Universal prevention of distress aimed at pregnant women: a systematic review and meta-analysis of psychological interventions
Open accessAbstract
Background: There is sufficient meta-analytic evidence that antenatal interventions for women at risk (selective prevention) or for women with severe psychological symptoms (indicated prevention) are effective in reducing postpartum distress. However, women without risk or severe psychological symptoms might also experience distress. This meta-analysis focused on the effectiveness of preventive psychological interventions offered to universal populations of pregnant women on symptoms of depression, anxiety, and general stress. Paternal and infant outcomes were also included. Method: We included 12 universal prevention studies in the meta-analysis, incorporating a total of 2559 pregnant women. Results: Overall, ten studies included depression as an outcome measure, five studies included stress, and four studies anxiety. There was a moderate effect of preventive interventions implemented during pregnancy on the combined measure of maternal distress ( d = .52), on depressive symptoms (d = .50), and on stress (d = .52). The effect on anxiety (d = .30) was smaller. The effects were not associated with intervention timing, intervention type, intervention delivery mode, timing of post-test, and methodological quality. The number of studies including partner and/or infant outcomes was too low to assess their effectiveness. Conclusions: This meta-analysis suggests that universal prevention during pregnancy is effective on decreasing symptoms of maternal distress compared to routine care, at least with regard to depression. While promising, the results with regard to anxiety and stress are based on a considerably lower number of studies, and should thus be interpreted with caution. More research is needed on preventing other types of maternal distress beyond depression. Furthermore, there is a lack of research with regard to paternal distress. Also, given the large variety in interventions, more research is needed on which elements of universal prevention work. Finally, as maternal distress symptoms can affect infant development, it is important to investigate whether the positive effects of the preventive interventions extend from mother to infant. Systematic review registration number: International prospective register of systematic reviews (PROSPERO) registration number: CRD42018098861.
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Universal prevention (e.g., CBT, IPT, mindfulness, and psychoeducation) during pregnancy is effective in decreasing symptoms of maternal distress compared to routine care.
“Studies suggest that universal prevention (e.g., CBT, IPT, mindfulness, and psychoeducation) during pregnancy is effective in decreasing symptoms of maternal distress compared to routine care and recommends psychotherapy as a part of standard prenatal self-care [178, 194, 195].”
From Brain structural and functional outcomes in the offspring of women experiencing psychological distress during pregnancy (2024) · cites this paper as [195]
The Conclusions report that universal prevention during pregnancy decreases maternal-distress symptoms compared with routine care, and Study characteristics lists CBT, IPT, mindfulness, and psychoeducation among the interventions reviewed. The Conclusions qualify the finding as established at least for depression; evidence for anxiety and stress came from fewer studies and should be interpreted cautiously. The claim omits that limitation. (LLM, conf=0.86)
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Cites
Statistical Power Analysis for the Behavioral Sciences
Muller, K. E., & Cohen, J. (1989) · Technometrics · doi:10.2307/1270020 · Cited by 99,588 · see citing works
Statistical power analysis for the behavioral sciences
Cohen, J. (1990) · Computers Environment and Urban Systems · doi:10.1016/0198-9715(90)90050-4 · Cited by 65,406 · see citing works
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817 · see citing works
Detection of Postnatal Depression: Development of the 10-item Edinburgh Postnatal Depression Scale
