NICU-based Interventions To Reduce Maternal Depressive and Anxiety Symptoms: A Meta-analysis
Tamar Mendelson1, Fallon Cluxton-Keller2, Genevieve C Vullo3
1Departments of Mental Health, and tmendel1@jhu.edu.
Context:
Parents whose infants are being treated in the NICU are at high risk for depression and anxiety, with negative implications for parenting and infant development.
Objective:
We conducted a systematic review and meta-analysis of NICU-based interventions to reduce maternal depressive or anxiety symptoms.
Data Sources:
PubMed, Embase, PsychInfo, Cochrane, and CINAHL were searched for relevant studies. Reference lists from selected studies were reviewed.
Study Selection:
Inclusion criteria included randomized controlled design, a parent-focused intervention delivered in the NICU, valid maternal depressive or anxiety symptom measures at pre- and postintervention, and publication in a peer-reviewed journal in English.
Data Extraction:
Data extraction was conducted independently by 2 coders.
Results:
Twelve studies met inclusion criteria for qualitative review; 2 were excluded from quantitative analyses for high risk of bias. Fixed- and random-effects models, with 7 eligible studies assessing depressive symptoms, indicated an effect of -0.16 (95% confidence interval [CI], -0.32 to -0.002; P < .05) and, with 8 studies assessing anxiety symptoms, indicated an effect of -0.12 (95% CI, -0.29 to 0.05; P = .17). The subset of interventions using cognitive behavioral therapy significantly reduced depressive symptoms (effect, -0.44; 95% CI, -0.77 to -0.11; P = .01).
Limitations:
The small number and methodological shortcomings of studies limit conclusions regarding intervention effects.
Conclusions:
Combined intervention effects significantly reduced maternal depressive but not anxiety symptoms. The evidence is strongest for the impact of cognitive behavioral therapy interventions on maternal depressive symptoms.
