Effectiveness of interventions to prevent perinatal depression: An umbrella review of systematic reviews and meta-analysis

Effectiveness of Smart Mama application on postpartum depression, anxiety, and maternal-infant bonding among women during the postnatal period: a randomized controlled trial

BACKGROUND

Postpartum depression and anxiety are significant public health concerns that have serious well documented negative effects on mothers and their families. However, they often remain under-recognized because of limited in-person interactions, time restrictions, lack of adequate support, and pervasive stigmatization. This study investigated the effectiveness of the Smart Mama application on postpartum depression, anxiety levels, and maternal-infant bonding at 12 weeks postpartum.

MATERIALS AND METHODS

This prospective parallel-group randomized controlled trial included 148 participants from March 1, 2023, to March 31, 2024. Those who agreed to participate were randomly assigned to receive the Smart Mama intervention (n = 74) or routine care (n = 74), using permuted stratified block randomization. The primary outcome was assessed using the Edinburgh Postnatal Depression Scale (EPDS). The secondary outcomes were evaluated using the State-Trait Anxiety Inventory (STAI) and Maternal-Infant Bonding Scale (MIBS) at baseline and the 12-week follow-up using validated standardized tools.

RESULTS

Compared with the control group, the Smart Mama intervention group showed a significant reduction in postpartum depressive symptoms (P for time × group interaction = 0.04), with a reduction in the EPDS mean score from 9.03 (standard deviation, 2.47) to 5.61 (3.3), whereas the control group showed a change from 9.01 (2.75) to 7.16 (3.1) at 12 weeks post-intervention. Similarly, the Smart Mama intervention led to a significantly greater decrease in both state and trait anxiety levels (both P for time × group interaction < 0.05) compared to the control group. No statistically significant effect on maternal-infant bonding was observed between the intervention and control group (P for time × group interaction = 0.25).

CONCLUSION AND IMPLICATIONS

The Smart Mama intervention significantly reduced postpartum depressive symptoms and anxiety. This study provides empirical evidence and novel insights into the effectiveness of mobile device applications. By integrating a holistic approach, Smart Mama represents a promising and innovative solution for enhancing maternal health outcomes, empowering self-care activities, and overcoming barriers to accessibility.

TRIAL REGISTRATION

The study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trial Registry (ID: (UMIN000050065) on January 19, 2023 ( https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000056562 ).

Effects of psychological intervention combined with education on psychological resilience and healthy behavior of patients with pulp disease

BACKGROUND

The two-way, three-stage psychological intervention for patients with dental pulp disease offers a reference for nursing interventions in such cases.

AIM

To examine the effects of a three-stage psychological intervention on psychological resilience and health behaviors.

METHODS

A total of 114 patients with dental pulp disease treated between December 2022 and December 2023 were allocated into two groups according to the random lottery method, with 57 patients in each group. The control group adopted the teaching method, while the observation group used a three-stage psychological intervention combined with the teaching method. We compared psychological resilience, coping strategies, dental fear, health behavior habits, and stigma between the two groups.

RESULTS

The intervention group showed significantly improved scores on the psychological resilience scale (Connor-Davidson Resilience Scale) (P < 0.05); positive and negative response scores also improved after the intervention (P < 0.05); significant differences were observed between the observation and control groups in the Chinese version of the Stouthard Dental Fear Scale (Dental Anxiety Inventory), the Social Impact Scale, and health behavior score (P < 0.05).

CONCLUSION

Combining a three-stage psychological intervention with the back-teaching method effectively reduces dental fear and stigma in patients with dental pulp disease. It also improves psychological resilience, coping strategies, and health behavior habits, achieving significant results.

Proactive approaches to preventing postpartum depression in non-depressive pregnant women: a comprehensive scoping review

Introduction

Postpartum depression is a significant global health challenge that affects mothers, infants, and families. Although various preventive strategies show promise, comprehensive reviews evaluating interventions among pregnant women without a clinical diagnosis of depression remain limited. This scoping review aims to identify and synthesize the existing evidence on proactive postpartum depression prevention programs initiated during pregnancy.

