The efficacy of collaborative psychological interventions in reducing anxiety levels in pregnant women: a systematic review and meta-analysis

Abstract

Background: Anxiety during pregnancy can be harmful to both mother and baby, with anxiety rates remaining high despite psychological intervention efforts. This study aimed to evaluate the effectiveness of collaborative and single psychological interventions in reducing anxiety compared with standard antenatal care.

Methods: A literature search was conducted in four databases (Scopus, Cochrane Library, PubMed, and ScienceDirect) for relevant studies published from 2016 to January 2024. The population in this review is pregnant women with anxiety who received psychological interventions either from a single health worker or involving collaboration. Psychological interventions were compared with standard antenatal care with maternal anxiety outcome scores to measure the efficacy of pre-post psychological intervention methods, with measurements taken only during pregnancy. The study designs included the use of the Randomized Controlled Trials method. This study restricted articles to languages ​​other than English and used a review design and pharmacological interventions. Two independent reviewers performed data extraction and quality assessment using RoB 2. Statistical analysis was conducted using R-Studio. Data analysis was performed using meta-count packages with a random effect model.

Results: There were 14 eligible articles identified from the initial 3,346 records, with 1 article excluded from the meta-analysis. Psychological interventions were effective in reducing anxiety compared with standard care (Standardised Mean Difference (SMD) - 0.64, 95% CI - 0.98--0.31). Analysis by type of intervention group showed differences between the two groups in mindfulness interventions (SMD - 0.55, 95% CI - 0.8--0.31), motivational interviewing (SMD - 0.70, 95% CI - 1.08--0.33), and supportive counseling (SMD - 0.73, 95% CI - 1.19-0.28). There were no differences between the Cognitive Behavioral Therapy (SMD - 0.80, 95% CI (- 1.80-0.19)) and Thinking Healthy Program intervention groups (SMD - 0.35, 95% CI - 0.81-0.11). Analysis of interventions conducted by a multidisciplinary team (collaborative) showed higher efficacy (SMD - 0.88, 95% CI - 1.60--0.15) compared with a single professional (noncollaborative) (SMD - 0.47, 95% CI - 0.72--0.22).

Conclusions: Collaborative interventions show better efficacy than a single intervention, with psychological therapy being more effective in reducing anxiety rather than standard antenatal care. Future research should improve the cooperative approach and examine its long-term effects on maternal and newborn outcomes.

Trial registration: This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration code CRD42024497417.

Keywords: Anxiety; Collaboration; Pregnant woman; Psychological intervention.

Fig. 1

Flow of studies found by the systematic review

Fig. 2

Risk of bias graph: reviewers’ domain assessments as study percentages

Fig. 3

Forest plot showing anxiety outcomes of all interventions

Fig. 4

Forest plot showing anxiety outcomes from intervention subgroups in random effects model

Fig. 5

Forest plot showing anxiety outcomes by collaborative and noncollaborative treatments

Fig. 6

Forest Plot showing the duration of observation or follow-up after intervention

Fig. 7

Funnel plot