Department of Public Mental Health, Health Services Academy, Islamabad, Pakistan.
Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom.
J Affect Disord. 2024 Nov 1;364:41-47. doi: 10.1016/j.jad.2024.08.021. Epub 2024 Aug 11.
The "Healthy Mother Healthy Baby" (HMHB) study is a phase three, single-blind randomized clinical trial conducted at Holy Family Hospital (HFH) in association with Rawalpindi Medical University (RMU). We aimed to examine the mediators of a specialized psychosocial approach based on Cognitive Behavioural Therapy principles, targeting pregnant women experiencing anxiety. The HMHB intervention was effective in treating perinatal anxiety symptoms and preventing future depressive episodes.
The trial randomized participants into two arms: the HMHB intervention or Enhanced Usual Care (EUC), following World Health Organization guidelines. The HMHB intervention comprised strategies to strengthen social support networks, improving mother-baby bonding and strategies to deal with interpersonal conflicts, economic challenges, and societal gender preferences using cognitive and behavioural techniques and culturally resonant illustrations. Participants underwent rigorous data collection at three pivotal timepoints: baseline, third trimester, and 6-weeks postnatal. The primary outcome was anxiety symptom severity scores using the Hospital Anxiety and Depression Scale (HADS) at 6-weeks post-childbirth. Four potential mediators - social support, behavioural activation, perceived stress, and pregnancy experience - were assessed in the third trimester of pregnancy.
A total of 1200 participants were randomized to the HMHB and EUC arms. In the six-week follow-up time point, 379 participants remained in the EUC group, and 387 continued in the HMHB group. Post-intervention, HMHB participants displayed significant improvements in postnatal anxiety and depression scores. Mediation analyses revealed social support and pregnancy hassles as significant mediators of the intervention's effect on postnatal anxiety outcomes, while only social support emerged as a significant mediator for depression outcomes.
The HMHB intervention showed promising results in improving anxiety and depression scores among pregnant women. Significant mediation effects suggest the importance of targeting social support and managing pregnancy-related hassles for optimal intervention effectiveness.
“健康母亲健康婴儿”（HMHB）研究是一项在拉瓦尔品第医科大学（RMU）附属的Holy Family Hospital（HFH）进行的三阶段、单盲随机临床试验。我们旨在检验一种基于认知行为疗法原则的专门心理社会方法的中介因素，该方法针对的是经历焦虑的孕妇。HMHB 干预措施在治疗围产期焦虑症状和预防未来抑郁发作方面是有效的。
该试验将参与者随机分为两组：HMHB 干预组或增强常规护理（EUC）组，遵循世界卫生组织的指南。HMHB 干预组包括增强社会支持网络、改善母婴联系的策略，以及使用认知和行为技术以及具有文化共鸣的插图来处理人际冲突、经济挑战和社会性别偏好的策略。参与者在三个关键时间点接受了严格的数据收集：基线、妊娠晚期和产后 6 周。主要结果是产后 6 周时使用医院焦虑和抑郁量表（HADS）评估的焦虑症状严重程度评分。在妊娠晚期评估了四个潜在的中介因素 - 社会支持、行为激活、感知压力和妊娠体验。
共有 1200 名参与者被随机分配到 HMHB 和 EUC 组。在 6 周的随访时间点，EUC 组有 379 名参与者，HMHB 组有 387 名参与者。干预后，HMHB 组参与者的产后焦虑和抑郁评分显著改善。中介分析显示，社会支持和妊娠困难是干预对产后焦虑结果的影响的显著中介因素，而只有社会支持是抑郁结果的显著中介因素。
HMHB 干预措施在改善孕妇的焦虑和抑郁评分方面显示出有希望的结果。显著的中介效应表明，针对社会支持和管理与妊娠相关的困难对于最佳干预效果至关重要。