Methods

Following PRISMA guidelines for scoping reviews, we systematically searched PubMed and Scopus, supplemented by manual reference reviews. Our search strategy combined terms related to postpartum depression, pregnancy, and preventive interventions. Studies were included if they evaluated interventions conducted during pregnancy, targeting women without a clinical diagnosis of depression, and assessed PPD outcomes using established diagnostic criteria or validated screening tools. Only English-language articles published between 2013 and 2023 were considered.

Results

A total of 49 studies met the inclusion criteria. Interventions were categorized into nine themes: psychoeducation (n = 18), home visits (n = 6), cognitive behavioral therapy (CBT) (n = 6), mindfulness (n = 6), exercise (n = 4), dietary supplements (n = 3), interpersonal therapy (IPT) (n = 4), consultation (n = 1), and inhalation aromatherapy (n = 1). Psychoeducational and mindfulness-based interventions consistently reduce PPD risk, particularly when delivered in structured, theory-driven formats and incorporating family support. Digital CBT interventions demonstrated limited effectiveness due to lower engagement, while home-visit and consultation-based interventions were effective when integrated into existing maternal healthcare despite scalability challenges. Exercise and dietary supplement interventions yielded inconsistent outcomes, indicating that factors such as adherence, duration, and intensity are crucial determinants of effectiveness.

Conclusion

Various proactive interventions are available to prevent PPD, and this scoping review systematically maps the different strategies used and their outcomes. Proactive, theory-based, and multi-component interventions, particularly psychoeducational and mindfulness programs, demonstrate promising potential. Future research should emphasize evaluating long-term outcomes, optimizing digital engagement strategies, and developing culturally tailored models to enhance scalability and accessibility across diverse populations, including low-resource settings.

Interventions to reduce inequalities for pregnant women living with disadvantage in high-income countries: an umbrella review

BACKGROUND

Women facing multiple disadvantage such as financial poverty, poor mental health or domestic abuse, may experience inequalities in health prior to and during pregnancy, as well as into early motherhood. This can have lifelong intergenerational impacts. The primary aim of this overview was to identify the breadth and efficacy of interventions that work across health and social care to reduce inequalities in maternal or child health. The second aim was to explore their relevance to women with lived experience.

METHODS

An overview of systematic reviews and meta-analyses from high-income countries that aim to reduce inequalities for women with social disadvantage during pregnancy was performed. Searches were conducted in eight electronic databases up to August 2023 and supplemented with grey literature searches. We included any individual, hospital, or community level activities specific to women during the pre-conception, antenatal or postpartum period up to one year after. The protocol was registered. Two workshops with women with lived experience of disadvantage explored the relevance of identified interventions, and gaps in evidence, in relation to their experiences.

RESULTS

A total of 36 reviews, including 734 primary studies, were included in the narrative synthesis. The majority of reviews included studies undertaken in North America and were of critically low or low quality. Interventions were grouped into 11 categories. The majority of interventions were aimed at single social exposures and targeted individual behavior during pregnancy and the postnatal period. Some at risk populations were excluded from all reviews. There was potential benefit of home-based interventions, psychosocial interventions, models of maternity care and interdisciplinary programs of care for some population groups, across a range of maternal and child health outcomes. Our lived experience group felt these interventions had potential to meet their shared needs for advocacy, support and information, but they should also consider culture, past trauma and factors underpinning pregnancy such as housing and finances.

CONCLUSIONS

Further high-quality research is required to demonstrate efficacy and cost-effectiveness of potentially effective interventions in the European health systems. Additional research gaps include interventions prior to pregnancy, culture informed care and upstream determinants of health (PROSPERO: CRD42023455502).

Use of Whooley Questions and GAD-2 Tools in Screening for Perinatal Mental Health: Current Expert Considerations

BACKGROUND/OBJECTIVES

Mental health screening of perinatal women is recommended as an essential element of routine maternity health care. Knowledge of screening conditions in healthcare settings as indicated by NICE is limited. This scoping review examines current expert considerations in the scientific literature on the use of Whooley questions and GAD-2 tools in screening for women's perinatal mental health.

