NICU-based Interventions To Reduce Maternal Depressive and Anxiety Symptoms: A Meta-analysis

Abstract

CONTEXT: Parents whose infants are being treated in the NICU are at high risk for depression and anxiety, with negative implications for parenting and infant development. OBJECTIVE: We conducted a systematic review and meta-analysis of NICU-based interventions to reduce maternal depressive or anxiety symptoms. DATA SOURCES: PubMed, Embase, PsychInfo, Cochrane, and CINAHL were searched for relevant studies. Reference lists from selected studies were reviewed. STUDY SELECTION: Inclusion criteria included randomized controlled design, a parent-focused intervention delivered in the NICU, valid maternal depressive or anxiety symptom measures at pre- and postintervention, and publication in a peer-reviewed journal in English. DATA EXTRACTION: Data extraction was conducted independently by 2 coders. RESULTS: Twelve studies met inclusion criteria for qualitative review; 2 were excluded from quantitative analyses for high risk of bias. Fixed- and random-effects models, with 7 eligible studies assessing depressive symptoms, indicated an effect of –0.16 (95% confidence interval [CI], –0.32 to –0.002; P < .05) and, with 8 studies assessing anxiety symptoms, indicated an effect of –0.12 (95% CI, –0.29 to 0.05; P = .17). The subset of interventions using cognitive behavioral therapy significantly reduced depressive symptoms (effect, –0.44; 95% CI, –0.77 to –0.11; P = .01). LIMITATIONS: The small number and methodological shortcomings of studies limit conclusions regarding intervention effects. CONCLUSIONS: Combined intervention effects significantly reduced maternal depressive but not anxiety symptoms. The evidence is strongest for the impact of cognitive behavioral therapy interventions on maternal depressive symptoms.