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Costantini I, López-López JA, Caldwell D, Campbell A, Hadjipanayi V, Cantrell SJ, Thomas T, Badmann N, Paul E, James DM, Cordero M, Jewell T, Evans J, Pearson RM. Early parenting interventions to prevent internalising problems in children and adolescents: a global systematic review and network meta-analysis. BMJ Ment Health 2023; 26:e300811. [PMID: 37907332 PMCID: PMC10619111 DOI: 10.1136/bmjment-2023-300811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/14/2023] [Indexed: 11/02/2023]
Abstract
QUESTION We compared the effectiveness of different types of parenting interventions based on an a priori taxonomy, and the impact of waitlists versus treatment as usual (TAU), in reducing child internalising problems. STUDY SELECTION AND ANALYSIS We conducted a systematic review and network meta-analysis of published and unpublished randomised controlled trials (RCTs) until 1 October 2022 that investigated parenting interventions with children younger than 4 years. EXCLUSION CRITERIA studies with children born preterm, with intellectual disabilities, or families receiving support for current abuse, neglect, and substance misuse. We assessed the certainty of evidence using the Confidence in Network Meta-Analysis framework. We used random-effects network meta-analysis to estimate standardised mean differences (SMDs) with 95% credible intervals (CrIs). FINDINGS Of 20 520 citations identified, 59 RCTs (18 349 participants) were eligible for the network meta-analysis. Parenting interventions focusing on the dyadic relationship (SMD: -0.26, 95% CrI: -0.43 to -0.08) and those with mixed focus (-0.09, -0.17 to -0.02) were more effective in reducing internalising problems than TAU at the first time point available. All interventions were more effective than waitlist, which increased the risk of internalising problems compared with TAU (0.36, 0.19 to 0.52). All effects attenuated at later follow-ups. Most studies were rated as with 'high risk' or 'some concerns' using the Risk of Bias Assessment Tool V.2. There was no strong evidence of effect modification by theoretically informed components or modifiers. CONCLUSIONS We found preliminary evidence that relationship-focused and mixed parenting interventions were effective in reducing child internalising problems, and the waitlist comparator increased internalising problems with implications for waiting times between referral and support. Considering the high risk of bias of most studies included, the findings from this meta-analysis should be interpreted with caution. PROSPERO registration number CRD42020172251.
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Affiliation(s)
- Ilaria Costantini
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
- Division of Psychiatry, University College London, London, UK
| | - José A López-López
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
- Department of Basic Psychology and Methodology, University of Murcia, Murcia, Spain
| | - Deborah Caldwell
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
- NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Amy Campbell
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | | | - Sarah J Cantrell
- Department of Paediatrics, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
| | | | | | - Elise Paul
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Deborah M James
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Miguel Cordero
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
- Centro de Epidemiología y Políticas de Salud, Universidad del Desarrollo Facultad de Medicina Clínica Alemana, Las Condes, Chile
| | - Tom Jewell
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Jonathan Evans
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Rebecca M Pearson
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
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Prioreschi A, Pearson R, Richter L, Bennin F, Theunissen H, Cantrell SJ, Maduna D, Lawlor D, Norris SA. Protocol for the PLAY Study: a randomised controlled trial of an intervention to improve infant development by encouraging maternal self-efficacy using behavioural feedback. BMJ Open 2023; 13:e064976. [PMID: 36882258 PMCID: PMC10008478 DOI: 10.1136/bmjopen-2022-064976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION The early infant caregiving environment is crucial in the formation of parent-child relationships, neurobehavioural development and thus child outcomes. This protocol describes the Play Love And You (PLAY) Study, a phase 1 trial of an intervention designed to promote infant development through encouraging maternal self-efficacy using behavioural feedback, and supportive interventions. METHODS AND ANALYSIS 210 mother-infant pairs will be recruited at delivery from community clinics in Soweto, South Africa, and individually randomised (1:1) into two groups. The trial will consist of a standard of care arm and an intervention arm. The intervention will start at birth and end at 12 months, and outcome assessments will be made when the infants are 0, 6 and 12 months of age. The intervention will be delivered by community health helpers using an app with resource material, telephone calls, in person visits and behavioural feedback with individualised support. Every 4 months, mothers in the intervention group will receive rapid feedback via the app and in person on their infant's movement behaviours and on their interaction styles with their infant. At recruitment, and again at 4 months, mothers will be screened for mental health risk and women who score in the high-risk category will receive an individual counselling session from a licensed psychologist, followed by referral and continued support as necessary. The primary outcome is efficacy of the intervention in improving maternal self-efficacy, and the secondary outcomes are infant development at 12 months, and feasibility and acceptability of each component of the intervention. ETHICS AND DISSEMINATION The PLAY Study has received ethical approval from the Human Research Ethics Committee of the University of the Witwatersrand (M220217). Participants will be provided with an information sheet and required to provide written consent prior to being enrolled. Study results will be shared via publication in peer-reviewed journals, conference presentation and media engagement. TRIAL REGISTRATION NUMBER This trial was registered with the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za) on 10 February 2022 (identifier: PACTR202202747620052).
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Affiliation(s)
- Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Rebecca Pearson
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Academic Mental Health, Addiction and Suicide Research, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Linda Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Fiona Bennin
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Helene Theunissen
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah J Cantrell
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Dumsile Maduna
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Deborah Lawlor
- Department of Social Medicine, MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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