METHODS

The search included literature in English published prior to April 2023. Searches in PsycINFO, PubMed, Scopus, Scilit, and Google Scholar used the terms "Whooley questions" and "GAD-2".

RESULTS

A total of 9 articles on studies using both of these tools were included. During pregnancy, rapid screening instruments permit the identification of women at increased risk for postpartum depression. They also detect continuity between depressive or anxious symptoms during pregnancy and depressive symptoms after delivery. Effectiveness compares favorably to that of some lengthier screening instruments. Rapid self-report tools appear to be most suitable for initial screening. They are indicative only of perinatal mental health and have no diagnostic value. In the individual studies considered in this review, the reliability and sensitivity of the Whooley questions and GAD-2 are unclear. Because of their self-reporting nature, outcomes may be subject to recall bias.

CONCLUSIONS

Future evaluation of the instruments' performance over the perinatal period is needed.

Lived Experiences of Migrant Fathers in the Perinatal Period: A Systematic Review and Analysis

The worldwide population of migrant families is on the rise, and there is growing acknowledgement of the significance of supporting parental mental health within these families. However, understanding of the experiences of migrant fathers during the perinatal period remains incomplete. The objective of this review is to provide an overview of existing research on perinatal migrant fathers' experiences in different cultures. Multiple searches were conducted in April 2023 for quantitative, qualitative, and mixed-methods studies across six electronic databases: Medline, CINAHL, Embase, PsycINFO, Web of Science, and Scopus. Fourteen eligible articles were identified, including nine qualitative studies, five quantitative studies, and no mixed-methods studies. The Mixed-methods Appraisal Tool was used to assess the quality of these studies. The quantitative findings were transformed into narrative summaries to be analysed thematically along with the qualitative data. Three themes were identified: (1) Cultural competence (dealing with cultural differences, needs related to original country); (2) Parenthood in a new country (challenges and adaptation to fatherhood, challenging traditional gender norms, lack of extended family and building new support networks, being the main supporter for the family); (3) Needs of the fathers and their personal difficulties. The findings of this review suggest a direction for future research in perinatal psychology. The review also provides insights into the need for social and community support for migrant fathers and how healthcare services can support this group during the perinatal period.

Depression outcome in women with recurrent spontaneous abortion: A systematic review and meta-analysis

BACKGROUND

It is widely recognized that depression is highly prevalent among women experiencing recurrent spontaneous abortion (RSA), exerting detrimental effects on both the individual and the family.

OBJECTIVE

To assess the depression risk and associated factors among women with RSA.

DATA SOURCES

Our search strategy encompassed PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure (CNKI), and WANFANG. The research was conducted in May 2022. We included both randomized and nonrandomized studies that reported the prevalence of depression among women with RSA.

DATA EXTRACTION AND SYNTHESIS

Two independent evaluators reviewed the titles and abstracts, assessed the full-text papers, extracted data from the included studies, and evaluated their quality using the Newcastle-Ottawa Scale (NOS). We performed random-effects meta-analyses to pool the data. Odds ratios (ORs) and standardized mean differences (SMDs) were combined based on effect sizes for binary and continuous outcomes.

MAIN OUTCOMES

To conduct a meta-analysis to understand the risk of depression in women with RSA who were not treated with psychiatric medications, as well as an analysis of potential factors for depressive symptoms.

RESULTS

Out of the initially identified 527 papers, a total of 20 studies (N = 13087) that fulfilled the inclusion criteria were selected. Compared to healthy controls, patients with RSA had a significantly higher risk of depression (OR: 4.26, 95 % confidence interval [CI]: 2.44-7.41; SMD: 0.89, 95 % CI: 0.51-1.26). The occurrence of depression among RSA patients was found to be significantly associated with several factors including the severity of depressive symptoms (OR: 3.82, 95 % CI: 2.22-6.59), number of spontaneous miscarriages (SMD: 0.59, 95 % CI: 0.01-1.18), history of therapeutic termination of pregnancy (SMD: 0.20, 95 % CI: 0.09-0.32), history of live birth (SMD: -0.32, 95 % CI: -0.49--0.15), and duration of marriage (SMD: 0.15, 95 % CI: 0.02-0.27).