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987) · British Journal of Psychiatry · doi:10.1192/bjp.150.6.782 · Cited by 14,183 · see citing works
Maternal Depression and Child Psychopathology: A Meta-Analytic Review
Goodman, S. H., Rouse, M. H., Connell, A. M., Broth, M. R., Hall, C. M., & Heyward, D. (2011) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-010-0080-1 · Cited by 2,621 · see citing works
Sensitivity and attachment: A meta-analysis on parental antecedents of infant attachment
De Wolff, M. S., & van Ijzendoorn, M. H. (1997) · Child Development · doi:10.1111/j.1467-8624.1997.tb04218.x · Cited by 2,526 · see citing works
Effects of perinatal mental disorders on the fetus and child
Stein, A., Pearson, R. M., Goodman, S. H., Rapa, E., Rahman, A., McCallum, M., Howard, L. M., & Pariante, C. M. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61277-0 · Cited by 2,166 · see citing works
Attachment and development: A prospective, longitudinal study from birth to adulthood
Sroufe, L. A. (2005) · Attachment & Human Development · doi:10.1080/14616730500365928 · Cited by 1,685 · see citing works
Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis
Dennis, C., Falah‐Hassani, K., & Shiri, R. (2017) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.116.187179 · Cited by 1,568 · see citing works
Postpartum depression effects on early interactions, parenting, and safety practices: a review
Field, T. (2010) · Infant Behavior and Development · doi:10.1016/j.infbeh.2009.10.005 · Cited by 1,493 · see citing works
The course of anxiety and depression through pregnancy and the postpartum in a community sample
Heron, J., O'Connor, T. G., Evans, J., Golding, J., & Glover, V. (2004) · Journal of Affective Disorders · doi:10.1016/j.jad.2003.08.004 · Cited by 1,151 · see citing works
Landry, S. H., Smith, K. E., & Swank, P. R. (2006) · Developmental Psychology · doi:10.1037/0012-1649.42.4.627 · Cited by 950 · see citing works
Paulson, J. F., Dauber, S., & Leiferman, J. A. (2006) · Pediatrics · doi:10.1542/peds.2005-2948 · Cited by 706 · see citing works
Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety?
Matthey, S., Barnett, B., Howie, P., & Kavanagh, D. J. (2003) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00012-5 · Cited by 547 · see citing works
Brennan, P. A., Hammen, C. L., Andersen, M. J., Bor, W., Najman, J. M., & Williams, G. M. (2000) · Developmental Psychology · doi:10.1037//0012-1649.36.6.759 · Cited by 519 · see citing works
US Preventive Services Task Force, Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Grossman, D. C., et al. (2019) · JAMA · doi:10.1001/jama.2019.0007 · Cited by 494 · see citing works
Feinberg, M. E., & Kan, M. L. (2008) · Journal of Family Psychology · doi:10.1037/0893-3200.22.2.253 · Cited by 453 · see citing works
Brennan, P. A., Hammen, C. L., Andersen, M. J., et al. (2000) · Developmental Psychology · doi:10.1037/0012-1649.36.6.759 · Cited by 403 · see citing works
Sockol, L. E. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.01.052 · Cited by 395 · see citing works
Perinatal anxiety disorder prevalence and incidence
Fairbrother, N., Janssen, P., Antony, M. M., Tucker, E., & Young, A. H. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.12.082 · Cited by 375 · see citing works
Postnatal anxiety prevalence, predictors and effects on development: A narrative review
Field, T. (2018) · Infant Behavior and Development · doi:10.1016/j.infbeh.2018.02.005 · Cited by 333 · see citing works
A systematic review of the effects of postnatal maternal anxiety on children
Glasheen, C., Richardson, G. A., & Fabio, A. (2009) · Archives of Women s Mental Health · doi:10.1007/s00737-009-0109-y · Cited by 322 · see citing works
Lever Taylor, B., Cavanagh, K., & Strauss, C. (2016) · PLOS ONE · doi:10.1371/journal.pone.0155720 · Cited by 284 · see citing works
The effects of paternal depression on child and adolescent outcomes: A systematic review
Sweeney, S., & MacBeth, A. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.05.073 · Cited by 257 · see citing works
Feldman, R., Eidelman, A. I., & Rotenberg, N. (2004) · Child Development · doi:10.1111/j.1467-8624.2004.00816.x · Cited by 253 · see citing works
