Parent-training programmes for improving maternal psychosocial health

 

Abstract

Background

Mental health problems are common and there is evidence to suggest that the origins of such problems lie in infancy and childhood. In particular, research suggests that maternal psychosocial health can have a significant effect on the mother-infant relationship, and that this in turn can have consequences for both the short and long-term psychological health of the child. The use of parenting programmes is increasing and evidence of their effectiveness in improving outcomes for children has been provided. Evidence is now required of their effectiveness in improving outcomes for mothers.

Objectives

To address whether group-based parenting programmes are effective in improving maternal psychosocial health including anxiety, depression, and self-esteem.

Search methods

A range of electronic databases were searched including MEDLINE, EMBASE CINAHL, PsychLIT, ERIC, ASSIA, Sociofile and the Social Science Citation Index,the Cochrane Library (CENTRAL), and the National Research Register (NRR).

Selection criteria

Randomised controlled trials were included in which participants had been allocated to an experimental and a control group, the latter being a waiting-list, no-treatment or a placebo control group. Studies had to include at least one standardised instrument measuring maternal psychosocial health.

Data collection and analysis

A systematic critical appraisal of all included studies was undertaken using a modified version of the Journal of the American Medical Association (JAMA) published criteria. Treatment effect for each outcome was standardised by dividing the mean difference in post-intervention scores for the intervention and treatment group, by the pooled standard deviation, to produce an effect size. Where appropriate the results were combined in a meta-analysis using a fixed-effect model, and 95% confidence intervals were used to assess the significance of the findings.

Main results

A total of 23 studies were included in the original review which was increased to 26 at the first update (2003). 20 provided sufficient data to calculate effect sizes, providing a total of 64 assessments of aspects of psychosocial functioning including depression, anxiety, stress, self-esteem, social competence, social support, guilt, mood, automatic thoughts, dyadic adjustment, psychiatric morbidity, irrationality, anger and aggression, mood, attitude, personality, and beliefs. Data sufficient to combine in meta-analysis existed for only five outcomes (depression; anxiety/stress; self-esteem; social support; and relationship with spouse/marital adjustment). Meta-analyses showed statistically significant results favouring the intervention group for depression; anxiety/stress; self-esteem; and relationship with spouse/marital adjustment. The meta-analysis of the social support data showed no evidence of effectiveness. Of remaining data, approximately 22% of outcomes measured showed significant differences between the intervention and the control group. A further 40% showed non-significant differences favouring the intervention group. Approximately one-third of outcomes showed no evidence of effectiveness.

A meta-analysis of follow-up data on three outcomes - depression, self-esteem and relationship with spouse/marital adjustment - was conducted. Rresults suggest a continued improvement in self-esteem, depression, and marital adjustment at follow-up, although the latter two findings were not statistically significant.

This review has been updated (2003) with three new included studies. The size of effect for the main outcomes has not been substantially altered by this update.

Additional sensitivity analyses to assess the impact of quasi randomised studies on the result have also been added. Where the quasi randomised studies are excluded from the analysis, the result was found to be slightly more conservative.

Authors' conclusions

It is suggested that parenting programmes can make a significant contribution to the short-term psychosocial health of mothers; however, longterm data are lacking. .

Whilst the results of this review are positive overall, some studies showed no effect. Further research is needed to assess which factors contribute to successful outcomes in these programmes with particular attention being paid to the quality of delivery.

These results suggest that parenting programmes have a potential role to play in the promotion of mental health.

 

Plain language summary

Parent training for improving maternal psychosocial health

Parenting programmes are increasingly being used to promote the well-being of parents and children, and this review aims to establish whether they can improve maternal psycho-social health in particular.

The findings of the review are based on a total of 26 studies and these have been classified into five groups according to the theoretical approach underpinning the programme - behavioural, cognitive-behavioural, multi-modal, behavioural-humanistic and rational-emotive therapy. The 23 studies produced a total of 64 assessments of maternal health, including measures of maternal depression, anxiety, and self-esteem. The combined data show that parenting programmes can be effective in improving a range of aspects of maternal psychosocial functioning. While it was not possible to compare the effectiveness of the programmes in the five different categories, all of the programmes reviewed were successful in producing positive change in maternal psychosocial health.

Further research is needed to clarify some of the questions arising from this review.

