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

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.