Rao, W.-W., Zhu, X.-M., Zong, Q.-Q., Zhang, Q., Hall, B. J., Ungvari, G. S., & Xiang, Y.-T. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.10.030 · Cited by 253 · see citing works
Stein, A., Craske, M. G., Lehtonen, A., Harvey, A., Savage-McGlynn, E., Davies, B., Goodwin, J., Murray, L., Cortina-Borja, M., & Counsell, N. (2012) · Journal of Abnormal Psychology · doi:10.1037/a0026847 · Cited by 240 · see citing works
Yelland, J. S., Sutherland, G. A., & Brown, S. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-771 · Cited by 230 · see citing works
A Preventive Intervention for Pregnant Women on Public Assistance at Risk for Postpartum Depression
Zlotnick, C., Miller, I. W., Pearlstein, T. B., Howard, M. M., & Sweeney, P. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.8.1443 · Cited by 218 · see citing works
Austin, M.-P., Frilingos, M., Lumley, J., Hadzi-Pavlovic, D., Roncolato, W., Acland, S., Saint, K., Segal, N., & Parker, G. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.04.001 · Cited by 212 · see citing works
Woolhouse, H., Mercuri, K., Judd, F., & Brown, S. J. (2014) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-014-0369-z · Cited by 212 · see citing works
Rees, S., Channon, S., & Waters, C. S. (2018) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-018-1173-5 · Cited by 212 · see citing works
Milgrom, J., Schembri, C., Ericksen, J., Ross, J., & Gemmill, A. W. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.10.045 · Cited by 175 · see citing works
A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women
Sockol, L. E. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.01.018 · Cited by 158 · see citing works
McCoy, S. J. B., Beal, J. M., Shipman, S. B. M., Payton, M. E., & Watson, G. H. (2006) · PubMed · Cited by 156 · see citing works
Preventing postpartum depression: A meta-analytic review
Sockol, L. E., Epperson, C. N., & Barber, J. P. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2013.10.004 · Cited by 156 · see citing works
Matvienko‐Sikar, K., & Dockray, S. (2016) · Women and Birth · doi:10.1016/j.wombi.2016.10.003 · Cited by 117 · see citing works
Paternal Mental Health and Socioemotional and Behavioral Development in Their Children
Kvalevaag, A. L., Ramchandani, P. G., Hove, O., Assmus, J., Eberhard-Gran, M., & Biringer, E. (2013) · Pediatrics · doi:10.1542/peds.2012-0804 · Cited by 111 · see citing works
Screening for postpartum depression in an inner-city population
Morris-Rush, J. K., Freda, M. C., & Bernstein, P. S. (2003) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2003.279 · Cited by 105 · see citing works
Mamma Mia – A randomized controlled trial of an internet-based intervention for perinatal depression
Haga, S. M., Drozd, F., Lisøy, C., Wentzel-Larsen, T., & Slinning, K. (2019) · Psychological Medicine · doi:10.1017/s0033291718002544 · Cited by 99 · see citing works
Fontein‐Kuipers, Y., Nieuwenhuijze, M., Ausems, M., Budé, L., & de Vries, R. (2014) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.12500 · Cited by 91 · see citing works
Self-citationRandomized controlled trial to prevent postpartum depression in mothers on public assistance
Zlotnick, C., Tzilos, G. K., Miller, I. W., Seifer, R., & Stout, R. L. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.09.059 · Cited by 83 · see citing works
Risk factors for antenatal anxiety: A systematic review of the literature
Bayrampour, H., Vinturache, A., Hetherington, E., Lorenzetti, D., & Tough, S. (2018) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2018.1492097 · Cited by 83 · see citing works
Sedgwick, A. W., DAVIDSOND, A. H., TAPLIN, R. E., & Thomas, D. W. (1988) · Australian and New Zealand Journal of Medicine · doi:10.1111/j.1445-5994.1988.tb00131.x · Cited by 82 · see citing works
The effectiveness of antenatal interventions to prevent postnatal depression in high-risk women
Clatworthy, J. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.02.029 · Cited by 75 · see citing works
Bittner, A., Peukert, J., Zimmermann, C., Junge-Hoffmeister, J., Parker, L., Stöbel-Richter, Y., & Weidner, K. (2014) · Journal of Perinatal & Neonatal Nursing · doi:10.1097/jpn.0000000000000027 · Cited by 62 · see citing works
