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Fleet JA, Adelson P, McKellar L, Steen M. Antenatal education incorporating complementary medicine techniques for labour and birth to reduce the rates of epidural in primiparous women: A randomised control trial. Midwifery 2024; 139:104170. [PMID: 39241698 DOI: 10.1016/j.midw.2024.104170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 08/21/2024] [Accepted: 08/28/2024] [Indexed: 09/09/2024]
Abstract
PROBLEM Globally medical management of labour and birth has significantly increased, with epidurals attributed to the cascade of interventions. BACKGROUND There are few randomised control trials that evaluate the effectiveness of antenatal education programs. A previous trial at two Australian hospitals found an antenatal program of integrative complementary therapies significantly reduced rates of interventions for low-risk primiparous women. AIM To reduce rates of intervention in labour and birth, with a primary outcome of decreased epidural use during labour. METHODS Low to moderate risk primiparous women were randomised at 24-36 weeks' gestation to the intervention group and standard care, or standard care alone. Clinical and psychological measures were analysed by intention-to-treat. Trial registration ACTRN12618001353280 FINDINGS: In total, 178 women participated (n = 88 intervention, n = 90 Standard care), demographic characteristics were similar between groups, almost half (49 %) reported a pre-existing medical condition, and wellbeing scores fell within the average range. Epidural use was lower in the intervention group (47.7% vs 56.7 %) with higher rates of vaginal birth (52.3% vs 42.2 %), however, no statistical differences for birth outcomes were found between groups. Attitude to childbirth scores were statistically higher for women who attended the intervention (59.1 vs 54.3 p00.001). DISCUSSION Higher psychometric scores demonstrated women in the intervention group felt an increased sense of coping and control. Antenatal education that includes complementary therapies can reduce fear and improve attitudes about childbirth. CONCLUSIONS Replicating study protocols enabled the generalisability of findings to a more diverse group of women, and data will contribute to a larger meta-analysis design to detect smaller treatment effects for operative birth.
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Affiliation(s)
- Julie-Anne Fleet
- UniSA Clinical & Health Sciences, University of South Australia, City East Campus, Centenary Building, North Terrace, Adelaide, SA 5000, Australia; Rosemary Bryant AO Research Centre, University of South Australia, Australia.
| | - Pamela Adelson
- Rosemary Bryant AO Research Centre, University of South Australia, Australia
| | - Lois McKellar
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Australian Catholic University (Mel), Australia. https://twitter.com/DrLoisMcKellar1
| | - Mary Steen
- Bentley Campus and Department of Nursing and Midwifery Education and Research (DNAMER), Faculty of Health Sciences, King Edward Memorial Hospital, Curtin University, Perth, WA, Australia. https://twitter.com/ProfMarySteen
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Reangsing C, Punsuwun S, Oerther S. Effects of mindfulness-based interventions (MBIs) on depression in pregnant women: A systematic review and meta-analysis. J Affect Disord 2024; 352:51-59. [PMID: 38360361 DOI: 10.1016/j.jad.2024.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE We synthesized the effects of mindfulness-based interventions (MBIs) on depression in pregnant women. METHOD Ten electronic databases were searched from inception to September 2022. We reviewed studies on outcomes for pregnant women with depression receiving mindfulness-based interventions. We only reviewed studies written in English. A random-effects model was used to compute the effect size. Funnel plot, Q statistics, and I2 were used to test the heterogeneity across studies. We examined moderators to explore sources of heterogeneity. RESULTS Across 19 included studies (N = 1480), 717 pregnant women participated in mindfulness interventions; 763 served as controls. Mean age ranged from 25.3 to 33.6 years. Overall, mindfulness-based interventions showed reduced depression compared to control groups (g = 0.457, 95%CI 0.254, 0.659, I2 = 68 %). With subgroup analysis, mindfulness-based cognitive therapy had a greater effect on reducing depressive symptoms (g = 1.13) than mindfulness-based stress reduction (g = 0.64) and adapted mindfulness-based interventions (g = 0.31). No quality indicators moderated the ES of mindfulness-based interventions on depression. CONCLUSION Mindfulness-based interventions significantly improved depression among pregnant women, especially mindfulness-based cognitive therapy (MBCT). Clinicians and health providers should consider using MBIs as alternative complementary treatment for improving and preventing depression in pregnant women.
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Affiliation(s)
- Chuntana Reangsing
- School of Nursing, Mae Fah Luang University, Chiangrai, Thailand; Nursing Innovation Research and Resource Unit, Mae Fah Luang University, Thailand.
| | | | - Sarah Oerther
- Trudy Busch Valentine School of Nursing, Saint Louis University, MO, USA
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Kundarti FI, Kiswati, Komalyna INT. Mindfullness based intervention reduce anxiety in labor. GACETA SANITARIA 2024; 38:102359. [PMID: 38330537 DOI: 10.1016/j.gaceta.2024.102359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To determine the effectiveness of mindfulness interventions on anxiety through a systematic review. METHOD Systematic review by searching articles through the PubMed, ProQuest, Science Direct, Wiley Library, Sage Journal, and Cochrane Library databases with publication years January 2012 to January 2022 RESULTS: Eleven articles met the inclusion criteria covering several countries, including Canada 1 article, Egypt 1 article, Taiwan 1 article, Amsterdam 2 articles, Iran 1 article, Austria 1 article, San Francisco 1 article, Germany 1 article, Sweden 1 article, China 1 article, and Spain 1 article. CONCLUSIONS Management of anxiety about childbirth is important for pregnant women. Mindfulness interventions are effective for reducing anxiety about labor and increasing comfort during labor. Mindfulness intervention mechanisms have the potential to reduce anxiety by increasing skills to regulate emotions.
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Affiliation(s)
- Finta Isti Kundarti
- Department of Midwifery, Health Polytechnic Ministry of Health Malang, Malang, Indonesia.
| | - Kiswati
- Department of Midwifery, Health Polytechnic Ministry of Health Malang, Malang, Indonesia
| | - I Nengah Tanu Komalyna
- Department of Nutrition, Health Polytechnic Ministry of Health Malang, Malang, Indonesia
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Torres-Giménez A, Sureda B, Roca-Lecumberri A, Andrés-Perpiñá S, Solé E, Gelabert E. Efficacy of contextual therapies in perinatal depression and anxiety: A systematic review and meta-analysis. J Psychiatr Res 2024; 169:209-223. [PMID: 38043257 DOI: 10.1016/j.jpsychires.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/14/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND There are previous meta-analyses on the efficacy of cognitive behavioral therapy or mindfulness-based therapies in the perinatal period, but no previous review has focused on contextual therapies as a whole. The aim of this study was to carry out a systematic review and meta-analysis of the efficacy of contextual therapies on depressive and anxious symptoms in women in the perinatal period. METHODS A systematic search for randomized clinical trials has been carried out in the PUBMED, CINAHL, Psyc-INFO and Cochrane Library search engines. For the quantitative synthesis, the Morris effect size measure has been used. RESULTS A total of 34 RCTs have been found, of which 30 have been used for meta-analysis. The mean effect size of the studies on depression scores was dppc2 = -0.81 (95% CI = -1.12 to -0.50), while it was dppc2 = -1.04 (95% CI = -1.54 to -0.53) in the case of studies on anxiety scores. These effect sizes decreased to medium effect sizes when corrected for publication bias. LIMITATIONS The main limitations are the quality of the included studies, publication bias, and the limited number of studies on contextual therapies other than mindfulness-based therapies. CONCLUSIONS In conclusion, this systematic review found a large number of efficacy studies on mindfulness-based therapies and a small number of studies on the other contextual therapies. The effect sizes found are consistent with previous meta-analyses in the perinatal period.
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Affiliation(s)
- Anna Torres-Giménez
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Bàrbara Sureda
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain
| | - Alba Roca-Lecumberri
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Susana Andrés-Perpiñá
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eva Solé
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Estel Gelabert
- Departament of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
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Sari YP, Hsu YY, Nguyen TTB. The Effects of a Mindfulness-Based Intervention on Mental Health Outcomes in Pregnant Woman: A Systematic Review and Meta-Analysis. J Nurs Res 2023; 31:e306. [PMID: 38036493 DOI: 10.1097/jnr.0000000000000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Pregnancy stress, anxiety, and depression increase the risk of short-term and long-term health problems for the mother and fetus. Mindfulness-based intervention (MBI) is one of the most popular, nonpharmacological interventions used to treat mental health problems. The results of prior research indicate MBI has a less consistent effect on mental health problems in pregnant women. PURPOSE The purpose of this systematic review and meta-analysis was to clarify and determine the effect of MBI on mental health outcomes in pregnant women. METHODS Six databases, including Embase, Ovid MEDLINE, CINAHL, EBSCOhost, Cochrane Library, and ScienceDirect, were searched from their dates of inception to November 2021. Google Scholar was also used for the literature inquiry. The inclusion criteria followed the PICO (Patient/Problem, Intervention, Comparison, and Outcome) model in terms of only including studies that used mindfulness therapy, reported mental health outcomes, and applied randomized controlled trial and quasi-experimental approaches. The Cochrane risk of bias tool was applied to evaluate the quality of the studies. Review Manager 5 software with random effect with a standardized mean difference (SMD) was used to analyze level of effect. RESULTS Thirteen studies (10 randomized controlled trials and three quasi-experimental studies) were included. MBI was found to have a small effect on mental health outcomes in pregnant women (p < .0001, SMDs = -0.48, 95% CI [-0.74, -0.22], I2 = 87%). Specifically, MBI had moderate effects on stress and anxiety (SMDs = -0.59, 95% CI [-1.09, -0.09], and SMDs = -0.55, 95% CI [-1.00, -0.10], respectively) and no significant effect on depression (SMDs = -0.33, 95% CI [-0.74, 0.08]). CONCLUSIONS MBIs have a small but notable effect on mental health in pregnant women. The high heterogeneity found in this review may reflect the different types and durations of interventions used. Notably, none of the studies in the review examined intervention effects by trimester. Future research should use larger sample sizes and assess the effects of therapy for each trimester of pregnancy.
