Lim Xueying, Ang Mei Qi, Foo Audrey, Chng Kimberly Kai Yi, Koh Serena Siew Lin
Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, Singapore City, Singapore.
Kandang Kerbau Women's and Children's Hospital, Singapore City, Singapore.
Int J Gynaecol Obstet. 2025 May;169(2):485-497. doi: 10.1002/ijgo.16019. Epub 2024 Dec 9.
The increasing prevalence of psychological distress among mothers is outpacing the effectiveness of conventional coping methods like cognitive behavioral therapy. The efficacy of alternatives such as writing therapy for maternal psychological well-being remains uncertain due to a lack of extensive research and inconsistent findings.
The aim of this study was to evaluate the effectiveness of expressive writing therapy in comparison to standard postpartum care for alleviating psychological distress, encompassing symptoms of depression, anxiety, or stress, in postpartum women.
For this purpose, seven bibliographic databases, including CINAHL, Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science, and gray literature were examined up to December 27, 2022 for randomized controlled trials, comparing expressive writing against standard care or controlled writing among postpartum women with psychological distress.
Data was collected using a random effect model for meta-analysis.
A meta-analysis of five studies with 483 participants found that expressive writing therapy was more effective than standard care or controlled writing in reducing postpartum depression and stress among women with psychological distress. Expressive writing resulted in a significant reduction in initial depression with standard mean difference (SMD) = -0.65%, 95% confidence interval (CI) = -1.08 to -0.22, Z = 2.96, P = 0.003, in comparison to controlled writing as an intervention. Regarding expressive writing versus standard care, a narrative review was conducted due to an I above 75%. The results showed significant improvements compared to the baseline at the seventh day and third month post-intervention. In terms of stress scores, there was a significant difference favoring expressive writing over standard care at the first month (SMD = -0.80%, 95% CI = -1.35 to -0.24, Z = 2.81, P = 0.005) and third month (SMD = -0.53%, 95% CI = -0.86 to -0.20, Z = 3.13, P = 0.002) post-intervention. Stress scores are also greatly reduced for expressive writing versus controlled writing with SMD = -0.79%, 95% CI = -1.03 to -0.55, Z = 6.48, P < 0.00001. However, the effectiveness of expressive writing on postpartum anxiety should be interpreted cautiously due to low certainty.
Expressive writing serves as an effective alternative for non-pharmacological intervention for postpartum women with depression and stress, but more research is needed for postpartum anxiety. As substantial heterogeneity was detected, results must be interpreted cautiously. Postpartum women with psychological distress are encouraged to use expressive writing as an affordable way to promote maternal mental health for the benefit of both the mother and the child.
母亲中心理困扰的患病率不断上升，传统应对方法如认知行为疗法的效果已难以满足需求。由于缺乏广泛研究且结果不一致，诸如写作疗法等替代方法对母亲心理健康的疗效仍不确定。
本研究旨在评估与标准产后护理相比，表达性写作疗法在缓解产后女性心理困扰（包括抑郁、焦虑或压力症状）方面的有效性。
为此，截至2022年12月27日，对包括CINAHL、Cochrane图书馆、EMBASE、PsycINFO、PubMed、Scopus和Web of Science在内的七个文献数据库以及灰色文献进行了检索，以查找随机对照试验，比较表达性写作与标准护理或对照写作对有心理困扰的产后女性的效果。
使用随机效应模型进行荟萃分析来收集数据。
对五项研究（共483名参与者）的荟萃分析发现，在减轻有心理困扰女性的产后抑郁和压力方面，表达性写作疗法比标准护理或对照写作更有效。与作为干预措施的对照写作相比，表达性写作使初始抑郁显著降低，标准平均差（SMD）=-0.65%，95%置信区间（CI）=-1.08至-0.22，Z=2.96，P=0.003。关于表达性写作与标准护理的比较，由于I值高于75%，进行了叙述性综述。结果显示，干预后第七天和第三个月与基线相比有显著改善。在压力评分方面，干预后第一个月（SMD=-0.80%，95%CI=-1.35至-0.24，Z=2.81，P=0.005）和第三个月（SMD=-0.53%，95%CI=-0.86至-0.20，Z=3.13，P=0.002），表达性写作比标准护理有显著优势。与对照写作相比，表达性写作的压力评分也大幅降低，SMD=-0.79%，95%CI=-1.03至-0.55，Z=6.48，P<0.00001。然而，由于确定性较低，表达性写作对产后焦虑的有效性应谨慎解释。
表达性写作是产后抑郁和压力女性非药物干预的有效替代方法，但对产后焦虑还需要更多研究。由于检测到大量异质性，结果必须谨慎解释。鼓励有心理困扰的产后女性使用表达性写作作为促进母亲心理健康的经济实惠的方法，这对母亲和孩子都有益。