Beattie, J., Hall, H., Biro, M. A., East, C., & Lau, R. (2017) · Midwifery · doi:10.1016/j.midw.2017.04.006 · Cited by 58 · see citing works
Mao, H., Li, H.-J., Chiu, H. F. K., Chan, W. C., & Chen, S. (2012) · Perspectives In Psychiatric Care · doi:10.1111/j.1744-6163.2012.00331.x · Cited by 57 · see citing works
A Preventive Intervention for Pregnant Women on Public Assistance at Risk for Postpartum Depression
Zlotnick, C. (2006) · American Journal of Psychiatry · doi:10.1176/appi.ajp.163.8.1443 · Cited by 54 · see citing works
Postnatal Depression, Mother–Infant Interactions, and Child Development
Murray, L., Fearon, P. R. M., & Cooper, P. (2015) · Wiley eBooks · doi:10.1002/9781118509722.ch9 · Cited by 46 · see citing works
Daley-McCoy, C., Rogers, M., & Slade, P. (2015) · Archives of Women s Mental Health · doi:10.1007/s00737-015-0510-7 · Cited by 37 · see citing works
Ramezani, S., Khosravi, A., Motaghi, Z., Hamidzadeh, A., & Mousavi, S. A. (2016) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2016.1266470 · Cited by 36 · see citing works
Can Early Intervention Improve Maternal Well-Being? Evidence from a Randomized Controlled Trial
Doyle, O., Delaney, L. D., O’Farrelly, C., Fitzpatrick, N., & Daly, M. (2017) · PLoS ONE · doi:10.1371/journal.pone.0169829 · Cited by 34 · see citing works
Evans, K., Morrell, C. J., & Spiby, H. (2018) · Journal of Advanced Nursing · doi:10.1111/jan.13456 · Cited by 33 · see citing works
The effects of stress inoculation training on perceived stress in pregnant women
Khorsandi, M., Vakilian, K., Salehi, B., Goudarzi, M. T., & Abdi, M. (2016) · Journal of Health Psychology · doi:10.1177/1359105315589800 · Cited by 28 · see citing works
Prenatal Predictors of Postnatal Quality of Caregiving Behavior in Mothers and Fathers
Hechler, C., Beijers, R., Riksen-Walraven, M., & de Weerth, C. (2019) · Parenting · doi:10.1080/15295192.2019.1556010 · Cited by 21 · see citing works
Self-citationAkbarzadeh, M., Rafiee, B., Asadi, N., & Zare, N. (2016) · Trends in Medical Research · doi:10.3923/tmr.2016.62.68 · Cited by 19 · see citing works
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Wu, Y., De Asis-Cruz, J., & Limperopoulos, C. (2024) · Molecular Psychiatry · doi:10.1038/s41380-024-02449-0 · Cited by 124 · see citing works
“Studies suggest that universal prevention (e.g., CBT, IPT, mind-fulness, and psychoeducation) during pregnancy is effective in decreasing symptoms of maternal distress compared to routine care and recommends psychotherapy as a part of standard prenatal self-care [178, 194, 195].”
BackgroundMissler, M., van Straten, A., Denissen, J., Donker, T., & Beijers, R. (2020) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-020-03341-9 · Cited by 66 · see citing works
Self-citation
- Authors
- Missler, M., Donker, T., Beijers, R., Ciharova, M., Moyse, C., de Vries, R., Denissen, J., & van Straten, A.
- Affiliations
- Radboud University Nijmegen (NL)
- University of Freiburg (DE)
- Amsterdam Public Health (NL)
- Utrecht University (NL)
- Corresponding author
- Missler, Marjolein
- Venue
- BMC Pregnancy and Childbirth
- Published
- 2021-04-01
- Volume
- 21
- Issue
- 1
- Pages
- 276-276
- ISSN
- 1471-2393 (ISSN-L)
- PMC
- PMC8017784
- OpenAlex
- W3139914012
- Cited by
- 40
- References
- 57
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 4 · 2023: 9 · 2022: 4 · 2021: 4 · 2020: 1
- FWCI
- 0.94
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Pregnancy and Childbirth (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- FreiDok plus (Universitätsbibliothek Freiburg) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (406.14.106)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Keywords
- universal prevention, maternal distress, antenatal depression, prenatal anxiety, maternal stress, postpartum depression prevention, infant outcomes
- MeSH terms
- Psychological Distress, Psychosocial Intervention, Anxiety, Depression, Female, Humans, Mothers, Pregnancy, Pregnancy Complications, Stress, Psychological, Randomized Controlled Trials as Topic, Treatment Outcome
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