期刊论文详细信息
BMC Pregnancy and Childbirth
Antenatal mindfulness intervention to reduce depression, anxiety and stress: a pilot randomised controlled trial of the MindBabyBody program in an Australian tertiary maternity hospital
Stephanie J Brown3  Fiona Judd1  Kristine Mercuri2  Hannah Woolhouse2 
[1] Department of Psychiatry, University of Melbourne, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville 3050, VIC, Australia;Centre for Women’s Mental Health, Royal Women’s Hospital, Flemington Road, Parkville, Melbourne 3052, VIC, Australia;General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Melbourne 3053, VIC, Australia
关键词: Stress in pregnancy;    Antenatal care;    Antenatal anxiety;    Antenatal depression;    Mindfulness;   
Others  :  1092169
DOI  :  10.1186/s12884-014-0369-z
 received in 2014-04-17, accepted in 2014-10-15,  发布年份 2014
PDF
【 摘 要 】

Background

Mindfulness interventions to reduce psychological distress are well-suited to pregnancy, due to their brief and non-pharmacological nature, but there is a need for more robust evidence determining their usefulness. This pilot study was designed to explore the feasibility of a randomised controlled trial of a mindfulness intervention to reduce antenatal depression, anxiety and stress.

Methods

The study was designed in two parts 1) a non-randomised trial targeting women at risk of mental health problems (a selected population) and 2) a randomised controlled trial (RCT) of a universal population. Process evaluation focused on feasibility of recruitment pathways, participant retention, acceptability of study measures, and engagement with mindfulness practices. Measurement of psychological distress was taken pre and post intervention through the Centre for Epidemiologic Studies Depression Scale Revised, the Depression Anxiety and Stress Scale-21, the State-Trait Anxiety Inventory, and the Perceived Stress Scale.

Results

20 women were recruited to the non-randomised trial, and 32 to the RCT. Recruitment through a mailed study brochure at the time of booking-in to the hospital resulted in the largest number of participants in the RCT (16/32; 50%), and resulted in considerably earlier recruitment (50% in first trimester, 50% second trimester) compared to recruitment through the antenatal clinic waiting room (86% in second trimester, 14% third trimester). Over a third of women in the universal population scored above clinical cut-offs for depression and anxiety, indicating a sample with more symptomology than the general population. The most common reason for loss to follow-up was delivery of baby prior to follow-up (n = 9). In the non-randomised study, significant within group improvements to depression and anxiety were observed. In the intervention arm of the RCT there were significant within group improvements to anxiety and mindfulness. No between group differences for the intervention and ‘care as usual’ control group were observed.

Conclusions

This small pilot study provides evidence on the feasibility of an antenatal mindfulness intervention to reduce psychological distress. Major challenges include: finding ways to facilitate recruitment in early pregnancy and engaging younger women and other vulnerable populations.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12613000742774 webcite (31/10/2012).

【 授权许可】

   
2014 Woolhouse et al.; licensee BioMed Central Ltd.

【 预 览 】
附件列表
Files Size Format View
20150128180804253.pdf 485KB PDF download
Figure 1. 45KB Image download
【 图 表 】

Figure 1.

