The effectiveness of psychological interventions for anxiety in the perinatal period: A systematic review and meta-analysis

Background: Anxiety disorders are a relatively common occurring mental health issue during pregnancy and the perinatal period. There is evidence that untreated perinatal anxiety is a risk factor for adverse outcomes for mother and infant. Despite their potential acceptability to users, psychological interventions research for this population is still in its infancy. This systematic review and meta-analysis aimed to comprehensively evaluate the evidence of the effectiveness of psychological interventions for reducing perinatal anxiety. Method: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases searched included EMBASE, MEDLINE, PsychINFO, MIDIRS, CINAHL and the Cochrane Library. Search terms included: Psychological Therapy, Perinatal Period, Antenatal, Postnatal, Anxiety, Obsessive Compulsive Disorder and Phobia. Results: The search strategy identified 2025 studies. A total of 21 studies published between 2004 and 2021 fulfilled inclusion criteria. Of those, 17 were included in the meta-analysis. Overall results indicated that psychological interventions were more effective than control conditions in reducing symptoms of perinatal anxiety with a medium post treatment effect size. Significant effect sizes were also identified for online, face-to-face, group and guided self-help treatment modalities. Limitations: A small sample of studies are represented and limited to articles published in English. The review was unable to draw specific conclusions about what works (i.e. therapeutic modality/delivery) for whom (i.e. specific diagnoses) due to purposefully broad inclusion criteria. The longer-term effects of psychological interventions for perinatal anxiety and infant outcomes could not be established. Conclusions: This review demonstrates that psychological interventions are effective in reducing symptoms of both anxiety and comorbid anxiety and depression in the antenatal and postnatal periods. The results also demonstrate the efficacy of delivering such interventions in multiple settings, including online, and in group format. Further research is required to optimise treatment delivery to individual needs.

Screening for Perinatal OCD: A Comparison of the DOCS and the EPDS

Screening for perinatal-occurring obsessive-compulsive disorder (OCD) is rare. We sought to evaluate the Dimensional Obsessive-Compulsive Scale (DOCS) as a screening tool for perinatal OCD and compare the screening accuracy of the DOCS with the commonly recommended Edinburgh Postnatal Depression Scale (EPDS). English-speaking, pregnant individuals aged 19+ ( N = 574) completed online questionnaires and diagnostic interviews to assess for OCD prenatally and twice postpartum. The DOCS total score demonstrated the highest level of accuracy. Neither the EPDS-Full nor the three-item Anxiety subscale of the EPDS (EPDS-3A) met the criteria of a sufficiently accurate screening tool for OCD at any of the assessment points. Findings provide support for the DOCS as a screening tool for perinatal OCD and indicate a need for disorder-specific screening for perinatal anxiety and their related disorders (AD). Generalizability of findings is limited to Canada only. Future research would benefit from comparisons with measures of perinatal OCD (e.g., the Perinatal Obsessive-Compulsive Scale).

Women’s experiences and perceptions of anxiety and stress during the perinatal period: a systematic review and qualitative evidence synthesis

Background The perinatal period, from pregnancy to the first year postpartum, is a transitional period that can result in anxiety and stress for some women. Perinatal anxiety and stress can adversely impact the physical and psychological health of women and children. Understanding women’s lived experiences of perinatal anxiety and stress is essential to better support women. The aim of this qualitative evidence synthesis was to examine women’s experiences and perceptions of, and barriers and facilitators to coping with, perinatal anxiety and stress. Methods Databases CINAHL, EMBASE, MEDLINE, PsycINFO and Maternity and Infant Care were searched from inception to June 2020. Eligible studies included women who were pregnant or up to one year postpartum and examined women’s experiences of anxiety and/or stress during the perinatal period. Data were synthesised using thematic synthesis. Results Of 20,318 identified articles, 13 studies met inclusion criteria and were included in this review. Five key themes emerged: Social support, women’s experiences of healthcare, social norms and expectations, factors that impact on coping and mother and baby’s health. Conclusion This review provided a comprehensive synthesis of perinatal anxiety and stress. Findings indicate that increased support for perinatal mental health in antenatal and postpartum care is needed. Addressing unrealistic expectations and conceptualisations of motherhood is also important to better support women. Enhancing women’s social support networks and provision of clear and consistent information are also essential to support women and minimise stress and anxiety in the perinatal period.

