果的可用数据。只有两项研究纳入了青少年父亲。没有研究基于低收入或中等收入国家。
尽管在积极心理健康和上学出勤率结果方面的效果令人鼓舞，但在心理社会干预对改善怀孕和为人父母的青少年的心理健康、预防障碍、自残和其他风险行为的有效性方面，存在着至关重要的证据差距。迫切需要适应和设计新的心理社会干预措施，可以对怀孕青少年和青少年父母及其扩展网络进行试点测试和推广，特别是在低收入环境中。
