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创伤性分娩后父母心理健康的心理干预措施的有效性:系统评价和荟萃分析。

Effectiveness of Psychological Interventions to Improve the Mental Well-Being of Parents Who Have Experienced Traumatic Childbirth: A Systematic Review and Meta-Analysis.

机构信息

Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Singapore.

School of Community Health and Midwifery, University of Central Lancashire, Preston, UK.

出版信息

Trauma Violence Abuse. 2023 Jul;24(3):1238-1253. doi: 10.1177/15248380211060808. Epub 2021 Dec 13.

Abstract

Considering the adverse impact that traumatic childbirth experiences can have on parental mental well-being, studies that have investigated the potential of providing postnatal psychological support for this group of parents require evaluation. This systematic review aimed to examine the effectiveness of psychological interventions at improving the mental well-being of parents who have experienced traumatic childbirth in terms of anxiety, depression, fear of childbirth, and post-traumatic stress disorder (PTSD) symptoms. Seven electronic databases were searched from their respective inception dates up to January 2021. Only quantitative studies that reported the effects of psychological interventions on anxiety, depression, fear of childbirth, and/or PTSD symptoms in selective (at risk of traumatic childbirth experience) or indicated (self-defined childbirth experience as traumatic for any reason) populations of parents (mothers and/or fathers) were included. Eight studies were included and meta-analyses were conducted using a random-effect model. All studies were conducted on mothers only, and one study had minimal father involvement. Results showed that psychological interventions were more effective in reducing fear of childbirth and improving PTSD symptoms compared to anxiety and depression. Greater improvement in depression was reported at 3-8 weeks' follow-up than at immediate post-intervention. Subgroup analyses showed that technology-based interventions were feasible, and indicated interventions were more effective than selective interventions. Conducting future interventions in more geographical regions, engaging and including fathers more actively, incorporating both personalized professional therapy and informal peer support, striving for flexibility and convenience, as well as addressing topics on self-doubt and coping skills can improve current interventions.

摘要

考虑到创伤性分娩经历对父母心理健康可能产生的不利影响,需要对研究为这组父母提供产后心理支持的潜在效果进行评估。本系统评价旨在考察心理干预对改善创伤性分娩经历父母心理健康的效果,评估指标包括焦虑、抑郁、分娩恐惧和创伤后应激障碍(PTSD)症状。从各数据库建库起至 2021 年 1 月,共检索了 7 个电子数据库。仅纳入定量研究,这些研究报告了心理干预对选择性(有创伤性分娩经历风险)或指示性(出于任何原因自我定义分娩经历为创伤性)父母人群(母亲和/或父亲)的焦虑、抑郁、分娩恐惧和/或 PTSD 症状的影响。共纳入 8 项研究,采用随机效应模型进行荟萃分析。所有研究均仅在母亲中进行,其中一项研究仅有少量父亲参与。结果显示,与焦虑和抑郁相比,心理干预更能有效降低分娩恐惧和改善 PTSD 症状。与干预即刻相比,在干预后 3-8 周时,抑郁改善更为显著。亚组分析显示,基于技术的干预措施是可行的,指示性干预措施比选择性干预措施更有效。在更多地理区域开展未来干预、更积极地让父亲参与、将个性化专业治疗和非正式同伴支持相结合、追求灵活性和便利性、以及解决自我怀疑和应对技能等问题,可能会改善当前干预措施。

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