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Affiliation(s)
- Yanti Puspita Sari
- MSN, RN, Doctoral Candidate, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan; and Assistant Professor, Maternity and Child Health Nursing Department, Faculty of Nursing, Universitas Andalas, Padang, West Sumatra, Indonesia
| | - Yu-Yun Hsu
- PhD, RN, Professor, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan
| | - Tram Thi Bich Nguyen
- MS, RN, Doctoral Student, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan; and Lecturer, Medical Simulation Center, Duy Tan University, Vietnam
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Pingeton BC, Cochran A, Goodman SH, Laurent H, Sbrilli MD, Knight B, Newport DJ, Stowe ZN. Positive affect improves a transdiagnostic model of perinatal depression symptoms. J Affect Disord 2023; 336:112-119. [PMID: 37230263 PMCID: PMC10448502 DOI: 10.1016/j.jad.2023.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Accurate measurement of perinatal depression is vital. We aimed to 1) test whether a factor that measured positive affect (PA) bettered a transdiagnostic model of depression symptoms and 2) replicate the model in a second sample. METHODS We conducted secondary analyses from two samples (n's = 657 and 142) of women in treatment at perinatal psychiatric clinics. Data were derived from items from seven commonly used measures. We compared fit indices from our original factor model-one general and six specific factors derived from the Research Domain Criteria (Loss, Potential Threat, Frustrative Nonreward, and Sleep-Wakefulness) and depression literatures (Somatic and Coping)-to our novel factor model with a PA factor. The PA factor was created by recategorizing items that measured affective states with a positive valence into a new factor. Sample 1 data were split into six perinatal periods. RESULTS In both samples, the addition of a PA factor improved model fit. At least partial metric invariance was found between perinatal periods, with the exception of trimester 3 - postpartum period 1. LIMITATIONS Our measures did not operationalize PA in the same way as in the positive valence system in RDoC and we were unable to perform longitudinal analyses on our cross-validation sample. CONCLUSIONS Clinicians and researchers are encouraged to consider these findings as a template for understanding symptoms of depression in perinatal patients, which can be used to guide treatment planning and the development of more effective screening, prevention, and intervention tools to prevent deleterious outcomes.
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Affiliation(s)
- Blaire C Pingeton
- Department of Psychology, Emory University, United States of America.
| | - Amy Cochran
- Department of Mathematics, Department of Population Health Sciences, University of Wisconsin, United States of America
| | - Sherryl H Goodman
- Department of Psychology, Emory University, United States of America
| | - Heidemarie Laurent
- Department of Psychology, University of Illinois at Urbana-Champaign, United States of America
| | - Marissa D Sbrilli
- Department of Psychology, University of Illinois at Urbana-Champaign, United States of America
| | - Bettina Knight
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, United States of America
| | - D Jeffrey Newport
- Departments of Psychiatry and Behavioral Sciences and Women's Health, University of Texas at Austin Dell Medical School, United States of America
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin at Madison, United States of America
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Yang JM, Ye H, Long Y, Zhu Q, Huang H, Zhong YB, Luo Y, Yang L, Wang MY. Effects of Web-Based Mindfulness-Based Interventions on Anxiety, Depression, and Stress Among Frontline Health Care Workers During the COVID-19 Pandemic: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e44000. [PMID: 37527546 PMCID: PMC10467633 DOI: 10.2196/44000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/28/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Since 2019, the COVID-19 outbreak has spread around the world, and health care workers, as frontline workers, have faced tremendous psychological stress. OBJECTIVE The purpose of this study is to explore whether web-based mindfulness-based interventions continue to have a positive impact on anxiety, depression, and stress among health care workers during the COVID-19 pandemic. METHODS The inclusion criteria were as follows: (1) participants were frontline health care workers during the COVID-19 pandemic; (2) the experimental group was a web-based mindfulness-based intervention; (3) the control group used either general psychological intervention or no intervention; (4) outcome indicators included scales to assess anxiety, depression, and stress; and (5) the study type was a randomized controlled study. Studies that did not meet the above requirements were excluded. We searched 9 databases, including Web of Science, Embase, PubMed, Cochrane Library, Scopus, ScienceDirect, SinoMed, China National Knowledge Infrastructure (CNKI), and Wanfang Database, for randomized controlled studies on the effects of web-based mindfulness-based interventions on common mental disorder symptoms among health care workers from January 1, 2020, to October 20, 2022. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database scale. The Cochrane risk of bias tool was used to assess the risk of bias. Subgroup analysis was used to look for sources of heterogeneity and to explore whether the results were the same for subgroups under different conditions. Sensitivity analysis was used to verify the stability of the pooled results. RESULTS A total of 10 randomized controlled studies with 1311 participants were included. The results showed that web-based mindfulness-based interventions were effective in reducing the symptoms of anxiety (standard mean difference [SMD]=-0.63, 95% CI -0.96 to -0.31, P<.001, I2=87%), depression (SMD=-0.52, 95% CI -0.77 to -0.26, P<.001, I2=75%), and stress (SMD=-0.20, 95% CI -0.35 to -0.05, P=.01, I2=58%) among health care workers during the COVID-19 pandemic, but with wide CIs and high heterogeneity. CONCLUSIONS Web-based mindfulness-based interventions may be effective in reducing the symptoms of anxiety, depression, and stress among frontline health care workers during the COVID-19 pandemic. However, this effect is relatively mild and needs to be further explored by better studies in the future. TRIAL REGISTRATION PROSPERO CRD42022343727; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343727.
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Affiliation(s)
- Jia-Ming Yang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Gannan Medical University, Ganzhou, China
| | - Hua Ye
- Gannan Medical University, Ganzhou, China
| | - Yi Long
- Gannan Medical University, Ganzhou, China
| | - Qiang Zhu
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Hui Huang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yan-Biao Zhong
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou, China
| | - Yun Luo
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou, China
| | - Lei Yang
- Department of Rehabilitation Medicine, The Second People's Hospital of Kunming, Kunming, China
- Department of Geriatric Medicine, The Second People's Hospital of Kunming, Kunming, China
- Kunming Institute of Geriatrics, The Second People's Hospital of Kunming, Kunming, China
| | - Mao-Yuan Wang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou, China
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Rådmark L, Osika W, Wallén MB, Nissen E, Lönnberg G, Bränström R, Henje E, Gardner R, Fransson E, Karlsson H, Niemi M. Autonomic function and inflammation in pregnant women participating in a randomized controlled study of Mindfulness Based Childbirth and Parenting. BMC Pregnancy Childbirth 2023; 23:237. [PMID: 37038176 PMCID: PMC10084615 DOI: 10.1186/s12884-023-05528-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 03/16/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Pregnancy and childbirth are significant events in many women's lives, and the prevalence of depressive symptoms increases during this vulnerable period. Apart from well documented cognitive, affective, and somatic symptoms, stress and depression are associated with physiological changes, such as reduced heart-rate variability (HRV) and activation of the inflammatory response system. Mindfulness Based Interventions may potentially have an effect on both HRV, inflammatory biomarkers, and self-assessed mental health. Therefore, the aim of this study was to assess the effects of a Mindfulness Childbirth and Parenting (MBCP) intervention on HRV, serum inflammatory marker levels, through an RCT study design with an active control group. METHODS This study is a sub-study of a larger RCT, where significant intervention effects were found on perinatal depression (PND) and perceived stress. Participants were recruited through eight maternity health clinics in Stockholm, Sweden. In this sub-study, we included altogether 80 women with increased risk for PND, and blood samples and HRV measures were available from 60 of the participants (26 in the intervention and 34 in the control group). RESULTS Participants who received MBCP reported a significantly larger reduction in perceived stress and a significantly larger increase in mindfulness, compared to participants who received the active control treatment. However, in this sub-study, the intervention had no significant effect on PND, inflammatory serum markers or measures of HRV. CONCLUSIONS No significant differences were found regarding changes in HRV measures and biomarkers of inflammation, larger studies may be needed in the future. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02441595 . Registered 12 May 2015 - Retrospectively registered.
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Affiliation(s)
- Lina Rådmark
- Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, CSS, Center for Social Sustainability, Karolinska Institutet, Alfred Nobels allé 23, 141 83, Huddinge, Sweden
| | - Walter Osika
- Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, CSS, Center for Social Sustainability, Karolinska Institutet, Alfred Nobels allé 23, 141 83, Huddinge, Sweden
- Northern Stockholm Psychiatry, Stockholm Health Care Services, Vårdvägen 1, 112 81, Stockholm, Sweden
| | | | - Eva Nissen
- Karolinska Institutet, Department Women's and Children's Health, Stockholm, Sweden
| | - Gunilla Lönnberg
- Karolinska Institutet, Department Women's and Children's Health, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, 752 37, Uppsala, Sweden
| | - Richard Bränström
- Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Eva Henje
- Department of Clinical Science, Child and Adolescent Psychiatry, Umeå University, 901 85, Umeå, Sweden
| | - Renee Gardner
- Department of Global Public Health, Karolinska Institutet, Solnavägen 1 E, 10431, Stockholm, Sweden
| | - Emma Fransson
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solnavägen 9, 171 65, Stockholm, Sweden
- Department of Women´s and Children´s Health, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden
| | - Håkan Karlsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Maria Niemi
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, CSS, Center for Social Sustainability, Karolinska Institutet, Alfred Nobels allé 23, 141 83, Huddinge, Sweden.
- Department of Global Public Health, Karolinska Institutet, Solnavägen 1 E, 10431, Stockholm, Sweden.
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Leng LL, Yin XC, Ng SM. Mindfulness-based intervention for clinical and subthreshold perinatal depression and anxiety: A systematic review and meta-analysis of randomized controlled trial. Compr Psychiatry 2023; 122:152375. [PMID: 36841089 DOI: 10.1016/j.comppsych.2023.152375] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/21/2023] [Accepted: 01/28/2023] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES About one in four mothers will experience depression and anxiety during pregnancy and within their first year following childbirth. The meta-analysis aggregated the findings of randomized controlled trials (RCTs) evaluating the immediate post-intervention and maintenance effects of MBI on perinatal depression and anxiety. METHODS A systematic search was conducted in PubMed, PsycINFO, Medline, Scopus, and Web of Science for English-language journal articles from the first available date until Oct 27th, 2022. RESULTS Twenty-five published RCTs were identified and reviewed, with a total of 2495 perinatal women. MBI was superior to controls for clinical and subthreshold perinatal depression and anxiety. The benefit for depression reduction was stable over time and sustained to the postpartum period, but the maintenance effect on perinatal anxiety was less conclusive. Moreover, MBI's post-intervention effects on depression and anxiety were moderated by perinatal women's symptom severity. The post intervention effects were significantly greater among women in Low- and Middle-Income countries, where perinatal mental health care is less available and accessible. Greater improvement in mindfulness was also associated with a significantly larger post-intervention effect on perinatal depression. CONCLUSIONS This meta-analysis suggests that MBIs may complement and extend the available range of effective interventions for clinical and subthreshold perinatal depression and anxiety.