Validation of the intolerance of uncertainty scale as a screening tool for perinatal anxiety

Background To date, there is a significant lack of research validating clinical tools for early and accurate detection of anxiety disorders in perinatal populations. Intolerance of uncertainty was recently identified as a significant risk factor for postpartum anxiety symptoms and is a key trait of non-perinatal anxiety disorders. The present study aimed to validate the Intolerance of Uncertainty Scale (IUS) in a perinatal population and evaluate its use as a screening tool for anxiety disorders. Methods Psychiatric diagnoses were assessed in a sample of perinatal women (n = 198), in addition to completing a self-report battery of questionnaires. Psychometric properties including internal consistency and convergent and discriminant validity were assessed. Determination of an optimal clinical cut-off score was measured through a ROC analysis in which the area under the curve, sensitivity, specificity, as well as positive and negative predictive values were calculated. Results The IUS demonstrated excellent internal consistency (α = 0.95) and an optimal clinical cut-off score of 64 or greater was established, yielding a sensitivity of 89%. The IUS also demonstrated very good positive (79%) and negative (80%) predictive values. Conclusions These findings suggest that the IUS represents a clinically useful screening tool to be used as an aid for the early and accurate detection of perinatal anxiety.

Psychological effects of isolation on antenatal women during COVID-19 pandemic

Background: Pregnancy is a time of increased vulnerability for the development of anxiety and depression. This study evaluated the psychological effect of isolation on antenatal women admitted with COVID-19 disease.Methods: A cross-sectional study conducted at Government medical college Kozhikode from 1 November 2020 to 31 January 2021. One hundred antenatal women with COVID-19 disease admitted in isolation ward in quarantine were randomly selected. Clinical and demographic data collected at the time of admission. After one week of admission, mental health assessment done using following mental health assessment tools. They were general anxiety disorder-7 (GAD-7), perinatal anxiety screening scale (PASS), patient health questionnaire-9 (PHQ-9).Results: Out of the 100 women selected, 74 responded with the questionnaires. All of them were educated, 62% studied up to plus two. Majority from joint family contributed 68.9% and 85.1% were home makers. Mean age was 26 years. Primigravidae were 48.6% and mean BMI of 25.71 kg/m2. Commonest medical comorbidity was diabetes mellitus present in 28.4%. Mental health assessment done using 3 sets of questionnaires, PHQ-9, GAD-7 and PASS showed that women in our study did not have any increased risk of depression, general anxiety or perinatal anxiety. Infact they reported of feeling safer and more comfortable at the hospital compared to home.Conclusions: Present study showed that antenatal women with COVID-19 disease admitted in hospital did not have any increased risk of general anxiety, depression or perinatal anxiety.

Perbedaan Kecemasan Ibu Hamil Trimester III Sebelum dan Sesudah Pemberian Murottal Al-Qur’an Surah Ar-Rahman di Wilayah Kerja Puskesmas Kaliabang Tengah Kota Bekasi

