产后妇女创伤后应激障碍（PTSD）和创伤后应激症状的早期心理干预预防和治疗：系统评价和荟萃分析。
Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: A systematic review and meta-analysis.
机构信息
Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, Belfast, Northern Ireland, United Kingdom.
Southern Health and Social Care Trust, Craigavon, Northern Ireland, United Kingdom.
出版信息
PLoS One. 2021 Nov 24;16(11):e0258170. doi: 10.1371/journal.pone.0258170. eCollection 2021.
BACKGROUND
Pre-term or full-term childbirth can be experienced as physically or psychologically traumatic. Cumulative and trans-generational effects of traumatic stress on both psychological and physical health indicate the ethical requirement to investigate appropriate preventative treatment for stress symptoms in women following a routine traumatic experience such as childbirth.
OBJECTIVE
The objective of this review was to investigate the effectiveness of early psychological interventions in reducing or preventing post-traumatic stress symptoms and post-traumatic stress disorder in post-partum women within twelve weeks of a traumatic birth.
METHODS
Randomised controlled trials and pilot studies of psychological interventions preventing or reducing post-traumatic stress symptoms or PTSD, that included women who had experienced a traumatic birth, were identified in a search of Cochrane Central Register of Randomised Controlled Trials, MEDLINE, Embase, Psychinfo, PILOTS, CINAHL and Proquest Dissertations databases. One author performed database searches, verified results with a subject librarian, extracted study details and data. Five authors appraised extracted data and agreed upon risk of bias. Analysis was completed with Rev Man 5 software and quality of findings were rated according to Grading of Recommendation, Assessment, Development, and Evaluation.
RESULTS
Eleven studies were identified that evaluated the effectiveness of a range of early psychological interventions. There was firm evidence to suggest that midwifery or clinician led early psychological interventions administered within 72 hours following traumatic childbirth are more effective than usual care in reducing traumatic stress symptoms in women at 4-6 weeks. Further studies of high methodological quality that include longer follow up of 6-12 months are required in order to substantiate the evidence of the effectiveness of specific face to face and online early psychological intervention modalities in preventing the effects of stress symptoms and PTSD in women following a traumatic birth before introduction to routine care and practice.
PROSPERO REGISTRATION
CRD42020202576, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=202576.
背景
早产或足月分娩可能会对身体或心理造成创伤。创伤应激对心理和身体健康的累积和代际影响表明，有必要研究一种适当的预防治疗方法，以应对分娩等常规创伤经历后女性的应激症状。
目的
本综述旨在调查产后 12 周内经历创伤性分娩的女性中，早期心理干预对减轻或预防产后创伤后应激症状和创伤后应激障碍的有效性。
方法
通过对 Cochrane 中央随机对照试验注册库、MEDLINE、Embase、Psychinfo、PILOTS、CINAHL 和 Proquest Dissertations 数据库的搜索，确定了预防或减少创伤后应激症状或创伤后应激障碍的心理干预的随机对照试验和试点研究，这些研究纳入了经历过创伤性分娩的女性。一位作者进行了数据库搜索，与主题顾问验证了结果，提取了研究细节和数据。五位作者评估了提取的数据，并就偏倚风险达成一致。使用 RevMan 5 软件进行分析，并根据推荐、评估、制定和评估分级对研究结果的质量进行了评级。
结果
确定了 11 项研究，评估了一系列早期心理干预的有效性。有确凿证据表明，在创伤性分娩后 72 小时内，由助产士或临床医生主导的早期心理干预，比常规护理更能有效减少女性在 4-6 周时的创伤应激症状。需要进一步进行方法学质量高的研究，包括对 6-12 个月的更长时间随访，以证实特定面对面和在线早期心理干预模式在预防创伤性分娩后女性应激症状和 PTSD 影响的有效性证据，然后再将其纳入常规护理和实践。
PROSPERO 注册号：CRD42020202576，https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=202576。
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