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Affiliation(s)
- Ling Li Leng
- The Department of Sociology, Zhejiang University, Hangzhou, China.
| | - Xi Can Yin
- School of Humanities, Southeast University, Nanjing, China
| | - Siu Man Ng
- Social Work and Social Administration Department, The University of Hong Kong, China
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Zhang X, Lin P, Sun J, Sun Y, Shao D, Cao D, Cao F. Prenatal stress self-help mindfulness intervention via social media: a randomized controlled trial. J Ment Health 2023; 32:206-215. [PMID: 34264775 DOI: 10.1080/09638237.2021.1952947] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prenatal stress is a pressing issue. However, there is a lack of robust evidence for psychosocial interventions to manage this problem. AIMS This study aimed to examine the effectiveness of a mindfulness-based intervention on reducing prenatal stress compared to participation in health education groups. METHODS A randomized controlled trial was conducted in a prenatal clinic of comprehensive tertiary care from April to October 2017. A total of 108 pregnant women were randomly assigned to an intervention or a control group. Participants completed self-report measures of depression, anxiety, perceived stress, fatigue, positive and negative affect, and mindfulness before, immediately after, and 15 weeks after the 4-week intervention period. Generalized estimating equations were used to analyze the intervention outcomes. RESULTS The results supported greater improvement in terms of perceived stress (Wald χ2=26.94, p<0.001), fatigue (Wald χ2=17.61, p<0.001), positive affect (Wald χ2=9.03, p = 0.011), negative affect (Wald χ2=11.37, p = 0.003), and mindfulness (Wald χ2=24.97, p<0.001) in the intervention group than in the control group. CONCLUSIONS The self-help mindfulness intervention decreased prenatal stress and negative affect and improved positive affect and mindfulness.
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Affiliation(s)
- Xuan Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Pingzhen Lin
- The First Hospital of Quanzhou, Quanzhou, Fujian Province, China
| | - Jiwei Sun
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Yaoyao Sun
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Di Shao
- School of Health Care Management of Shandong University, Jinan, Shandong Province, China
| | - Danfeng Cao
- Shandong Province Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Fenglin Cao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
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11
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Wang S, Zhang C, Sun M, Zhang D, Luo Y, Liang K, Xu T, Pan X, Zheng R, Shangguan F, Wang J. Effectiveness of mindfulness training on pregnancy stress and the hypothalamic-pituitary-adrenal axis in women in China: A multicenter randomized controlled trial. Front Psychol 2023; 14:1073494. [PMID: 36935954 PMCID: PMC10018028 DOI: 10.3389/fpsyg.2023.1073494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction In the past two decades, mindfulness-based intervention programs have gradually become popular.Many studies have confirmed that these programs can effectively alleviate prenatal stress and negative emotion.The mindfulness-based stress-buffering hypothesis suggests that mindfulness training can induce changes in the levels of the cortisol secreted by the HPA axis, thereby reducing stress susceptibility. However, to date, only a few high-quality evidence-based medical studies have analyzed the effect of the mindfulness-based intervention in a maternal population.Thus, this study investigated the effects of a mindfulness-based psychosomatic intervention on pregnancy stress and the HYPERLINK "javascript:;" hypothalamic-pituitary-adrenal (HPA) axis of pregnant Chinese women. Methods Women experiencing first-time pregnancy (n = 117) were randomly allocated to the intervention group or parallel active control group, and data were collected at baseline and post-intervention periods. The participants completed questionnaires regarding mindfulness and pregnancy stress. Saliva samples was collected at the time of waking up, and 30, 45, and 60 min after waking up for analyzing the salivary cortisol levels. We analyzed differences between the two groups and changes within the same group before and after the intervention. Results and discussion A total of 95 participants completed the trial. Compared with the parallel active control group, the intervention group exhibited lower levels of stress after the intervention (P = 0.047). For HPA-axis-related indicators after the intervention, Delta value (P = 0.01) and AUCM value (P = 0.031) of the intervention group were significantly higher than that of the control group. Mindfulness-based interventions effectively reduced the level of pregnancy stress and adjusted the HPA axis function in pregnant women in China. Clinical Trial Registration https://www.chictr.org.cn, identifier ChiCTR 2000033149.
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Affiliation(s)
- Shulei Wang
- National Center for Women and Children’s Health, China CDC, Beijing, China
- Yantai Center for Disease Control and Prevention, Yantai, Shandong, China
| | - Chen Zhang
- Fengtai Mental Health Center, Beijing, China
- School of Psychology, Capital Normal University, Beijing, China
| | - Mengyun Sun
- National Center for Women and Children’s Health, China CDC, Beijing, China
| | - Daming Zhang
- Shanxi Maternal and Child Health Hospital, Taiyuan, Shanxi, China
| | - Ying Luo
- Shandong Maternal and Child Health Hospital, Jinan, Shandong, China
| | - Kairu Liang
- Sichuan Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Tao Xu
- National Center for Women and Children’s Health, China CDC, Beijing, China
| | - XiaoPing Pan
- National Center for Women and Children’s Health, China CDC, Beijing, China
| | - Ruimin Zheng
- National Center for Women and Children’s Health, China CDC, Beijing, China
- *Correspondence: Ruimin Zheng,
| | - Fangfang Shangguan
- School of Psychology, Capital Normal University, Beijing, China
- Fangfang Shangguan,
| | - Jia Wang
- Shandong Provincial Hospital, Jinan, Shandong, China
- Jia Wang,
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Van der Meulen RT, Veringa-Skiba IK, Van Steensel FJA, Bögels SM, De Bruin EI. Mindfulness-based childbirth and parenting for pregnant women with high fear of childbirth and their partners: outcomes of a randomized controlled trial assessing short- and longer-term effects on psychological well-being, birth and pregnancy experience. Midwifery 2023; 116:103545. [PMID: 36375411 DOI: 10.1016/j.midw.2022.103545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Mindfulness-Based Childbirth and Parenting (MBCP) reduces mothers' anticipated fear of childbirth (FOC), nonurgent obstetric interventions during childbirth and may improve childbirth outcomes in women with high FOC (Veringa-Skiba et al, 2022). The aim of this study was to examine the short- and longer-term outcomes of MBCP on psychological well-being, pregnancy and birth experience, as compared to enhanced care-as-usual (ECAU), in pregnant women with high FOC and their partners. DESIGN Participants were randomly assigned to MBCP or ECAU and completed questionnaires preintervention (T1), immediately after intervention (T2), two to four weeks after childbirth (T3) and 16-20 weeks after childbirth (T4). Both intention-to-treat and per-protocol analyses were conducted. SETTING The courses were provided by trained midwives. PARTICIPANTS Participants included 141 pregnant women and 120 partners. INTERVENTION MBCP comprised a nine-weekly three-hour session mindfulness group course for pregnant couples; ECAU consisted of two 90-minute individual couple consultation sessions. MEASUREMENTS Measures of psychological well-being included measures like stress, depression, anxiety and fatigue. Measures of pregnancy and birth experience concerned experiencing uplifts during pregnancy, experienced fear of childbirth, labour pain and satisfaction with childbirth. FINDINGS No differences between MBCP and ECAU in the total group of birthing women were found. However, women with (at least an onset of) labour that participated in MBCP reported a better birth experience compared to ECAU at T3. Concerning the total partner group only one difference between MBCP and ECAU was found at T4; MBCP partners reported an increase in fatigue. However, in the partner risk group (i.e., partners with lower psychological well-being before intervention) partners experienced better psychological well-being at T2 and T3 after MBCP than ECAU. KEY CONCLUSIONS MBCP and ECAU demonstrate similar effects on psychological well-being, birth and pregnancy experience. However, MBCP appears superior to ECAU for labouring women in having a better childbirth experience and for partners at risk for psychological complaints in increasing their psychological well-being. IMPLICATIONS FOR PRACTICE MBCP only positively affects the childbirth experience of those who experience (onset of) natural birth. It might be advisable to include partners at risk for psychological complaints in the MBCP.
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Affiliation(s)
- R T Van der Meulen
- University of Amsterdam, Research Institute of Child Development and Education (RICDE), Nieuwe Achtergracht 127, 1018 WS, Amsterdam, the Netherlands; UvA minds, Academic Treatment Center, Banstraat 29, 1071 JW Amsterdam, the Netherlands.
| | - I K Veringa-Skiba
- University of Amsterdam, Research Institute of Child Development and Education (RICDE), Nieuwe Achtergracht 127, 1018 WS, Amsterdam, the Netherlands
| | - F J A Van Steensel
- University of Amsterdam, Research Institute of Child Development and Education (RICDE), Nieuwe Achtergracht 127, 1018 WS, Amsterdam, the Netherlands
| | - S M Bögels
- University of Amsterdam, Research Institute of Child Development and Education (RICDE), Nieuwe Achtergracht 127, 1018 WS, Amsterdam, the Netherlands
| | - E I De Bruin
- University of Amsterdam, Research Institute of Child Development and Education (RICDE), Nieuwe Achtergracht 127, 1018 WS, Amsterdam, the Netherlands; UvA minds, Academic Treatment Center, Banstraat 29, 1071 JW Amsterdam, the Netherlands
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Shan T, Tian X. The effects of mindfulness upbringing perception on social entrepreneurship orientation: A moderated mediation model of prosocial motivation and perceived pressure from external stakeholders. Front Psychol 2022; 13:968484. [PMID: 36312148 PMCID: PMC9606459 DOI: 10.3389/fpsyg.2022.968484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022] Open
Abstract
Driven by economic and social benefits, social enterprises create new development models that combine wealth creation, social welfare provision, and environmental improvement through innovative approaches. The social entrepreneurship orientation reflects the behavioral tendency to transplant entrepreneurship orientation into the field of social value creation. It is a strategy to balance and integrate economic interests and social interests, which has a significant impact on social entrepreneurship performance. The purpose of this study is to explore the internal mechanism of the impact of social entrepreneurs’ mindfulness upbringing perception on social entrepreneur orientation. To reveal the internal mechanism, we propose a moderated and mediation model of prosocial motivation and perceived pressure from external stakeholders. In this study, random sampling was conducted among social start-ups in China. In order to improve the accuracy of the scale, a pre-survey was conducted before the formal survey. The data analysis results of the pre-survey showed that the scale in this study was suitable for the Chinese context and had good external validity. Through using survey data from social entrepreneurs in China, hierarchical regression analysis and bootstrapping model are adapted to test and verify mediation and moderation effects. The results show that mindfulness upbringing perception indeed positively influences social entrepreneurship orientation directly and partly through the mediating effect of prosocial motivation. Moreover, findings suggest the perceived pressure from external stakeholders negatively moderates not only the relationship between prosocial motivation and social entrepreneurship orientation but also the overall mediation model. This indicates that social entrepreneurs with low perceived pressure from external stakeholders will improve their social entrepreneurship orientation rapidly when their prosocial level is high. Based on these findings, we conclude that social entrepreneurship orientation may be achieved more effectively through the complex process of mindfulness upbringing perception, prosocial motivation, and perceived pressure from external stakeholders. Finally, the study proposes the theoretical and practical implications and suggestions for follow-up research.
