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anxiety in perinatal women, which may have excluded important intervention studies and prevention programs, and unpublished literature.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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Post and Antenatal Depression Association (2012) The cost of perinatal depression in Australia. Deloitte Access Economics Pty Ltd, Canberra
Austin M-P, Frilingos M, Lumley J, Hadzi-Pavlovic D, Roncolato W, Acland S et al (2008) Brief antenatal cognitive behaviour therapy group intervention for the prevention of postnatal depression and anxiety: a randomised controlled trial. J Affect Disord 105(1):35–44
Austin M-P, Tully L, Parker G (2007) Examining the relationship between antenatal anxiety and postnatal depression. J Affect Disord 101(1-3):169–174. https://doi.org/10.1016/j.jad.2006.11.015
Ayers S, Coates R, Matthey S (2015) Identifying perinatal anxiety, First edn. Wiley, West Sussex
Beck AT, Steer RA (1996) Beck anxiety inventory. The Psychological Corporation, San Antonio
Betts KS, Williams GM, Najman JM, Alati R (2014) Maternal depressive, anxious, and stress symptoms during pregnancy predict internalizing problems in adolescence. Depress Anxiety 31(1):9–18. https://doi.org/10.1002/da.22210
Biaggi A, Conroy S, Pawlby S, Pariante CM (2016) Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord 191:62–77. https://doi.org/10.1016/j.jad.2015.11.014
Bittner A, Peukert J, Zimmermann C, Junge-Hoffmeister J, Parker LS, Stobel-Richter Y, Weidner K (2014) Early intervention in pregnant women with elevated anxiety and depressive symptoms: efficacy of a cognitive-behavioral group program. J Perinat Neonatal Nurs 28(3):185–195. https://doi.org/10.1097/JPN.0000000000000027
Byrne J, Hauck Y, Fisher C, Bayes S, Schutze R (2014) Effectiveness of a mindfulness-based childbirth education pilot study on maternal self-efficacy and fear of childbirth. J Midwifery & Women’s Health 59(2):192–197. https://doi.org/10.1111/jmwh.12075
Challacombe FL, Salkovskis PM (2011) Intensive cognitive-behavioural treatment for women with postnatal obsessive-compulsive disorder: a consecutive case series. Behav Res Ther 49(6):422–426. https://doi.org/10.1016/j.brat.2011.03.006
Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150(06):782–786. https://doi.org/10.1192/bjp.150.6.782
Dennis CL, Falah-Hassani K, Shiri R (2017) Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry 210(05):315–323. https://doi.org/10.1192/bjp.bp.116.187179
Fairbrother N, Janssen P, Antony MM, Tucker E, Young AH (2016) Perinatal anxiety disorder prevalence and incidence. J Affect Disord 200:148–155. https://doi.org/10.1016/j.jad.2015.12.082
FirstMB,GibbonM (2004) The structured clinical interview for DSM-IV Axis I Disorders (SCID-I) and the structured clinical interview for DSM-IV Axis II Disorders (SCID-II)
Glasheen C, Richardson GA, Fabio A (2010) A systematic review of the effects of postnatal maternal anxiety on children. Arch Womens Ment Health 13(1):61–74. https://doi.org/10.1007/s00737-009-0109-y
Goodman J, Guarino A, Chenausky K, Klein L, Prager J, Petersen R et al (2014) CALM pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety. Arch Womens Ment Health 17(5):373–387
Goodman JH, Watson GR, Stubbs B (2016) Anxiety disorders in postpartum women: a systematic review and meta-analysis. J Affect Disord 203:292–331. https://doi.org/10.1016/j.jad.2016.05.033
Grant K-A, McMahon C, Austin M-P (2008) Maternal anxiety during the transition to parenthood: a prospective study. J Affect Disord 108(1):101–111. https://doi.org/10.1016/j.jad.2007.10.002
Green SM, Haber E, Frey BN, McCabe RE (2015) Cognitive-behavioral group treatment for perinatal anxiety: a pilot study. Arch Womens Ment Health 18(4):631–638. https://doi.org/10.1007/s00737-015-0498-z
Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32(1):50–55. https://doi.org/10.1111/j.2044-8341.1959.tb00467.x
Higgins J, GreenSM (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. Retrieved fromwww.handbook.cochrane.org
Hofmann SG, Smits JA (2008) Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatr 69(4):621–632. https://doi.org/10.4088/JCP.v69n0415
Huizink AC, Mulder EJ, de Medina PGR, Visser GH, Buitelaar JK (2004) Is pregnancy anxiety a distinctive syndrome? Early Hum Dev 79(2):81–91. https://doi.org/10.1016/j.earlhumdev.2004.04.014
Levin JS (1991) The factor structure of the pregnancy anxiety scale. J Health Soc Behav 32(4):368–381. https://doi.org/10.2307/2137104
Lilliecreutz C, Josefsson A, Sydsjo G (2010) An open trial with cognitive behavioral therapy for blood- and injection phobia in pregnant women—a group intervention program. Arch Womens Ment Health 13(3):259–265. https://doi.org/10.1007/s00737-009-0126-x
