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A systematic review of psychological treatments for clinical anxiety during the perinatal period

Abstract

Maternal anxiety is common during the perinatal period, and despite the negative outcomes of anxiety on the mother and infant, its treatment has received limited attention. This paper describes the first review of psychological interventions for clinical anxiety during the perinatal period. A systematic search was carried out of six electronic databases. Five studies which evaluated psychological interventions for clinical anxiety in perinatal women were identified. Of the five studies included, four were open trials and one was a randomised controlled trial. Three studies evaluated group-based interventions; one study evaluated an online-delivered intervention; and one study a combined pharmacologic-psychological intervention. All participants demonstrated significant reductions in anxiety symptom severity from pre- to post-treatment. However, this review was limited to published literature evaluating treatments for clinical anxiety in perinatal women, which may have excluded important intervention studies and prevention programs, and unpublished literature. This review identifies an area of research that needs urgent attention, as very few studies have evaluated psychological treatments for perinatal anxiety. The studies included in this review demonstrate that symptoms of anxiety during the perinatal period appear to improve during treatment. Future research is needed to establish the efficacy of perinatal anxiety interventions in randomised controlled trials, whether reductions persist long term and whether benefits extend to other outcomes for the mother, infant and family.

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Fig. 1

Notes

  1. 1.

    Clinical cut-off scores for each measure were determined based on validation papers of that measure in perinatal or general adult population samples, e.g. > 40 on STAI (Spielberger et al. 1970;Grant et al. 2008).

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Contributors

SL, JN and GA designed the study and wrote the protocol and search strategy. SL, MW, AJ and HH conducted the searches, screened the titles, abstracts and full-texts for eligibility for inclusion. SL extracted the data from manuscripts, independently checked by MW, and conducted the data analysis with supervision from JN. All authors contributed to and have approved the final version of the manuscript for publication.

Funding

This study was supported by the Australian Rotary Health and the David Henning Memorial Foundation in the form of a PhD scholarship awarded to Siobhan Loughnan. Rotary Health Australia and the David Henning Memorial Foundation had no role in the study design, collection, data analysis or interpretation of the data, writing the manuscript or the decision to submit the paper for publication.

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Authors

Corresponding author

Correspondence to Siobhan A. Loughnan.

Ethics declarations

The protocol was developed according to the Cochrane Handbook for Systematic Reviews of Interventions (Higgins and Green 2011), was registered with PROSPERO [CRD42017052446] and followed the PRISMA guidelines (Moher et al. 2009).

Conflict of interest

The authors declare that they have no conflict of interest.

Appendix

Appendix

PsycINFO Search

  1. 1.

    (Perinatal OR peripartum OR antenatal OR antepartum OR prenatal OR pregnan* OR postnatal OR postpartum OR birth OR (after birth)).mp. [mp = title, abstract, heading word, table of contents, key concepts, original title, tests and measures]

  2. 2.

    (Anxiety OR (anxiety disorder) OR worry OR distress OR stress OR (generali$ed. anxiety disorder) OR general$ anxiety OR obsessive compulsive disorder OR (post-traumatic stress disorder) OR (traumatic stress) OR agoraphobia OR phobia$ OR (health anxiety) OR depression) mp. [mp = title, abstract, heading word, table of contents, key concepts, original title, tests and measures]

  3. 3.

    (Intervention OR treatment OR therap* OR (treatment outcome) OR self-help OR counsel$ing OR psychotherapy* OR bibliotherapy OR (behave$ change) OR CBT OR (cognitive behave$ therapy) OR (cognitive therapy) OR (interpersonal psychotherapy) OR (psychodynamic therapy) OR relaxation).mp. [mp = title, abstract, heading word, table of contents, key concepts, original title, tests and measures]

  4. 4.

    1 and 2 and 3

  5. 5.

    Limit 4 to (human, adulthood and English language)

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Loughnan, S.A., Wallace, M., Joubert, A.E. et al. A systematic review of psychological treatments for clinical anxiety during the perinatal period. Arch Womens Ment Health 21, 481–490 (2018). https://doi.org/10.1007/s00737-018-0812-7

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Keywords

  • Perinatal
  • Pregnancy
  • Antenatal
  • Postpartum
  • Postnatal
  • Anxiety