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Li Y, Chen J, Chen B, Wang T, Wu Z, Huang X, Li S. Effect of mindfulness meditation on depression during pregnancy: A meta-analysis. Front Psychol 2022; 13:963133. [PMID: 36186359 PMCID: PMC9515986 DOI: 10.3389/fpsyg.2022.963133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study systematically evaluates the effect of mindfulness meditation on depression during pregnancy. We provide evidence-based suggestions for preventing and reducing depression during pregnancy by exploring the most effective intervention mode, cycle, and frequency of mindfulness meditation. Methods Records were retrieved from PubMed, Web of Science, EBSCO, and Science Direct. A total of 1,612 randomized controlled trial studies on the effect of mindfulness meditation on pregnancy depression were collected. 10 studies with 658 subjects meeting the inclusion criteria were extracted and analyzed by Revman 5.3 to evaluate study qualities. Stata 12.0 was used for the meta-analysis. Results Mindfulness meditation had a positive effect on depression during pregnancy [standardized difference of the mean (SMD) = -0.786, 95% confidence interval (-1.289, -0.283), P < 0.001]. Subgroup analysis showed that mindfulness-based cognitive therapy (MBCT) had the best intervention effect on depression during pregnancy (SMD = 2.795), the best intervention duration was below 4 weeks (SMD = 1.756), applied from the first to the third stage of pregnancy (SMD = 1.024), the frequency guided by experts was less than six times a week (SMD = 2.055) of <60 min each time (SMD = 1.068), and completing homework by themselves every day for 30 mins (SMD = 1.822) was most significant for the improvement of depression during pregnancy. We found high heterogeneity across studies [q = 97.003, DF = 10, I2 = 88.0% (P < 0.001), I2 > 75%]. This may be caused by variance in measurement tools, among which Beck Depression Inventory-II was a significant source of heterogeneity. Conclusion Mindfulness meditation can improve the prevention, remission, and reduction of depression during pregnancy and can be used as an auxiliary measure for the clinical treatment of pregnancy depression.
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Affiliation(s)
- Yuchao Li
- Sports Department, University of Electronic Science and Technology of China, Chengdu, China
| | - Jinghui Chen
- School of Physical Education, Sichuan University, Chengdu, China
| | - Baoxia Chen
- School of Physical Education, Sichuan University, Chengdu, China
| | - Tingting Wang
- Sports Department, Chengdu Normal Primary School Attached Huarun, Chengdu, China
| | - Zhusheng Wu
- School of Physical Education, Sichuan University, Chengdu, China
| | - Xia Huang
- School of Physical Education, Sichuan University, Chengdu, China
| | - Shanshan Li
- School of Physical Education, Sichuan University, Chengdu, China
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15
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Yan H, Wu Y, Li H. Effect of mindfulness-based interventions on mental health of perinatal women with or without current mental health issues: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord 2022; 305:102-114. [PMID: 35257692 DOI: 10.1016/j.jad.2022.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND The effectiveness of mindfulness-based interventions (MBIs) on the mental health of perinatal women with or without current mental health issues remains unclear. METHODS Four electronic databases were searched from inception to October 1, 2021. Data synthesis, sensitivity analysis, subgroup analysis, and quality assessment were performed on the included studies. I2 and Q tests were applied to evaluate heterogeneity across studies. The risk of publication bias was assessed and visualized using a funnel plot. RESULTS A total of 21 RCTs with 1765 perinatal women were enrolled in the meta-analysis. We found MBIs were effective in reducing depression, anxiety, and stress, as well as increasing mindfulness in perinatal women with current mental health issues. However, MBIs were not prior to controls in reducing depression and stress, and increasing mindfulness in perinatal women without current mental health issues. The effectiveness of MBIs on reducing anxiety in perinatal women without current mental health issues was unclear. LIMITATIONS Considerable heterogeneity was found in the pooled analyses of the RCTs in depression and anxiety in perinatal women with mental health issues and stress in perinatal women without mental health issues. CONCLUSION MBIs could serve as a useful addition to existing support for perinatal women with current mental health issues. However, further studies were needed to explore and prove the effectiveness of MBIs on the mental health of perinatal women without current mental health.
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Affiliation(s)
- Haohao Yan
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yali Wu
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha 410008, Hunan, China
| | - Huabing Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China.
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Applying mindfulness techniques to the management of perinatal women with a depressive tendency in Taiwan: A qualitative study. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:149-154. [DOI: 10.1016/j.anr.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/21/2022] Open
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Ciochoń A, Apanasewicz A, Danel DP, Galbarczyk A, Klimek M, Ziomkiewicz A, Marcinkowska UM. Antenatal Classes in the Context of Prenatal Anxiety and Depression during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095073. [PMID: 35564465 PMCID: PMC9101236 DOI: 10.3390/ijerph19095073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023]
Abstract
Perinatal maternal anxiety and depression negatively affect intrauterine fetal development, birth outcome, breastfeeding initiation, duration, and milk composition. Antenatal classes potentially reduce the anxiety of pregnant women and may thus contribute to healthy infant development. The study investigates the relationship between participation in online or in-person antenatal classes and levels of anxiety and depression in Polish women during the COVID-19 pandemic. The study group included 1774 adult, non-smoking pregnant women. We compared the state anxiety (STAI-State) and depression levels (EPDS) in women who (i) attended antenatal classes in-person, (ii) attended online classes, and (iii) did not attend any of them. The statistical analyses included a GLM model and trend analysis, while controlling for maternal trait anxiety, age, pregnancy complications, trimester of pregnancy, previous pregnancies, and COVID-19 infections. We observed statistically significant differences in the level of anxiety (and depression). Women who did attend antenatal classes in person had the lowest levels of anxiety and depression. Considering the importance of maternal mental well-being on fetal development, birth outcome, and breastfeeding, in-person participation in antenatal classes should be recommended to pregnant women.
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Affiliation(s)
- Aleksandra Ciochoń
- Department of Environmental Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-066 Kraków, Poland; (A.C.); (A.G.); (M.K.); (U.M.M.)
| | - Anna Apanasewicz
- Department of Anthropology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland; (A.A.); (D.P.D.)
| | - Dariusz P. Danel
- Department of Anthropology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland; (A.A.); (D.P.D.)
| | - Andrzej Galbarczyk
- Department of Environmental Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-066 Kraków, Poland; (A.C.); (A.G.); (M.K.); (U.M.M.)
| | - Magdalena Klimek
- Department of Environmental Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-066 Kraków, Poland; (A.C.); (A.G.); (M.K.); (U.M.M.)
| | - Anna Ziomkiewicz
- Laboratory of Anthropology, Institute of Zoology and Biomedical Research, Jagiellonian University, 30-387 Kraków, Poland
- Correspondence: ; Tel.: +48-12-6645070
| | - Urszula M. Marcinkowska
- Department of Environmental Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-066 Kraków, Poland; (A.C.); (A.G.); (M.K.); (U.M.M.)
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Mellner C, Osika W, Niemi M. Mindfulness practice improves managers’ job demands-resources, psychological detachment, work-nonwork boundary control, and work-life balance – a randomized controlled trial. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2022. [DOI: 10.1108/ijwhm-07-2021-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeContemporary workplaces undergo frequent reorganizations in order to stay competitive in a working life characterized by globalization, digitalization, economic uncertainty, and ever-increased complexity. Managers are in the frontline of these challenges, leading themselves, organizations and their employees in high stress environments. This raises questions on how to support managers’ work-life sustainability, which is crucial for organizational sustainability. Mindfulness has been related to enhanced capacities to cope with challenges that are associated with organizational change. The authors evaluated short- and long-term effects of an eight-week mindfulness-based intervention in a company setting, which was going through reorganization.Design/methodology/approachForty managers (42.5% males), mean age 54.53 (SD 5.13), were randomized to the mindfulness intervention or a non-active wait-list control. Self-report data were provided on individual sustainability factors in a work context: job demands and resources, psychological detachment, i.e. possibilities for letting go of work-related thoughts during leisure, control over work-nonwork boundaries, work-life balance, and mindfulness at baseline, postintervention, and at 6-month follow-up.FindingsLinear mixed models (LMMs) analysis (all ps < 0.005 to 0.05) showed that the intervention group had a larger decrease in job demands and a smaller decrease in job resources, a larger increase in psychological detachment, work-nonwork boundary control, work-life balance, and mindfulness from baseline to postintervention when compared with the reference group. These initial effects were sustained at 6-month follow-up.Originality/valueThe study provides evidence that mindfulness practice can enhance managers’ long-term capacity to cope with challenging working conditions, and increase their work-life sustainability in times of organizational change and disruption.
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Veringa‐Skiba IK, de Bruin EI, van Steensel FJA, Bögels SM. Fear of childbirth, nonurgent obstetric interventions, and newborn outcomes: A randomized controlled trial comparing mindfulness-based childbirth and parenting with enhanced care as usual. Birth 2022; 49:40-51. [PMID: 34250636 PMCID: PMC9292241 DOI: 10.1111/birt.12571] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether mindfulness-based childbirth and parenting (MBCP) or enhanced care as usual (ECAU) for expectant couples decreases fear of childbirth (FOC) and nonurgent obstetric interventions during labor and improves newborn outcomes. DESIGN Randomized controlled trial. SETTING Midwifery settings, the Netherlands, April 2014-July 2017. POPULATION Pregnant women with high FOC (n = 141) and partners. METHODS Allocation to MBCP or ECAU. Hierarchical multilevel and intention-to-treat (ITT) and per-protocol (PP) analyses. MAIN OUTCOME MEASURES Primary: pre-/postintervention FOC, labor anxiety disorder, labor pain (catastrophizing and acceptance), and preferences for nonurgent obstetric interventions. Secondary: rates of epidural analgesia (EA), self-requested cesarean birth (sCB), unmedicated childbirth, and 1- and 5-minute newborn's Apgar scores. RESULTS MBCP was significantly superior to ECAU in decreasing FOC, catastrophizing of labor pain, preference for nonurgent obstetric interventions, and increasing acceptance of labor pain. MBCP participants were 36% less likely to undergo EA (RR 0.64, 95% CI [0.43-0.96]), 51% less likely to undergo sCB (RR 0.49, 95% CI [0.36-0.67]), and twice as likely to have unmedicated childbirth relative to ECAU (RR 2.00, 95% CI [1.23-3.20]). Newborn's 1-minute Apgar scores were higher in MBCP (DM -0.39, 95% CI [-0.74 to -0.03]). After correction for multiple testing, results remained significant in ITT and PP analyses, except EA in ITT analyses and 1-minute Apgar. CONCLUSIONS MBCP for pregnant couples reduces mothers' fear of childbirth, nonurgent obstetric interventions during childbirth and may improve childbirth outcomes. MBCP adapted for pregnant women with high FOC and their partners appears an acceptable and effective intervention for midwifery care.