Meades R, Ayers S (2011) Anxiety measures validated in perinatal populations: a systematic review. J Affect Disord 133(1):1–15. https://doi.org/10.1016/j.jad.2010.10.009
Meyer TJ, Miller MJ, Metzger RL, Borkovec TD (1990) Development and validation of the Penn State Worry Questionnaire. Behav Res Ther 28(6):487–495. https://doi.org/10.1016/0005-7967(90)90135-6
MilgromJ, DanaherBG, GemmillAW, HoltC, HoltCJ, SeeleyJR, …EricksenJ (2016) Internet cognitive behavioral therapy for women with postnatal depression: a randomized controlled trial of Mum Mood Booster. J Med Internet Res 18(3)
Milgrom J, Gemmill AW (2015) Identifying perinatal depression and anxiety: evidence-based practice in screening, psychosocial assessment and management. Wiley, Hoboken. https://doi.org/10.1002/9781118509722
Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnett B, Brooks J et al (2008) Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord 108:147–157
Misri S, Kendrick K (2007) Treatment of perinatal mood and anxiety disorders: a review. Can J Psychiatr 52(8):489–498. https://doi.org/10.1177/070674370705200803
Misri S, Reebye P, Corral M, Milis L (2004) The use of paroxetine and cognitive-behavioral therapy in postpartum depression and anxiety: a randomized controlled trial. J Clin Psychiatry 65(9):1236–1241. https://doi.org/10.4088/JCP.v65n0913
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097
Murray L, Cooper PJ, Wilson A, Romaniuk H (2003) Controlled trial of the short-and long-term effect of psychological treatment of post-partum depression. Br J Psychiatry 182(5):420–427. https://doi.org/10.1192/bjp.182.5.420
Muzik M, Rosenblum KL, Alfafara EA, Schuster MM, Miller NM, Waddell RM, Kohler ES (2015) Mom power: preliminary outcomes of a group intervention to improve mental health and parenting among high-risk mothers. Arch Women’s Mental Health 18(3):507–521. https://doi.org/10.1007/s00737-014-0490-z
Nieminen K, Andersson G, Wijma B, Ryding E-L, Wijma K (2016a) Treatment of nulliparous women with severe fear of childbirth via the Internet: a feasibility study. J Psychosom Obstet Gynecol 37(2):37–43. https://doi.org/10.3109/0167482X.2016.1140143
Nieminen K, Berg I, Frankenstein K, Viita L, Larsson K, Persson U et al (2016b) Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth—a randomized controlled trial. Cogn Behav Ther 45(4):287–306
O'Hara MW, Wisner KL (2014) Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstret Gynaecol 28(1):3–12. https://doi.org/10.1016/j.bpobgyn.2013.09.002
Öst L-G (1992) Blood and injection phobia: background and cognitive, physiological, and behavioral variables. J Abnorm Psychol 101(1):68–74. https://doi.org/10.1037/0021-843X.101.1.68
Ross LE, McLean LM (2006) Anxiety disorders during pregnancy and the postpartum period: a systematic review. J Clin Psychiatry 67(08):1285–1298. https://doi.org/10.4088/JCP.v67n0818
Sheehan D, Lecrubier Y, Sheehan KH, Sheehan K, Amorim P, Janavs J et al (1998) Diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59:22–33
Sockol L, Epperson CN, Barber JP (2011) A meta-analysis of treatments for perinatal depression. Clin Psychol Rev 31(5):839–849. https://doi.org/10.1016/j.cpr.2011.03.009
Somerville S, Dedman K, Hagan R, Oxnam E, Wettinger M, Byrne S et al (2014) The perinatal anxiety screening scale: development and preliminary validation. Arch Womens Ment Health 17(5):443–454
Spielberger CD, Gorsuch RL, Lushene PR, Vagg PR, Jacobs AG (1970) Manual for the state-trait anxiety inventory. Consulting Psychologists Press, Palo Alto
Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M et al (2014) Effects of perinatal mental disorders on the fetus and child. Lancet 384(9956):1800–1819
Stewart RE, Chambless DL (2009) Cognitive–behavioral therapy for adult anxiety disorders in clinical practice: a meta-analysis of effectiveness studies. American Psychological Association, Washington, D.C.
Wijma K, Wijma B, Zar M (1998) Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth. J Psychosom Obstet Gynecol 19(2):84–97. https://doi.org/10.3109/01674829809048501
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370
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.
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.
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.
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(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]
(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]
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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