Kecemasan pada ibu hamil mencapai 373.000.000 di Indonesia dan 107.000.000 (28,7%), kecemasan pada ibu hamil terjadi saat mendekati persalinan. Dampak kecemasan dapat menyebabkan depresi setelah melahirkan, berpengaruh pada kesehatan, kesejahteraan, dan perkembangan bayi. Terapi murottal Al-Qur’an dapat menghasilkan endorphin alami, menurunkan hormon stress, dan merileksasikan sehingga dapat menurunkan kecemasan. Tujuan penelitian ini adalah untuk mengetahui perbedaan kecemasan ibu hamil trimester III dengan pemberian murottal Al-Qur’an Surah Ar- Rahman di Wilayah Kerja Puskesmas Kaliabang Tengah Kota Bekasi. Desain penelitian Quasy Experimental pendekatan One Group Pretest-Posttest. Populasi seluruh ibu hamil trimester III yang berada di Wilayah Kerja Puskesmas Kaliabang Tengah Kota Bekasi berjumlah 68 ibu hamil dan sampel berjumlah 18 ibu hamil, dengan teknik purposive sampling. Pengumpulan data dilakukan dengan pengisian kuesioner PASS (Perinatal Anxiety Screening Scale). Analisa data menggunakan uji wilcoxon. Hasil penelitian ini yaitu ada perbedaan kecemasan ibu hamil trimester III sebelum dan sesudah pemberian murottal Al-Qur’an Surah Ar-Rahman (p<0,001). Terapi murottal Al-Qur’an dapat dijadikan sebagai salah satu alternatif untuk menurunkan kecemasan pada ibu hamil khususnya pada umat muslim. Hasil analisis univariat yaitu kecemasan ibu hamil trimester III sebelum pemberian murottal Al-Qur’an dengan rata-rata cemas ringan dan kecemasan ibu hamil trimester III sesudah pemberian murottal Al-Qur’an dengan rata-rata tidak cemas. Kecemasan ibu hamil trimester III sebelum pemberian murottal Al-Qur’an memiliki rata-rata kecemasan ringan sebanyak 6 responden (3,33%) dan sesudah pemberian murottal Al-Qur’an memiliki rata-rata tidak cemas sebanyak 14 responden (77,8%). Hasil analisis bivariat yaitu ada perbedaan kecemasan ibu hamil trimester III sebelum dan sesudah pemberian murottal Al-Qur’an Surah Ar-Rahman (p<0,001). Setelah diberikan terapi murottal terjadi penurunan kecemasan sebanyak 8 point. Bagi petugas kesehatan maupun ibu hamil muslim dapat menerapkan terapi murottal Al-Qur’an Surah Ar-Rahman dalam kehidupan sehari-hari untuk penanganan kecemasan pada ibu hamil. ABSTRAK Anxiety in pregnant women reaches 373.000,000 in Indonesia and 107.000,000 (28.7%), anxiety in pregnant women occurs when approaching delivery. The impact of anxiety can lead to depression after childbirth, affecting the health, well-being, and development of the baby. Murottal Al-Qur'an therapy can produce natural endorphins, reduce stress hormones, and relax so that it can reduce anxiety. The purpose of this study was to determine the difference in the anxiety of third trimester pregnant women with the provision of murottal Al-Qur'an Surah Ar-Rahman in the Work Area of ​​the Central Kaliabang Health Center, Bekasi City. Quasy Experimental research design with One Group Pretest-Posttest approach. The population of all third trimester pregnant women who are in the Work Area of ​​the Central Kaliabang Health Center Bekasi City is 68 pregnant women and a sample of 18 pregnant women, using purposive sampling technique. Data was collected by filling out the PASS (Perinatal Anxiety Screening Scale) questionnaire. Data analysis using Wilcoxon test. The results of this study were that there were differences in the anxiety of pregnant women in the third trimester before and after giving murottal Al-Qur'an Surah Ar-Rahman (p <0.001). Al-Qur'an murottal therapy can be used as an alternative to reduce anxiety in pregnant women, especially Muslims. The results of the univariate analysis are the anxiety of pregnant women in the third trimester before giving murottal Al-Qur'an with an average of mild anxiety and the anxiety of pregnant women in the third trimester after giving murottal Al-Qur'an with an average of not being anxious. The anxiety of pregnant women in the third trimester before giving murottal Al-Qur'an had an average of mild anxiety as many as 6 respondents (3.33%) and after giving murottal Al-Qur'an had an average of 14 respondents (77.8). %). The results of the bivariate analysis showed that there were differences in the anxiety of pregnant women in the third trimester before and after giving murottal Al-Qur'an Surah Ar-Rahman (p<0.001). After being given murottal therapy there was a decrease in anxiety as much as 8 points. For health workers and Muslim pregnant women can apply murottal Al-Qur'an Surah Ar-Rahman therapy in daily life for handling anxiety in pregnant women.