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Affiliation(s)
- Irena K. Veringa‐Skiba
- Research Institute of Child Development and Education (RICDE)Research Priority Area YieldUniversity of AmsterdamAmsterdamthe Netherlands
| | - Esther I. de Bruin
- Research Institute of Child Development and Education (RICDE)Research Priority Area YieldUniversity of AmsterdamAmsterdamthe Netherlands,UvA‐mindsAcademic Center of the University of AmsterdamAmsterdamthe Netherlands
| | - Francisca J. A. van Steensel
- Research Institute of Child Development and Education (RICDE)Research Priority Area YieldUniversity of AmsterdamAmsterdamthe Netherlands
| | - Susan M. Bögels
- Research Institute of Child Development and Education (RICDE)Research Priority Area YieldUniversity of AmsterdamAmsterdamthe Netherlands
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Loucks EB, Crane RS, Sanghvi MA, Montero-Marin J, Proulx J, Brewer JA, Kuyken W. Mindfulness-Based Programs: Why, When, and How to Adapt? Glob Adv Health Med 2022; 11:21649561211068805. [PMID: 35127272 PMCID: PMC8811951 DOI: 10.1177/21649561211068805] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022] Open
Abstract
This paper provides a framework for understanding why, when and how to adapt mindfulness-based programs (MBPs) to specific populations and contexts, based on research that developed and adapted multiple MBPs. In doing so, we hope to support teachers, researchers and innovators who are considering adapting an MBP to ensure that changes made are necessary, acceptable, effective, cost-effective, and implementable. Specific questions for reflection are provided such as (1) Why is an adaptation needed? (2) Does the theoretical premise underpinning mainstream MBPs extend to the population you are considering? (3) Do the benefits of the proposed adaptation outweigh the time and costs involved to all in research and implementation? (4) Is there already an evidenced-based approach to address this issue in the population or context? Fundamental knowledge that is important for the adaptation team to have includes the following: (1) essential ingredients of MBPs, (2) etiology of the target health outcome, (3) existing interventions that work for the health outcome, population, and context, (4) delivery systems and settings, and (5) culture, values, and communication patterns of the target population. A series of steps to follow for adaptations is provided, as are case examples. Adapting MBPs happens not only by researchers, but also by MBP teachers and developers, who endeavor to best serve the populations and contexts they work within. We hope that these recommendations for best practice provide a practical framework for skilfully understanding why, when, and how to adapt MBPs; and that this careful approach to adaptation maximizes MBP safety and efficacy.
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Affiliation(s)
- Eric B. Loucks
- Department of Epidemiology, Brown University School of Public
Health, Providence, RI, USA
- Department of Behavioral and Social
Sciences, Brown University School of Public
Health, Providence, RI, USA
- Mindfulness Center, Brown University, Providence, RI, USA
| | - Rebecca S. Crane
- Centre for Mindfulness Research and
Practice, School of Psychology, Bangor University, Bangor, UK
| | | | - Jesús Montero-Marin
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Mindfulness Centre, Oxford University, Oxford, UK
| | - Jeffrey Proulx
- Department of Behavioral and Social
Sciences, Brown University School of Public
Health, Providence, RI, USA
- Mindfulness Center, Brown University, Providence, RI, USA
| | - Judson A. Brewer
- Department of Behavioral and Social
Sciences, Brown University School of Public
Health, Providence, RI, USA
- Mindfulness Center, Brown University, Providence, RI, USA
| | - Willem Kuyken
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Mindfulness Centre, Oxford University, Oxford, UK
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Veringa-Skiba IK, Ziemer K, de Bruin EI, de Bruin EJ, Bögels SM. Mindful awareness as a mechanism of change for natural childbirth in pregnant women with high fear of childbirth: a randomised controlled trial. BMC Pregnancy Childbirth 2022; 22:47. [PMID: 35045820 PMCID: PMC8767678 DOI: 10.1186/s12884-022-04380-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/04/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Mindfulness-Based Childbirth and Parenting (MBCP) is effective in increasing natural childbirth in pregnant women with high fear of childbirth (FOC) as compared to enhanced care as usual (ECAU). We aimed to examine through which pathway of action MBCP reaches this effect, based on a model of approaching or avoiding the challenges related to childbirth. METHODS One hundred eleven pregnant women with high FOC were measured pre- and post-intervention on FOC (emotion pathway), catastrophic beliefs about labour pain (cognition pathway) and mindful awareness (attention pathway). A multiple mediation model was used to examine through which pathway the mechanism of change operated in relation to approach (i.e., natural childbirth) versus avoidance (i.e., self-requested caesarean section). RESULTS It was found that greater mindful awareness (18% R2 = 0.18, F[1107] = 22.77, p < 0.0001) was the only significant mechanism of change operating through the attentional pathway leading to natural childbirth. More specifically, nonreactivity to inner experience (a facet of mindful awareness) showed to be the strongest mechanism of change. More extensive meditation practice was positively associated with natural childbirth; however, the number of completed MBCP sessions was not associated with the outcome. CONCLUSIONS An increase in mindful awareness was the strongest mechanism of change for better adaptation to the challenges of childbirth. Decreases in neither FOC nor catastrophic beliefs about labour pain were identified as mechanisms of change. Additionally, the more one meditated, the more one was inclined towards a natural childbirth. MBCP enhances adaptation to the challenges of childbirth and less use of obstetric interventions in the presence of high FOC. TRIAL REGISTRATION The Netherlands Trial Register (NTR; 4302 ).
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Affiliation(s)
- Irena K Veringa-Skiba
- Research Institute of Child Development and Education (RICDE), 8 Faculty of Social and Behavioural Sciences, University of Amsterdam, Research Priority Area Yield, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands.
| | - Kelly Ziemer
- Research Institute of Child Development and Education (RICDE), 8 Faculty of Social and Behavioural Sciences, University of Amsterdam, Research Priority Area Yield, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
- University of California-Berkeley, School of Social Welfare, Haviland Hall, Berkeley, CA, 94709, USA
| | - Esther I de Bruin
- Research Institute of Child Development and Education (RICDE), 8 Faculty of Social and Behavioural Sciences, University of Amsterdam, Research Priority Area Yield, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
- UvA-minds, Academic Treatment Center of the University of Amsterdam, Banstraat 29, 1071 JW, Amsterdam, The Netherlands
| | - Ed J de Bruin
- UvA-minds, Academic Treatment Center of the University of Amsterdam, Banstraat 29, 1071 JW, Amsterdam, The Netherlands
- Department of Psychology, Health & Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Susan M Bögels
- Research Institute of Child Development and Education (RICDE), 8 Faculty of Social and Behavioural Sciences, University of Amsterdam, Research Priority Area Yield, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
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22
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Klatter CK, van Ravesteyn LM, Stekelenburg J. Is collaborative care a key component for treating pregnant women with psychiatric symptoms (and additional psychosocial problems)? A systematic review. Arch Womens Ment Health 2022; 25:1029-1039. [PMID: 36163596 PMCID: PMC9734206 DOI: 10.1007/s00737-022-01251-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/23/2022] [Indexed: 12/14/2022]
Abstract
Mental disorders during pregnancy are common, with long-lasting negative effects on mother and child. Treatment of these women is challenging, because of the high incidence of additional psychosocial problems and barriers on population and healthcare level. Collaborative care, collaboration between mental health and obstetric care professionals, may help to overcome these problems. The aim of this review is to review antenatal mental health interventions and analyse the impact of collaborative care. Two independent reviewers searched for RCT's in PubMed, Embase and PsycINFO. Trials studying the effect of psychological or pharmacological interventions on the mental health of pregnant women with psychiatric symptoms (and psychosocial problems) were eligible for inclusion. Two reviewers independently abstracted data and assessed study quality and risk of bias. Each study was scored on collaborative care criteria: multi-professional approach to patient care, structured management plan, scheduled patient follow-ups and enhanced interprofessional communication. Thirty-five studies were included. Most trials studied the effect of cognitive behavioural therapy and interpersonal psychotherapy on antenatal depression. Almost all interventions met at least one collaborative care criteria. Interventions were mostly provided by multiple professionals, but interprofessional communication rarely took place. Interventions that met more criteria did not more often show a positive effect on maternal mental health. There is lack of research on antenatal psychiatric disorders other than depressive and on long-term treatment outcomes. Collaborative care is partly implemented in most current interventions, but more trials (including interprofessional communication) are needed to be conclusive whether collaborative care is a key component in antenatal mental healthcare.
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Affiliation(s)
- Celine K Klatter
- Department of Global Health, Medical Sciences, University of Groningen/University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands.
| | - Leontien M van Ravesteyn
- Department of Global Health, Medical Sciences, University of Groningen/University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Jelle Stekelenburg
- Department of Global Health, Medical Sciences, University of Groningen/University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
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Lindgren H, Rådestad I, Pettersson K, Skokic V, Akselsson A. Epidural use among women with spontaneous onset of labour - an observational study using data from a cluster-randomised controlled trial. Midwifery 2021; 103:103156. [PMID: 34634721 DOI: 10.1016/j.midw.2021.103156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 08/11/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate whether the proportion of pregnant women who use epidural analgesia during birth differed between women registered at a maternity clinic randomised to Mindfetalness or to routine care. DESIGN An observational study including women born in Sweden with singleton pregnancies, with spontaneous onset of labour from 32 weeks' gestation. Data used from a cluster-randomised controlled trial applying the intention-to-treat principle in 67 maternity clinics where women were randomised to Mindfetalness or to routine care. ClinicalTrials.gov (NCT02865759). INTERVENTIONS Midwives were instructed to distribute a leaflet about Mindfetalness to pregnant women at 25 weeks' gestation. Mindfetalness is a self-assessment method for the woman to use to become familiar with the unborn baby's fetal movement pattern. When practising the method in third trimester, the women are instructed to daily lie down on their side, when the baby is awake, and focus on the movements' intensity, character and frequency (but not to count each movement). FINDINGS Of the 18 501 women with spontaneous onset of labour, 47 percent used epidural during birth. Epidural was used to a lower extent among women registered at a maternity clinic randomised to Mindfetalness than women in the routine-care group (46.2% versus 47.8%, RR 0.97, CI 0.94-1.00, p= 0.04). Epidural was more common among primiparous women, women younger than 35 years, those with educational levels below university, with BMI ≥25 and with a history of receiving psychiatric care or psychological treatment for mental illness. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Pregnant women who were informed about a self-assessment method, with the aim of becoming familiar with the unborn baby's fetal movement pattern, used epidural to a lower extent than women who were not informed about the method. Future studies are needed to investigate and understand the association between Mindfetalness and the reduced usage of epidural during birth.