【 参考文献 】
  • [1]Cooper PJ, Murray L: Postnatal depression. Br Med J 1998, 316(7148):1884-1886.
  • [2]Luoma I, Tamminen T, Kaukonen P, Laippala P, Puura K, Salmelin R, Almqvist F: Longitudinal study of maternal depressive symptoms and child well-being. J Am Acad Child Adolesc Psychiatry 2001, 40(12):1367-1374.
  • [3]O’Connor TG, Heron J, Glover V: Antenatal anxiety predicts child behavioural/emotional problems independently of postnatal depression. J Am Acad Child Adolesc Psychiatry 2002, 41(12):1470-1477.
  • [4]O’Connor TG, Heron J, Golding J, Beveridge M, Glover V: Maternal antenatal anxiety and children’s behavioural/emotional problems at 4 years. Br J Psychiatry 2002, 180(6):502-508.
  • [5]Glover V: Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Pract Res Clin Obstet Gynaecol 2014, 28(1):25-35.
  • [6]Lumley J, Austin MP, Mitchell C: Intervening to reduce depression after birth: a systematic review of the randomized trials. Int J Technol Assess Health Care 2004, 20(2):128-144.
  • [7]Bergman K, Sarkar P, O’Connor TG, Modi N, Glover V: Maternal stress during pregnancy predicts cognitive ability and fearfulness in infancy. J Am Acad Child Adolesc Psychiatry 2007, 46(11):1454-1463.
  • [8]Campbell JC: Health consequences of intimate partner violence. Lancet 2002, 359(9314):1331-1336.
  • [9]Huizink AC, Robles de Medina PG, Mulder EJ, Visser GH, Buitelaar JK: Stress during pregnancy is associated with developmental outcome in infancy. J Child Psychol Psychiatry 2003, 44(6):810-818.
  • [10]Rowe HJ, Fisher JR: Development of a universal psycho-educational intervention to prevent common postpartum mental disorders in primiparous women: a multiple method approach.BMC Public Health 2010, 10(1):499.
  • [11]Kabat-Zinn J: Coming to our Senses: Healing Ourselves and the World through Mindfulness. Hachette Publishing, London UK; 2005.
  • [12]Baer RA: Mindfulness training as a clinical intervention: a conceptual and empirical review. Clin Psychol Sci Pract 2003, 10(2):125-143.
  • [13]Teasdale JD, Moore RG, Hayhurst H, Pope M, Williams S, Segal ZV: Metacognitive awareness and prevention of relapse in depression: empirical evidence.J Consult Clin Psychol 2002, 70(2):275.
  • [14]Linehan M: Cognitive-behavioral Treatment of Borderline Personality Disorder. Guilford Press, New York, NY; 1993.
  • [15]Kabat-Zinn J: Full Catastrophe Living: How to Cope with Stress, Pain and Illness using Mindfulness Meditation?. Dell, New York, NY; 1990.
  • [16]Kabat-Zinn J, Wheeler E, Light T, Skillings A, Scharf MJ, Cropley TG, Hosmer D, Bernhard JD: Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing photo therapy (UVB) and photochemotherapy (PUVA). Psychosom Med 1998, 60(5):625-632.
  • [17]Goldenberg DL, Kaplan KH, Nadeau MG, Brodeur C, Smith S, Schmid CH: A controlled study of a stress-reduction, cognitive-behavioral treatment program in fibromyalgia. J Musculoskelet Pain 1994, 2(2):53-66.
  • [18]Segal ZV, Williams JMG, Teasdale JD: Mindfulness-Based Cognitive Therapy for Depression. Guilford Press, New York, NY; 2012.
  • [19]Duncan L, Bardacke N: Mindfulness-based childbirth and parenting education: promoting family mindfulness during the perinatal period. J Child Fam Stud 2010, 19(2):190-202.
  • [20]Chiesa A, Serretti A: Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis. Psychiatry Res 2011, 187(3):441-453.
  • [21]Vieten C, Astin J: Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: results of a pilot study. Arch Womens Ment Health 2008, 11(1):67-74.
  • [22]Dunn C, Hanieh E, Roberts R, Powrie R: Mindful pregnancy and childbirth: effects of a mindfulness-based intervention on women’s psychological distress and well-being in the perinatal period. Arch Womens Ment Health 2012, 15(2):139-143.
  • [23]Hughes A, Williams M, Bardacke N, Duncan LG, Dimidjian S, Goodman SH: Mindfulness approaches to childbirth and parenting. Br J Midwifery 2009, 17(10):630-635.
  • [24]Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008, 337:979-983.
  • [25]Feeley N, Cossette S, Côté J, Héon M, Stremler R, Martorella G, Purden M: The importance of piloting an RCT intervention. Can J Nurs Res 2009, 41(2):84-99.
  • [26]Lovibond S, Lovibond PF: Manual for the Depression Anxiety Stress Scales. Psychology Foundation of Australia, Sydney, Australia; 1996.
  • [27]Lovibond PF, Lovibond SH: The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther 1995, 33(3):335-343.
  • [28]Brown TA, Chorpita BF, Korotitsch W, Barlow DH: Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples.Behav Res Ther 1997, 35(1):79.