 

摘要

背景

親職訓練計畫能增進母親的心理社會健康

心理健康問題是相當常見的，並且証據示這些問題的根源是來自於嬰孩及童年時期。特別是有許多的研究証據顯示母親的心理社會健康對於母親及嬰孩的關係有重大的影響，而接下來也會對於孩子短期及長期的心理健康狀態有著後續的影響力。關於養育孩子的親職計畫在英國及各地逐漸增加，而這方面對於增進孩子成長結果的有效性也被証實。目前需要証實的部份是這個課程計畫對於增進媽媽健康之有效性。

目標

這篇回顧文章的主旨是要看看是否以團體為基礎的親職計畫課程對於增進母親的心理社會健康是有幫助的，包括了焦慮、憂鬱及自尊。

搜尋策略

我們在關於生物醫學、社會科學、教育及一般的參考電子資料庫中搜尋，包括了MEDLINE, EMBASE CINAHL, PsychLIT, ERIC, ASSIA, Sociofile及社會科學引文索引 (the Social Science Citation Index) 。其他資訊的資源包括了考科藍圖書館Cochrane Library (SPECTR, CENTRAL) 以及National Research Register (NRR) 等資料庫。

選擇標準

唯有符合隨機控制試驗的研究才會被選出，在這其中受試著被隨機分派到實驗組及控制組，後者是一份名單，為沒有接受治療或是使用安慰劑的控制組。研究至少必須包括一個以團體為基礎的親職訓練計畫課程，以及一份用來評估母親心理社會健康的標準工具。

資料收集與分析

對所有包含在內的研究採用了系統性評論估量的方式，根據的是Journal of the American Medical Association (JAMA) 這本期刊所發表的準則加以修正後的版本。在每個研究中對每個結果的治療效果標準化的方式，是透過分配在研究及治療組當中後測分數上的標準差異，藉著用公式計算共同標準偏差而產生了有效程度。這個適切的結果在統合分析中用固定效果模式 (fixedeffect model) 做結合，採用95% 的信賴區間，來評估結果的顯著性。

主要結論

在原始的回顧文獻中包括了23個研究，在第一次的更新 (2003年) 時增加到26個。有20個可以提供足夠的資料去計算有效程度。20個研究提供了64種關於心理社會功能的各方面結果的評估，包括了憂鬱、焦慮、壓力、自尊、社會能力、社會支持、罪惡感、情緒、自動化想法、配偶調適、精神科共病、非邏輯性、生氣與侵略、情緒、態度、人格與信念。資料足夠結合於統合分析的只有五個結果 (憂鬱、焦慮/壓力、自尊、社會支持、配偶/婚姻適應的關係) 。統合分析顯示出有統計上顯著意義的結果傾向於對以下族群做治療介入，包括憂鬱、焦慮/壓力、自尊、社會支持、配偶/婚姻適應的關係。社會支持的統合分析結果顯示並沒有有效的証據。其餘的資料並無法結合在統合分析當中，大約是22% 的結果，顯示出在接受治療的組別及控制組中有顯著的差異。而有40% 顯示出兩組並沒有顯著的差異。大約有三分之一的結果沒有有效的証據顯示。關於追蹤結果的統合分析方面有三項被完成，包括憂鬱、自尊及配偶/婚姻適應的關係。結果顯示有持續在自尊、憂鬱及婚姻適應的後續追蹤上有持續的進步，雖然後兩者並沒有統計學上顯著的意義。這篇回顧文章在2003年更新時加入了三個新的研究。也包括了一些新增加但被排除在外的研究。有一份研究在等待評估，兩份研究正在進行當中而會被納入未來此回顧文獻的更新當中。對於主要結果的效果規模並不會因更新而有太大本質上的改變。此外也加入了額外的敏感度分析，目的是為了要評估類似隨機研究結果的影響。當類似隨機研究的結果被排除於分析之外時，結果則稍微傾向保留。

作者結論

結果表示親職訓練計畫練課程可以對於媽媽短期的心理社會健康有具有顯著貢獻。然而目前仍缺乏証據顯示這些結果是否能隨著時間持續，在可得的有限追蹤資料中顯示出模擬兩可的結果。這顯示未來需要更多的証據證明親職訓練課程對於母親心智健康的長期效果。這個回顧文獻的結果整體而言是正向的，但是一些研究仍顯示出無效果。未來需要更多研究去評量在這個課程當中的哪些因子會造成成功的結果，而在生產的品質上需要特別的注意。這些結果顯示出親職訓練計畫課程對於促進心智健康扮演了一個潛在的重要角色。

翻譯人

本摘要由成功大學附設醫院謝佩君翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

在一些研究的証據上顯示：母親負面的心理社會健康對於父母及嬰孩關係的影響，在長期也可能會造成孩童不當的影響。親職訓練計畫愈來愈被用於促進父母及孩童的全人健康，而這個回顧研究的目的在建立這個計畫是否可以特別增進母親的心理社會健康。這個回顧研究的發現是根據全部26個研究，而這些研究依據在這計畫之下的理論而分成五組：行為取向、認知行為取向、多面向模式、行為人本取向以及理情治療。23個研究產生了對母親健康的64種評估，包括評估母親憂鬱、焦慮及自尊心。這個合併的資料顯示親職計畫在增進母親心理社會功能的層面來說是有效的。然而無法去比較在五種不同類別計畫的有效程度，而所有的回顧計畫在增進母親心理社會健康的改變上都是有成效的。需要更進一步的研究來澄清一些在這個回顧研究中所浮現的問題。