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Affiliation(s)
- Helena Lindgren
- Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | | | - Karin Pettersson
- Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
| | - Viktor Skokic
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anna Akselsson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.
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Wang DN, Weng XL, Gao LL. Mindfulness-based intervention in Chinese pregnant women with recurrent miscarriage: A non-randomized controlled study. Midwifery 2021; 103:103152. [PMID: 34601233 DOI: 10.1016/j.midw.2021.103152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/23/2021] [Accepted: 09/16/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Pregnant women with recurrent miscarriage have high rates of anxiety and depression. Mindfulness-based interventions have shown benefits in improving mental health in diverse populations; however, few studies have explored their efficacy in pregnant women with recurrent miscarriage, which was investigated in the present study. DESIGN A nonrandomized controlled study was carried out from August 2019 to November 2020. SETTING The study was conducted at a regional teaching hospital in Guangzhou, China that provides leading care for recurrent miscarriage. PARTICIPANTS A total of 158 pregnant women with recurrent miscarriage were recruited and allocated to the intervention group (n = 79) or the control group (n = 79); 131 women completed the study. INTERVENTION The mindfulness-based intervention consisted of a 1-h education session and daily mindfulness exercises guided by audio recordings during hospitalization. MEASUREMENTS AND FINDINGS Study outcomes included perceived stress measured with the Perceived Stress Scale; symptoms of anxiety and depression measured with the Self-rating Anxiety Scale and Edinburgh Postnatal Depression Scale, respectively; and positive and negative affect measured with the Positive Affect and Negative Affect Scale - Revised, respectively. Compared to the control group, participants in the intervention group showed significant decreases in perceived stress, depression symptoms, and negative affect and an increase in positive affect after the intervention. Anxiety increased significantly in the control group during the study but remained unchanged in the intervention group. KEY CONCLUSIONS A mindfulness-based intervention can reduce psychological symptoms and improve mental health in pregnant women with recurrent miscarriage. IMPLICATIONS FOR PRACTICE A mindfulness-based intervention should be incorporated into routine care to help improve the mental health of pregnant women with recurrent miscarriage.
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Affiliation(s)
- Dan-Ni Wang
- School of Nursing, Sun Yat-sen University, #74, Zhongshan Road II, Guangzhou, China, 510089.
| | - Xue-Ling Weng
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, #107, Yanjiang West Road, Guangzhou, China, 510120
| | - Ling-Ling Gao
- School of Nursing, Sun Yat-sen University, #74, Zhongshan Road II, Guangzhou, China, 510089.
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Effect of Parenting Interventions on Perinatal Depression and Implications for Infant Developmental Outcomes: A Systematic Review and Meta-Analysis. Clin Child Fam Psychol Rev 2021; 25:316-338. [PMID: 34580804 DOI: 10.1007/s10567-021-00371-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
Considering the significant impact of perinatal depression on both maternal wellbeing and infant development, it is important to examine the effectiveness of interventions designed to prevent or reduce these risks. This systematic review and meta-analysis synthesised evidence on parenting intervention in relation to how such programs affect symptoms of perinatal depression and infant outcomes within 12 months of postpartum. We followed the Cochrane Collaboration guidelines on conducting systematic reviews and meta-analyses. A total of five electronic databases were searched for controlled trials that met pre-determined eligibility criteria. Outcomes of interest were maternal depressive symptoms and infants' language, motor and socioemotional development. Seventeen studies involving 1665 participants were included in the systematic review. Estimates from a random effects model of 15 studies in the final meta-analysis revealed statistically significant reductions in maternal depressive symptoms at post-intervention for mothers allocated to receive parenting interventions (SMD = - 0.34, 95%CI - 0.44, - 0.24; z = 5.97, p < 0.001; I2 = 0%). Data on infant development outcomes from the included studies were scarce, and therefore, infant outcomes were not analysed in this review. For individual study outcomes, the majority of studies reported a general trend for reductions in maternal depressive symptoms from pre- to post-intervention. Although parenting interventions are frequently considered preventive strategies that are designed to offer support to parents and impart skills that promote their physical and psychological wellbeing, our findings suggest that these interventions have a positive effect on perinatal depressive symptoms. Implications and recommendations for future research are addressed. The systematic review protocol was registered with PROSPERO 2020 CRD42020184491.
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Trends of Perinatal Stress, Anxiety, and Depression and Their Prediction on Postpartum Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179307. [PMID: 34501906 PMCID: PMC8431252 DOI: 10.3390/ijerph18179307] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 01/22/2023]
Abstract
Perinatal stress, anxiety, and depression impacts not only women but also their child(ren). The purpose of this longitudinal study is to explore trends of stress, anxiety, and depressive symptoms from pregnancy to postpartum and understand predictions of stress and anxiety on postpartum depression. One-hundred-fifty-six women at 23-28 weeks gestation (T1), 147 at 32-36 weeks gestation (T2), 129 at over 36 weeks gestation (T3), and 83 at postpartum (T4) completed study surveys. The Perceived Stress Scale, Center for Epidemiologic Studies Depression scale, and State-Trait Anxiety Inventory were used to measure stress, depressive symptoms, and anxiety. Descriptive statistics, Pearson and Spearman's correlation, and Generalized Estimating Equation were applied to analyze the data. Results showed that levels of anxiety and depressive symptoms increased from 24 weeks gestation to postpartum, whereas stress levels decreased during pregnancy but increased in postpartum. Over half of women experienced anxiety symptoms, especially during late pregnancy and postpartum. Stress, anxiety, and depressive symptoms were inter-correlated. Notably, women at late pregnancy and postpartum were prone to stress, anxiety, and depression. Prenatal anxiety could predict postpartum depressive symptoms. Active assessment and management of stress, anxiety, and depression is needed and should begin from early pregnancy and continue until postpartum.
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Babbar S, Oyarzabal AJ, Oyarzabal EA. Meditation and Mindfulness in Pregnancy and Postpartum: A Review of the Evidence. Clin Obstet Gynecol 2021; 64:661-682. [PMID: 34162788 DOI: 10.1097/grf.0000000000000640] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Given their growing popularity, mindfulness practices including meditation are actively being studied in clinical trials to assess their efficacy at improving health outcomes during pregnancy and the postpartum period. We conducted a literature review to compile these studies and assessed their findings. There is sufficient evidence to support the practice of mindfulness practices in pregnancy to reduce anxiety, depression, and stress during pregnancy, which may continue to have beneficial effects through the postpartum period. There is limited evidence on the benefits of mindfulness and meditation for other aspects of pregnancy. However, due to the low-risk nature of these techniques, all women should be encouraged to engage in mindfulness practices during pregnancy.
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Affiliation(s)
- Shilpa Babbar
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City, Missouri
| | | | - Esteban A Oyarzabal
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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28
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The Role of Mindfulness in the Intimate Relationships and Psychological Wellbeing in Emerging Adulthood. SOCIAL SCIENCES-BASEL 2021. [DOI: 10.3390/socsci10070259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Little is known about the impact of mindfulness on psychological wellbeing, anxiety, and avoidance in couple relationships. In emerging adulthood, intimate relationships are associated with life satisfaction and changes that can cause psychological maladjustment. This study seeks to determine if dispositional mindfulness acts as a protective variable between psychological wellbeing, anxiety, and avoidance and identify the factors that are protectors. A sample was obtained of 391 young university students between 18 and 25 years old. The Five-Facet Mindfulness Questionnaire, the Ryff Scales of Psychological Wellbeing, and the Experiences in Close Relationships Scale were used. The results show that the highest levels of dispositional mindfulness are associated with greater psychological wellbeing. Dispositional mindfulness cannot act as a protective variable against anxiety and avoidance, and values were non-significant in intimate relationships. It is necessary to continue investigating the most protective facets of mindfulness for both anxiety and avoidance.
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29
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O'Connell MA, Khashan AS, Leahy-Warren P, Stewart F, O'Neill SM. Interventions for fear of childbirth including tocophobia. Cochrane Database Syst Rev 2021; 7:CD013321. [PMID: 34231203 PMCID: PMC8261458 DOI: 10.1002/14651858.cd013321.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Many women experience fear of childbirth (FOC). While fears about childbirth may be normal during pregnancy, some women experience high to severe FOC. At the extreme end of the fear spectrum is tocophobia, which is considered a specific condition that may cause distress, affect well-being during pregnancy and impede the transition to parenthood. Various interventions have been trialled, which support women to reduce and manage high to severe FOC, including tocophobia. OBJECTIVES To investigate the effectiveness of non-pharmacological interventions for reducing fear of childbirth (FOC) compared with standard maternity care in pregnant women with high to severe FOC, including tocophobia. SEARCH METHODS In July 2020, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. We contacted researchers of trials which were registered and appeared to be ongoing. SELECTION CRITERIA We included randomised clinical trials which recruited pregnant women with high or severe FOC (as defined by the individual trial), for treatment intended to reduce FOC. Two review authors independently screened and selected titles and abstracts for inclusion. We excluded quasi-randomised and cross-over trials. DATA COLLECTION AND ANALYSIS We used standard methodological approaches as recommended by Cochrane. Two review authors independently extracted data and assessed the studies for risk of bias. A third review author checked the data analysis for accuracy. We used GRADE to assess the certainty of the evidence. The primary outcome was a reduction in FOC. Secondary outcomes were caesarean section, depression, birth preference for caesarean section or spontaneous vaginal delivery, and epidural use. MAIN RESULTS We included seven trials with a total of 1357 participants. The interventions included psychoeducation, cognitive behavioural therapy, group discussion, peer education and art therapy. We judged four studies as high or unclear risk of bias in terms of allocation concealment; we judged three studies as high risk in terms of incomplete outcome data; and in all studies, there was a high risk of bias due to lack of blinding. We downgraded the certainty of the evidence due to concerns about risk of bias, imprecision and inconsistency. None of the studies reported data about women's anxiety. Participating in non-pharmacological interventions may reduce levels of fear of childbirth, as measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ), but the reduction may not be clinically meaningful (mean difference (MD) -7.08, 95% confidence interval (CI) -12.19 to -1.97; 7 studies, 828 women; low-certainty evidence). The W-DEQ tool is scored from 0 to 165 (higher score = greater fear). Non-pharmacological interventions probably reduce the number of women having a caesarean section (RR 0.70, 95% CI 0.55 to 0.89; 5 studies, 557 women; moderate-certainty evidence). There may be little to no difference between non-pharmacological interventions and usual care in depression scores measured with the Edinburgh Postnatal Depression Scale (EPDS) (MD 0.09, 95% CI -1.23 to 1.40; 2 studies, 399 women; low-certainty evidence). The EPDS tool is scored from 0 to 30 (higher score = greater depression). Non-pharmacological interventions probably lead to fewer women preferring a caesarean section (RR 0.37, 95% CI 0.15 to 0.89; 3 studies, 276 women; moderate-certainty evidence). Non-pharmacological interventions may increase epidural use compared with usual care, but the 95% CI includes the possibility of a slight reduction in epidural use (RR 1.21, 95% CI 0.98 to 1.48; 2 studies, 380 women; low-certainty evidence). AUTHORS' CONCLUSIONS The effect of non-pharmacological interventions for women with high to severe fear of childbirth in terms of reducing fear is uncertain. Fear of childbirth, as measured by W-DEQ, may be reduced but it is not certain if this represents a meaningful clinical reduction of fear. There may be little or no difference in depression, but there may be a reduction in caesarean section delivery. Future trials should recruit adequate numbers of women and measure birth satisfaction and anxiety.
