Mobile interventions targeting common mental disorders among pregnant and postpartum women: An equity-focused systematic review.
Mobile interventions targeting common mental disorders among pregnant and postpartum women: An equity-focused systematic review.
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DOI：
10.1371/journal.pone.0259474
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Pottie K
中科院分区：
文献类型：
--
作者：
Saad A;Magwood O;Aubry T;Alkhateeb Q;Hashmi SS;Hakim J;Ford L;Kassam A;Tugwell P;Pottie K
孕妇和产后妇女面临着主要的心理压力源，使她们患抑郁症和焦虑症等常见精神障碍的风险更高。然而，他们获得和接受传统精神卫生保健的机会有限，这是不公平的，特别是在2019冠状病毒病大流行期间。移动干预措施是解决这一中断的医疗保健服务的潜在解决方案，但需要更多地了解其有效性和对卫生公平的影响。这项以公平为重点的系统综述研究了针对孕妇和产后妇女常见精神障碍的流动干预措施的有效性和公平影响。我们系统地检索了MEDLINE、EMBASE、PsychINFO等3个数据库，从数据库建立之日起至2021年1月，检索了针对孕妇和产后妇女的移动干预的实验研究。我们使用汇总和叙述综合方法来分析有效性和公平性数据，使用Cochrane工具对纳入研究的方法学严密性进行批判性评价，并使用GRADE方法评估证据的确定性。我们检索了6148份记录，其中包括18项随机和非随机对照试验。移动干预对减少抑郁症的发生（OR = 0.51 [95% CI 0.41 ~ 0.64]；绝对风险降低RD: 7.14% [95% CI 4.92 ~ 9.36]; p<0.001）和围产期预防其严重程度（MD = -3.07; 95% CI -4.68 ~ -1.46; p<0.001）具有重要的临床影响。移动认知行为疗法（CBT）在治疗产后抑郁症方面是有效的（MD = -6.87; 95% CI -7.92至-5.82;p<0.001），而其他基于支持的干预措施没有额外的益处。焦虑结局和护理利用的结果有限。我们以公平为重点的分析表明，种族、年龄、教育和初产是影响流动干预有效性的特征。随着COVID-19大流行增加了对虚拟精神卫生保健的需求，移动干预措施在预防和管理孕妇和产后妇女常见精神障碍方面显示出希望。这些干预措施有可能解决卫生不平等问题，但需要进行更严格的研究，检查患者的交叉社会身份。
Pregnant and postpartum women face major psychological stressors that put them at higher risk of developing common mental disorders, such as depression and anxiety. Yet, their limited access to and uptake of traditional mental health care is inequitable, especially during the COVID-19 pandemic. Mobile interventions emerged as a potential solution to this discontinued healthcare access, but more knowledge is needed about their effectiveness and impact on health equity. This equity-focused systematic review examined the effectiveness and equity impact of mobile interventions targeting common mental disorders among pregnant and postpartum women. We systematically searched MEDLINE, EMBASE, PsychINFO and 3 other databases, from date of database inception and until January 2021, for experimental studies on mobile interventions targeting pregnant and postpartum women. We used pooled and narrative synthesis methods to analyze effectiveness and equity data, critically appraised the methodological rigour of included studies using Cochrane tools, and assessed the certainty of evidence using the GRADE approach. Our search identified 6148 records, of which 18 randomized and non-randomized controlled trials were included. Mobile interventions had a clinically important impact on reducing the occurrence of depression (OR = 0.51 [95% CI 0.41 to 0.64]; absolute risk reduction RD: 7.14% [95% CI 4.92 to 9.36]; p<0.001) and preventing its severity perinatally (MD = -3.07; 95% CI -4.68 to -1.46; p<0.001). Mobile cognitive behavioural therapy (CBT) was effective in managing postpartum depression (MD = -6.87; 95% CI -7.92 to -5.82; p<0.001), whereas other support-based interventions had no added benefit. Results on anxiety outcomes and utilization of care were limited. Our equity-focused analyses showed that ethnicity, age, education, and being primiparous were characteristics of influence to the effectiveness of mobile interventions. As the COVID-19 pandemic has increased the need for virtual mental health care, mobile interventions show promise in preventing and managing common mental disorders among pregnant and postpartum women. Such interventions carry the potential to address health inequity but more rigorous research that examines patients’ intersecting social identities is needed.
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DOI：
10.3389/fgwh.2020.00001
发表时间：
2020
期刊：
Frontiers in global women's health
影响因子：
--
作者：
Davenport MH;Meyer S;Meah VL;Strynadka MC;Khurana R
通讯作者：
Khurana R
影响因子：
6.3
作者：
Braveman, P;Gruskin, S
通讯作者：
Gruskin, S
影响因子：
2.6
作者：
Dennis-Tiwary, Tracy A.;Denefrio, Samantha;Gelber, Shari
通讯作者：
Gelber, Shari
影响因子：
3.5
作者：
Hantsoo, Liisa;Podcasy, Jessica;Kim, Deborah R.
通讯作者：
Kim, Deborah R.
影响因子：
7
作者：
Hedges, LV;Vevea, JL
通讯作者：
Vevea, JL