Flinders Institute for Mental Health and Wellbeing and Blackbird Initiative, College of Education, Psychology, and Social Work, Flinders University, Adelaide, South Australia, Australia.
University of Adelaide, Adelaide, Australia.
Arch Womens Ment Health. 2023 Jun;26(3):295-309. doi: 10.1007/s00737-023-01313-4. Epub 2023 Apr 20.
Perinatal borderline personality disorder (BPD) and complex post-traumatic stress disorder (cPTSD) are associated with significant impairment to interpersonal functioning, and risk of intergenerational transmission of psychopathology. Evaluation of interventions, however, is scarce. To date, no systematic review has addressed interventions for perinatal BPD, cPTSD, and associated symptomatology. Given the modest evidence to support informed clinical guidelines, the objective of this systematic review is to synthesise the literature on interventions for perinatal BPD and cPTSD, and to generate future directions for research. A comprehensive literature search following PRISMA guidelines was conducted in PsycInfo, MEDLINE, Emcare, Scopus, and ProQuest Dissertations and Theses Global databases. Seven original studies were included, of which only two were randomised controlled trials, using less intensive comparison conditions. Results suggest an association between Dialectical Behavioural Therapy (DBT) group skills training, a multimodal therapeutic approach at a Mother-Baby Unit (MBU), and Child-Parent Psychotherapy with improved perinatal mental health outcomes and remission of symptoms. MBU admission and home-visiting programs were associated with healthy postpartum attachment relationships. Home-visiting programs and DBT group skills were additionally associated with improved maternal parenting capabilities. Conclusions to inform clinical guidelines are limited by a lack of credible comparison conditions, and low quantity and quality of evidence. The feasibility of implementing intensive interventions in real-world settings is dubious. Hence, it is suggested that future research considers utilising antenatal screening to identify at-risk mothers, and the implementation of early intervention, using robust designs that can inform robust conclusions.
围产期边缘型人格障碍（BPD）和复杂创伤后应激障碍（cPTSD）与人际功能显著受损以及精神病理学代际传递的风险相关。然而，干预措施的评估却很少。迄今为止，尚无系统评价涉及围产期 BPD、cPTSD 及其相关症状的干预措施。鉴于支持知情临床指南的证据有限，本系统评价的目的是综合围产期 BPD 和 cPTSD 干预措施的文献，并为未来的研究方向提供信息。按照 PRISMA 指南进行了全面的文献检索，检索了 PsycInfo、MEDLINE、Emcare、Scopus 和 ProQuest Dissertations and Theses Global 数据库。共纳入了 7 项原始研究，其中只有 2 项是随机对照试验，使用了不太密集的对照条件。结果表明，接受辩证行为疗法（DBT）团体技能训练、母婴单位（MBU）的多模式治疗方法以及儿童-父母心理疗法与改善围产期心理健康结果和症状缓解之间存在关联。MBU 入院和家庭访视计划与产后健康依恋关系有关。家庭访视计划和 DBT 团体技能还与改善母亲育儿能力有关。由于缺乏可靠的对照条件以及证据数量和质量低，为临床指南提供结论的依据有限。在实际环境中实施强化干预措施的可行性值得怀疑。因此，建议未来的研究考虑利用产前筛查来识别高危母亲，并实施早期干预，使用可以得出可靠结论的稳健设计。
