Antenatal psychological intervention for universal prevention of antenatal and postnatal depression: A systematic review and meta-analysis
Antenatal psychological intervention for universal prevention of antenatal and postnatal depression: A systematic review and meta-analysis
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产前心理干预普遍预防产前产后抑郁症：系统评价和荟萃分析
DOI：
10.1016/j.jad.2020.04.063
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发表时间：
2020
影响因子：
6.6
通讯作者：
Nishi Daisuke
中科院分区：
文献类型：
--
作者：
Yasuma Naonori;Narita Zui;Sasaki Natsu;Obikane Erika;Sekiya Junpei;Inagawa Takuma;Nakajima Aiichiro;Yamada Yuji;Yamazaki Ryuichi;Matsunaga Asami;Saito Tomomi;Watanabe Kazuhiro;Imamura Kotaro;Kawakami Norito;Nishi Daisuke
产前和产后抑郁症的高患病率和严重后果使其预防至关重要。以前的系统评价和荟萃分析表明，心理干预对围产期抑郁症的风险个人的影响。然而，没有一个国家明确侧重于产前普遍预防。本研究的目的是进行系统回顾和荟萃分析，以澄清产前心理干预对围产期抑郁症的影响，特别是侧重于普遍prevention.MethodsFour电子数据库，科克伦对照试验登记册（CENTRAL），Embase，PubMed和PsycINFO，被用来搜索发表的随机对照试验从成立到2019年1月28日。12名研究者分别从标题和摘要进行第一次筛选，然后NY和ZN逐一进行全文审查。对于荟萃分析，使用Review Manager 5.3 for Windows进行随机效应模型。亚组分析也进行了研究，采用认知行为（CB）为基础的approach.ResultsA共13,026项研究进行了初步搜索。剔除重复研究后，筛选出9,919项研究，最终18项研究符合纳入标准。Meta分析结果显示，产前心理干预对产前和产后抑郁症均有显著影响（SMD = 0.28，95%CI = 0.11~0.44，SMD = 0.37，95%CI = 0.08~0.66），且存在中度至高度异质性（I2 = 61%，p = 0.01; I2 = 84%，p <0.001）。对于亚组分析，在产前阶段，基于CB的方法对产前抑郁症有显著影响（SMD = 0.53，95% CI = 0.13 - 0.94），具有高度异质性（I2 = 85%，p = 0.001），而产后抑郁症无显著性结果（SMD = 0.45，95%CI =-0.03至0.92）。局限性局限性包括语言偏见，因为我们仅纳入了以英语发表的研究，产前和产后抑郁症的评估，使用不同的方法造成了高异质性across study.ConclusionsPsychological干预在产前期间可以有效地为产前和产后抑郁症的普遍预防。然而，由于纳入研究的方法学质量相对较低，结果仍不确定。在未来的研究中需要更多设计良好的试验的证据。
BackgroundThe high prevalence and severe consequences of antenatal and postnatal depression makes their prevention critical. Previous systematic reviews and meta-analysis have shown the effects of psychological interventions on perinatal depression in individuals at risk. However, none have focused explicitly on universal prevention in the antenatal period. The purpose of this study is to conduct a systematic review and meta-analysis to clarify the effects of antenatal psychological interventions on perinatal depression, specifically focusing on universal prevention.MethodsFour electronic databases, the Cochrane Controlled Register of Trials (CENTRAL), Embase, PubMed, and PsycINFO, were used to search for published randomized controlled trials from inception to January 28, 2019. Twelve investigators conducted the first screening from title and abstract, individually, and then NY and ZN performed full-text review one by one. For the meta-analysis, a random effect model was conducted by using Review Manager 5.3 for Windows. Subgroup analyses were also conducted for studies that employed a cognitive behavioral (CB) based approach.ResultsA total of 13,026 studies were initially searched. After removing duplicates, 9,919 studies were screened, and finally 18 studies met the inclusion criteria. The meta-analysis showed a significant effect of antenatal psychological intervention on both antenatal and postnatal depression (SMD = 0.28, 95% CI = 0.11 to 0.44, SMD = 0.37, 95% CI = 0.08 to 0.66) with moderate to high level of heterogeneity (I2= 61%, p = 0.01; I2= 84%, p < 0.001). For subgroup analysis, a significant effect of a CB based approach on antenatal depression was found in an antenatal period (SMD = 0.53, 95% CI = 0.13 to 0.94) with high heterogeneity (I2= 85%, p = 0.001), while non-significant results were shown on postnatal depression (SMD = 0.45, 95% CI = -0.03 to 0.92).LimitationsLimitations include a language bias, as we included only studies published in English, and that the assessment of antenatal and postnatal depression using different methods caused high heterogeneity across studies.ConclusionsPsychological intervention in an antenatal period could be effective for universal prevention of both antenatal and postnatal depression. However, the results were still inconclusive due to relatively low methodological quality in the included studies. The evidence from more well-designed trials is needed in future studies.