  • [29]Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP: Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample.Psychol Assess 1998, 2:176.
  • [30]Radloff LS: The CES-D scale. Appl Psychol Meas 1977, 1(3):385-401.
  • [31]Ickovics JR, Reed E, Magriples U, Westdahl C, Schindler Rising S, Kershaw TS: Effects of group prenatal care on psychosocial risk in pregnancy: results from a randomised controlled trial. Psychol Health 2011, 26(2):235-250.
  • [32]Orr ST, James SA, Miller CA, Barakat B, Daikoku N, Pupkin M, Engstrom K, Huggins G: Psychosocial stressors and low birthweight in an urban population. Am J Prev Med 1996, 12(6):459-466.
  • [33]Hoffman S, Hatch MC: Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women.Health Psychol 2000, 19(6):535.
  • [34]Van Dam NT, Earleywine M: Validation of the Center for Epidemiologic Studies Depression Scale—Revised (CESD-R): pragmatic depression assessment in the general population. Psychiatry Res 2011, 186(1):128-132.
  • [35]Spielberger CD: State-Trait Anxiety Inventory. In The Corsini Encyclopedia of Psychology. John Wiley & Sons, Inc, Hoboken, NJ; 2010.
  • [36]Teixeira J, Fisk NM, Glover V: Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. BMJ 1999, 318(7177):153-157.
  • [37]Austin MP, Tully L, Parker G: Examining the relationship between antenatal anxiety and postnatal depression. J Affect Disord 2007, 101(1–3):169-174.
  • [38]Beck AT, Epstein N, Brown G, Steer RA: An inventory for measuring clinical anxiety: psychometric properties.J Consult Clin Psychol 1988, 56(6):893.
  • [39]Cohen S, Kamarck T, Mermelstein R: A global measure of perceived stress. J Health Soc Behav 1983, 24(4):385-396.
  • [40]Cohen S: Perceived Stress in a Probability Sample of the United States. Sage Publications, Thousand Oaks, CA, US; 1988.
  • [41]Roberti JW, Harrington LN, Storch EA: Further psychometric support for the 10‐item version of the perceived stress scale. J Coll Couns 2006, 9(2):135-147.
  • [42]Bastani F, Hidarnia A, Kazemnejad A, Vafaei M, Kashanian M: A randomized controlled trial of the effects of applied relaxation training on reducing anxiety and perceived stress in pregnant women. J Midwifery Womens Health 2005, 50(4):e36-e40.
  • [43]Chang MY, Chen CH, Huang KF: Effects of music therapy on psychological health of women during pregnancy. J Clin Nurs 2008, 17(19):2580-2587.
  • [44]Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L: Using self-report assessment methods to explore facets of mindfulness. Assessment 2006, 13(1):27-45.
  • [45]Christopher MS, Neuser NJ, Michael PG, Baitmangalkar A: Exploring the psychometric properties of the five facet mindfulness questionnaire. Mindfulness 2012, 3(2):124-131.
  • [46]Baer RA, Smith GT, Lykins E, Button D, Krietemeyer J, Sauer S, Walsh E, Duggan D, Williams JMG: Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment 2008, 15(3):329-342.
  • [47]Mercuri K, Woolhouse H: MindBabyBody Group Program: Facilitators Manual. The Royal Women’s Hospital and Murdoch Childrens Research Institute, Melbourne Australia; 2014.
  • [48]Smith JA, Osborn M: Interpretative Phenomenological Analysis. In Doing Social Psychology Research. The British Psychological Society and Blackwell Publishing Ltd, London, UK; 2008:229-254.
  • [49]Smith JA, Larkin M, Flowers P: Interpretative Phenomenological Analysis: Theory, Method and Research/Jonathan A. Smith, Paul Flowers and Michael Larkin. SAGE, Los Angeles; London; 2009.
  • [50]Fisher JR, Wynter KH, Rowe HJ: Innovative psycho-educational program to prevent common postpartum mental disorders in primiparous women: a before and after controlled study.BMC Public Health 2010, 10(1):432.
  • [51]Herrman H: The need for mental health promotion. Aust N Z J Psychiatry 2001, 35(6):709-715.
  • [52]Yelland JS, Sutherland GA, Brown JB: Postpartum anxiety, depression and social health: findings from a population-based survey of Australian women.BMC Public Health 2010, 10:771.
  • [53]Frohlich KL, Potvin L: Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations.Am J Public Health 2008, 98(2):216.
  • [54]Strategic Plan 2011–2015. Royal Women’s Hospital, Melbourne, Australia; 2010.
  • [55]Kraemer HC, Mintz J, Noda A, Tinklenberg J, Yesavage JA: Caution regarding the use of pilot studies to guide power calculations for study proposals.Arch Gen Psychiatry 2006, 63(5):484.
  • [56]Woolhouse H, Gartland D, Hegarty K, Donath S, Brown SJ: Depressive symptoms and intimate partner violence in the 12 months after childbirth: a prospective pregnancy cohort study. BJOG 2012, 119(3):315-323.
  文献评价指标  
  下载次数:7次 浏览次数:18次