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Affiliation(s)
- Maeve Anne O'Connell
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
| | | | - Fiona Stewart
- Cochrane Children and Families Network, c/o Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Sinéad M O'Neill
- School of Epidemiology and Public Health Alumna, University College Cork, Cork, Ireland
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30
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Skovbjerg S, Birk D, Bruggisser S, Wolf ALA, Fjorback L. Mindfulness-based stress reduction adapted to pregnant women with psychosocial vulnerabilities-a protocol for a randomized feasibility study in a Danish hospital-based outpatient setting. Pilot Feasibility Stud 2021; 7:118. [PMID: 34082839 PMCID: PMC8173971 DOI: 10.1186/s40814-021-00860-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022] Open
Abstract
Background This protocol is for a feasibility study of a mindfulness-based stress reduction (MBSR) program adapted for pregnant women with psychosocial vulnerabilities. The rationale for the study is the need for a wider array of evidence-based options to address prenatal mental health care needs in pregnant women. MBSR is a promising mental health intervention but has not yet been adapted for pregnant women with the aim of addressing prenatal mental health. The purpose is thus to evaluate the feasibility, acceptability, and clinical outcomes of an adapted MBSR program, prenatal MBSR, compared to usual care to inform a randomized controlled trial. Methods/design Pregnant women (n = 60) referred to an outpatient clinic at Copenhagen University Hospital, Amager and Hvidovre, Denmark, will be recruited for the study. The design is a single-center feasibility trial, with prenatal MBSR, as an add-on to usual care. The primary outcome is to assess the feasibility of a full-scale randomized controlled trial. The secondary feasibility outcome includes possible effects of the adapted MBSR program estimated by self-report questionnaires measuring stress, anxiety, depression, well-being, decentering, reflective functioning, mindfulness, and compassion. Participants will be randomized in a 1:1 ratio to prenatal MBSR or usual care. Discussion The study is part of the Good Start to Family Life study anchored at Copenhagen University Hospital, Amager and Hvidovre, Denmark. Teaching the skills of mindfulness meditation to a psychosocially vulnerable group of pregnant women could prove a viable and non-pharmacological approach to reduce stress, improve mental health, and provide support in the transition to parenthood. The outcomes of the feasibility study will inform the design of a fully powered randomized controlled trial. Trial registration ClinicalTrials.gov, NCT04571190. Registered on September 30, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00860-w.
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Affiliation(s)
- S Skovbjerg
- The Danish Center for Mindfulness, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - D Birk
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - S Bruggisser
- The Danish Center for Mindfulness, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A L A Wolf
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - L Fjorback
- The Danish Center for Mindfulness, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Zhang H, Zhang A, Liu C, Xiao J, Wang K. A Brief Online Mindfulness-Based Group Intervention for Psychological Distress Among Chinese Residents During COVID-19: a Pilot Randomized Controlled Trial. Mindfulness (N Y) 2021; 12:1502-1512. [PMID: 33758629 PMCID: PMC7972025 DOI: 10.1007/s12671-021-01618-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 12/31/2022]
Abstract
Objectives The coronavirus (COVID-19) global pandemic has increased psychological distress among the general population. The objective of this study is to evaluate a mindfulness-based intervention for psychological distress among Chinese residents during COVID-19. Methods This study used a switching replications design to test the feasibility and efficacy of a brief online mindfulness-based intervention for Chinese residents’ psychological distress. Fifty-one residents in the Hubei province were randomly allocated to two groups (experimental group and waitlist control group) with three waves of measurement at time 1, time 2, and time 3 for changes in mindfulness and psychological distress. Results In addition to significant within-group improvements over time for both groups, OLS linear regression with full information likelihood estimation revealed statistically significant between-group treatment effects across outcome domains, including mindfulness awareness, b = 2.84, p < 0.001, g = 6.92, psychological distress, b = −21.33, p < 0.001, g = 6.62, somatic symptoms, b = −6.22, p < 0.001, g = 4.42, depressive symptoms, b = −7.16, p < 0.001, g = 5.07, and anxiety symptoms, b = −8.09, p < 0.001, g = 6.84. Conclusions Results suggest that a brief online mindfulness-based intervention can be a feasible and promising intervention for improving mindfulness and decreasing psychological distress among Chinese residents staying at home during the COVID-19 outbreak. The study used a small convenience sample which led to a concern of external generalizability and with limited evaluation of long-term change.
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Affiliation(s)
- Hui Zhang
- School of Sociology, Huazhong University of Science and Technology, 1037, Luoyu Road, Hongshan District, Wuhan, China
| | - Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, MI USA
| | - Chengbin Liu
- School of Sociology, Huazhong University of Science and Technology, 1037, Luoyu Road, Hongshan District, Wuhan, China
| | - Jian Xiao
- Sinopharm Dongfeng General Hospital, Shiyan, China
| | - Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, CO USA
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Wu C, Ge Y, Zhang X, Du Y, He S, Ji Z, Lang H. The combined effects of Lamaze breathing training and nursing intervention on the delivery in primipara: A PRISMA systematic review meta-analysis. Medicine (Baltimore) 2021; 100:e23920. [PMID: 33530192 PMCID: PMC7850642 DOI: 10.1097/md.0000000000023920] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/30/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Lamaze breathing has been widely used as a breathing training method. Nursing intervention including postural nursing, delivery ball, doula nursing, massage and psychological nursing is usually provided by nurses during labor. A number of clinical studies have investigated the effect of Lamaze breathing training combined with nursing intervention on maternal pain relief and outcomes improvement. But there were some scholars who were against it. METHODS Randomized controlled trials from January 2000 to November 2019 in PubMed, Cochrance Library, Medline, Web of Science, Embase, Chinese Academic Journals, Chinese Biomedical Literature Database, VIP Database, Wanfang Database were searched. Two researchers independently screened the literature according to the criteria. After extracting the data, the researchers used Cochrane system to evaluate the literature quality. Statistical analyses were performed by using Comprehensive Meta Analysis V2 software. RESULTS Twenty-two randomized controlled trials conducted on 7035 primiparas were eligible. The results revealed that Lamaze breathing training combined with nursing intervention increased the rate of natural delivery (relative risk [RR] = 2.97, 95% confidence interval [CI] [2.48, 3.56]), shortened the length of labor (-2.604, 95% CI [-3.120, -2.087]), alleviated labor pain (RR = 0.194, 95% CI [0.115, 0.325]) and reduced postpartum bleeding (-2.966, 95% CI [-4.056, -1.877]). CONCLUSIONS Lamaze breathing training combined with nursing intervention was effective for ameliorating the process and outcomes of childbirth in primiparae and deserves to be promoted and applied in clinical practice.
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Affiliation(s)
- Chao Wu
- Air Force Medical University, Xi’an
| | | | - Xinyan Zhang
- Army 75 Group Military Hospital, Kungming, China
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Li P, Wang H, Chen G, Feng J, Fan D, Lin D, Rao J, Zhou Z, Liu Z, Guo X. Association Between Nausea and Vomiting During Pregnancy and Sleep Quality: Mediating Effect of Depressive Symptoms. Int J Gen Med 2021; 14:41-49. [PMID: 33447075 PMCID: PMC7802779 DOI: 10.2147/ijgm.s290216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Nausea and vomiting during pregnancy (NVP) of varying degrees of severity are commonly experienced by pregnant women. This paper explores the association between NVP and poor sleep quality. Patients and Methods A cross-sectional study was conducted in an obstetrics clinic. A total of 2494 pregnant women (representing a response rate of 92.7%) completed a self-administered questionnaire. Results Of the 2494 participants, the mean sleep duration was 7.76 hours, and 54.3% of them report poor sleep quality (ie, a Pittsburgh Sleep Quality Index global score > 5). In this study, 49.1%, 49.3% and 1.6% women reported mild, moderate, and severe NVP, respectively. Compare with women with mild NVP, women with moderate or severe NVP were more likely to report poor sleep quality (χ 2 = 30.16, p < 0.001). After adjusted for demographics and gestational age, moderate and severe NVP were associated with poor sleep quality (adjusted odds ratio (AOR) = 1.66, 95% confidence interval (CI) = 1.40-1.96, and AOR = 2.95, 95% CI = 1.44-6.02, respectively). Moreover, depressive symptoms mediated the association between NVP and poor sleep quality (β = 0.060, p = 0.033, 95% CI = 0.028-0.180). Conclusion Our study suggested that moderate and severe NVP increase the risk of poor sleep quality. Further studies are warranted that focus on the mechanisms of the association between NVP and poor sleep quality.