CONCLUSIONS

In clinical practice, it is crucial to provide appropriate psychological interventions for women undergoing RSA. These individuals face a significantly heightened risk of depression, which exhibits strong correlations with various demographic factors such as the severity of depressive symptoms, history of both spontaneous miscarriages and therapeutic termination of pregnancy, number of live births, and duration of marriage. Consequently, women who are suffering RSA deserves more assistance and emotional support.

Effectiveness of online psychological interventions to prevent perinatal depression in fathers and non-birthing partners: A systematic review and meta-analysis of randomized controlled trials

Little is known about the effectiveness of online preventive interventions for paternal perinatal depression (PPD). This systematic review (SR) and meta-analysis (MA) of randomized controlled trials (RCTs) evaluated the effectiveness of online psychological interventions to prevent PPD in fathers and non-birthing partners. The PRISMA 2020 guidelines were followed. The search was conducted in eight electronic databases and other sources from inception to 12 May 2023. The pooled standardized mean difference (SMD) was computed using random-effect models. Seven RCTs were included in the SR and 6 were included in the MA, representing 1.042 fathers from five different countries. No trials focused on non-birthing partners were found. The pooled SMD was -0.258 [95 % confidence interval - 0.513 to -0.004; p < 0.047]. The heterogeneity was moderate (I2 = 51 %; 95%CI [0 % to 81 %]) and nonsignificant (p = 0.070). However, sensitivity analyses showed that the effectiveness was stable only when the fixed effect model and the Egger's g were used to estimate the pooled SMD. No publication bias was found. Only two RCTs had an overall low risk of bias assessed by using the Cochrane ROB 2.0 tool. The quality of evidence based on GRADE was very low. In conclusion, online psychological interventions may be effective for the prevention of PPD. More high-quality evidence is warranted.

Global prevalence of perinatal depression and anxiety during the COVID-19 pandemic: An umbrella review and meta-analytic synthesis

INTRODUCTION

The prevalence of depression and anxiety symptoms in pregnant and postpartum women during the COVID-19 pandemic was assessed by several systematic reviews (SRs) and meta-analyses which provided contrasting and different results. We aimed to summarize the evidence relating to the global prevalence of anxiety and depression among pregnant and postpartum women during the COVID-19 pandemic.

MATERIAL AND METHODS

An umbrella review of SRs and meta-analyses was performed. Searches were conducted in electronic databases up to April 2023. SRs and meta-analyses reporting the prevalence of perinatal anxiety and depression during the COVID-19 pandemic were selected for eligibility. Primary studies extracted from eligible meta-analyses were included in the quantitative synthesis. The research protocol was registered on PROSPERO (CRD42020173125).

RESULTS

A total of 25 SRs (198 primary studies) and 12 meta-analyses (129 primary studies) were included in the qualitative and quantitative synthesis, respectively. Studies involved data from five continents and 45 countries. The pooled prevalence of antenatal and postpartum depression was 29% (n = 55; 95% CI: 25%-33%) and 26% (n = 54; 95% CI: 23%-30%), respectively. In the case of anxiety, the pooled antenatal and postnatal prevalence was 31% (n = 44; 95% CI: 26%-37%; n = 16; 95% CI: 24%-39%). Differences emerged between continents, with Africa having the highest prevalence of perinatal depression and Oceania and Europe having the highest prevalence of antenatal and postnatal anxiety. The prevalence also varied depending on the assessment tools, especially for antenatal anxiety. A medium-high quality of the studies was observed. One SR assessed strength-of-evidence, reporting very low strength.

CONCLUSIONS

During the COVID-19 pandemic, depression and anxiety were common, affecting almost one in three perinatal women globally. A high heterogeneity and a risk of publication bias were found, partially due to the variety of assessment tools and cut-offs. The results may not be generalized to minorities. Studies on the prevalence of clinical diagnoses are needed. Based on our results it is not possible to firmly affirm that the COVID-19 pandemic was the main factor that directly increased perinatal depression and anxiety during the past few years. Future studies should study other factors' impact.