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Affiliation(s)
- Pengsheng Li
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China.,Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China
| | - Haiyan Wang
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China.,Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China
| | - Gengdong Chen
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China.,Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China
| | - Jinping Feng
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China
| | - Dazhi Fan
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China.,Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China
| | - Dongxin Lin
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China.,Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China
| | - Jiaming Rao
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China.,Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China
| | - Zixing Zhou
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China.,Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China
| | - Zhengping Liu
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China.,Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China
| | - Xiaoling Guo
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, People's Republic of China
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Galante J, Friedrich C, Dawson AF, Modrego-Alarcón M, Gebbing P, Delgado-Suárez I, Gupta R, Dean L, Dalgleish T, White IR, Jones PB. Mindfulness-based programmes for mental health promotion in adults in nonclinical settings: A systematic review and meta-analysis of randomised controlled trials. PLoS Med 2021; 18:e1003481. [PMID: 33428616 PMCID: PMC7799763 DOI: 10.1371/journal.pmed.1003481] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/10/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is an urgent need for mental health promotion in nonclinical settings. Mindfulness-based programmes (MBPs) are being widely implemented to reduce stress, but a comprehensive evidence synthesis is lacking. We reviewed trials to assess whether MBPs promote mental health relative to no intervention or comparator interventions. METHODS AND FINDINGS Following a detailed preregistered protocol (PROSPERO CRD42018105213) developed with public and professional stakeholders, 13 databases were searched to August 2020 for randomised controlled trials (RCTs) examining in-person, expert-defined MBPs in nonclinical settings. Two researchers independently selected, extracted, and appraised trials using the Cochrane Risk-of-Bias Tool 2.0. Primary outcomes were psychometrically validated anxiety, depression, psychological distress, and mental well-being questionnaires at 1 to 6 months after programme completion. Multiple testing was performed using p < 0.0125 (Bonferroni) for statistical significance. Secondary outcomes, meta-regression and sensitivity analyses were prespecified. Pairwise random-effects multivariate meta-analyses and prediction intervals (PIs) were calculated. A total of 11,605 participants in 136 trials were included (29 countries, 77% women, age range 18 to 73 years). Compared with no intervention, in most but not all scenarios MBPs improved average anxiety (8 trials; standardised mean difference (SMD) = -0.56; 95% confidence interval (CI) -0.80 to -0.33; p-value < 0.001; 95% PI -1.19 to 0.06), depression (14 trials; SMD = -0.53; 95% CI -0.72 to -0.34; p-value < 0.001; 95% PI -1.14 to 0.07), distress (27 trials; SMD = -0.45; 95% CI -0.58 to -0.31; p-value < 0.001; 95% PI -1.04 to 0.14), and well-being (9 trials; SMD = 0.33; 95% CI 0.11 to 0.54; p-value = 0.003; 95% PI -0.29 to 0.94). Compared with nonspecific active control conditions, in most but not all scenarios MBPs improved average depression (6 trials; SMD = -0.46; 95% CI -0.81 to -0.10; p-value = 0.012, 95% PI -1.57 to 0.66), with no statistically significant evidence for improving anxiety or distress and no reliable data on well-being. Compared with specific active control conditions, there is no statistically significant evidence of MBPs' superiority. Only effects on distress remained when higher-risk trials were excluded. USA-based trials reported smaller effects. MBPs targeted at higher-risk populations had larger effects than universal MBPs. The main limitation of this review is that confidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is moderate to very low, mainly due to inconsistency and high risk of bias in many trials. CONCLUSIONS Compared with taking no action, MBPs of the included studies promote mental health in nonclinical settings, but given the heterogeneity between studies, the findings do not support generalisation of MBP effects across every setting. MBPs may have specific effects on some common mental health symptoms. Other preventative interventions may be equally effective. Implementation of MBPs in nonclinical settings should be partnered with thorough research to confirm findings and learn which settings are most likely to benefit.
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Affiliation(s)
- Julieta Galante
- University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge, United Kingdom
| | | | | | - Marta Modrego-Alarcón
- University of Zaragoza, Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
| | | | - Irene Delgado-Suárez
- University of Zaragoza, Zaragoza, Spain
- Institute of Medical Research Aragón, Zaragoza, Spain
| | | | - Lydia Dean
- University of Cambridge, Cambridge, United Kingdom
| | - Tim Dalgleish
- University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Ian R White
- University College London, London, United Kingdom
| | - Peter B Jones
- University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
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Abstract
Women's subjective childbirth experience is a risk factor for postpartum depression and childbirth-related posttraumatic stress symptoms. Subjective childbirth experience is influenced not only by characteristics of the childbirth itself but also by maternal characteristics. A maternal characteristic that may be associated with a more positive childbirth experience is trait mindfulness. The current study aimed to assess this association and to assess whether trait mindfulness during pregnancy had a moderating role in the possible association between non-spontaneous delivery and perception of childbirth. A subsample of 486 women, participating in a longitudinal prospective cohort study (Holistic Approach to Pregnancy and the first Postpartum Year study), completed the Three Facet Mindfulness Questionnaire-Short Form at 22 weeks of pregnancy. Women completed the Childbirth Perception Scale and the Edinburgh Postnatal Depression Scale between 7 and 21 days postpartum. The mindfulness facets acting with awareness and non-reacting were significantly associated with a more positive perception of childbirth, after adjusting for covariates. Moderation analyses showed a significant interaction between acting with awareness and non-spontaneous delivery and non-judging and non-spontaneous delivery. Non-spontaneous delivery was associated with a more negative perception of childbirth for low/medium scores of acting with awareness and non-judging, but not for high scores on these mindfulness facets. Trait mindfulness during pregnancy may enhance a positive perception of childbirth. Because this is among the first studies examining the association between maternal dispositional mindfulness and perception of childbirth, future research is needed to confirm the results of the current study.
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Guo P, Zhang X, Liu N, Wang J, Chen D, Sun W, Li P, Zhang W. Mind-body interventions on stress management in pregnant women: A systematic review and meta-analysis of randomized controlled trials. J Adv Nurs 2020; 77:125-146. [PMID: 33048358 DOI: 10.1111/jan.14588] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022]
Abstract
AIM To quantify the effect of mind-body interventions on stress in pregnant women. DESIGN A systematic review and meta-analysis of randomized controlled trials was performed. DATA SOURCES PubMed, Embase, CENTRAL, Web of Science and PsycINFO were searched from each database inception to January 2020. REVIEW METHODS Randomized controlled trials regarding mind-body interventions for stress in pregnant women were included. Methodological quality was evaluated using the Cochrane Collaboration 'Risk of Bias' tool and meta-analysis was performed via RevMan 5.3. Subgroup analysis and publication bias assessment were conducted. Post hoc sensitivity analysis was performed to investigate the source of heterogeneity. RESULTS In total, 28 studies comprising 1944 participants were included. The overall meta-analysis showed that antenatal stress of pregnant women in the mind-body interventions groups showed significant high improvements (SMD=-0.94; 95% CI [-1.25, -0.63]; p < .00001) compared with the control groups. Results of subgroup analyses indicated that all types of mind-body interventions including mindfulness intervention, cognitive behavioural therapy, relaxation techniques and yoga were beneficial to antenatal stress. Both groups and individual formats mind-body interventions were effective. 4-8 weeks mind-body interventions were seemed as the optimal choice. Moreover, mind-body interventions were concomitant with reducing antenatal anxiety and depression. CONCLUSION Mind-body interventions are promising approaches for stress reduction in pregnant women. Nevertheless, the results should be interpreted with caution because of high heterogeneity and publication bias. Further high-quality studies are needed to verify the findings. IMPACT Mind-body interventions have been widely implemented to ameliorate antenatal stress, but conflicting results were found across studies. This systematic review and meta-analysis suggested that mind-body interventions are relatively safe and convenient and can successfully promote antenatal stress. The suggestions proposed in this review may be useful for developing a scientific mind-body interventions regimen and encouraging the application of mind-body interventions in pregnant women, thereby managing antenatal stress effectively.
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Affiliation(s)
- Pingping Guo
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Xuehui Zhang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Na Liu
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Jie Wang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Dandan Chen
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Weijia Sun
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Ping Li
- Department of Developmental Pediatrics, Second Hospital of Jilin University, Changchun, Jilin, China
| | - Wei Zhang
- School of Nursing, Jilin University, Changchun, Jilin, China
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Akselsson A, Lindgren H, Georgsson S, Pettersson K, Steineck G, Skokic V, Rådestad I. Mindfetalness to increase women's awareness of fetal movements and pregnancy outcomes: a cluster-randomised controlled trial including 39 865 women. BJOG 2020; 127:829-837. [PMID: 31971325 DOI: 10.1111/1471-0528.16104] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine whether a method for raising women's awareness of fetal movements, Mindfetalness, can affect pregnancy outcomes. DESIGN Cluster-randomised controlled trial. SETTING Sixty-seven maternity clinics in Stockholm, Sweden. POPULATION Women with singleton pregnancy with birth from 32 weeks' gestation. METHODS Women registered at a clinic randomised to Mindfetalness were assigned to receive a leaflet about Mindfetalness (n = 19 639) in comparison with routine care (n = 20 226). Data were collected from a population-based register. MAIN OUTCOME MEASURES Apgar score <7 at 5 minutes after birth, visit to healthcare due to decrease in fetal movements. Other outcomes: Apgar score <4 at 5 minutes after birth, small-for-gestational-age and mode of delivery. RESULTS No difference (1.1 versus 1.1%, relative risk [RR] 1.0; 95% CI 0.8-1.2) was found between the Mindfetalness group and the Routine care group for a 5-minute Apgar score <7. Women in the Mindfetalness group contacted healthcare more often due to decreased fetal movements (6.6 versus 3.8%, RR 1.72; 95% CI 1.57-1.87). Mindfetalness was associated with a reduction of babies born small-for-gestational-age (RR 0.95, 95% CI 0.90-1.00), babies born after gestational week 41+6 (RR 0.91, 95% CI 0.83-0.98) and caesarean sections (19.0 versus 20.0%, RR 0.95; 95% CI 0.91-0.99). CONCLUSIONS Mindfetalness did not reduce the number of babies born with an Apgar score <7. However, Mindfetalness was associated with the health benefits of decreased incidence of caesarean section and fewer children born small-for-gestational-age. TWEETABLE ABSTRACT Introducing Mindfetalness in maternity care decreased caesarean sections but had no effect on the occurrence of Apgar scores <7.
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Affiliation(s)
- A Akselsson
- Department of Women and Children's Health, Karolinska Institutet, Sophiahemmet University, Stockholm, Sweden
| | - H Lindgren
- Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - S Georgsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, The Swedish Red Cross University College, Stockholm, Sweden
| | - K Pettersson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - G Steineck
- Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - V Skokic
- Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - I Rådestad
- Sophiahemmet University, Stockholm, Sweden
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