Effectiveness of parenting interventions on self-efficacy, anxiety, stress, and depression among parents of preterm infants: A systematic review and meta-analysis of randomized control trials

Abstract

Background: Parents of preterm infants need to acquire essential caregiving skills and effectively manage emotional distress during the transition into parenthood to meet their infants' care needs. Although various parenting programs have been developed, their effectiveness remains inconclusive.

Objective: To determine the effectiveness of parenting interventions on parenting self-efficacy and psychological outcomes, including anxiety, stress, and depression, among parents of preterm infants and to identify the key factors that contribute to effective parenting programs.

Design: A systematic review and meta-analysis of randomized control trials.

Methods: PubMed, MEDLINE Ovid, Web of Science, Cumulative Index to Nursing and Allied Health Literature Plus, Embase, and PsycINFO were searched from inception to December 20, 2024. Independent reviewers conducted the study selection, data extraction, and quality assessment. The Cochrane risk-of-bias tool version 2 was used to evaluate methodological quality. The pooled effects were analyzed using a random-effects model, and subgroup analysis and meta-regression were performed to identify potential moderators.

Results: Thirty-two randomized controlled trials with a total of 4058 participants were identified, 29 of which were included in the meta-analysis. Mothers who received parenting interventions demonstrated a significant improvement in parenting self-efficacy (standardized mean difference, SMD: 0.64, 95 % confidence interval, CI: 0.45 to 0.83) and a reduction in anxiety (SMD: -0.83, 95 % CI: -1.39 to -0.26), stress (SMD: -0.20, 95 % CI: -0.33 to -0.07), and depression (SMD: -0.19, 95 % CI: -0.32 to -0.06). The interventions also effectively reduced fathers' stress (SMD: -0.23, 95 % CI: -0.45 to -0.02). In studies reporting combined outcomes for both mothers and fathers, a significant reduction in depression (SMD: -0.31, 95 % CI: -0.60 to -0.02) was observed. The effects remained significant for all maternal outcomes at three months post-intervention, and maternal depression showed a sustained decrease from four to 12 months post-intervention. Interventions conducted in hospital settings and delivered in non-Organization for Economic Co-operation and Development countries were effective in enhancing mothers' parenting self-efficacy and reducing anxiety.

Conclusions: Parenting programs significantly enhance parenting self-efficacy and psychological health among mothers and fathers of preterm infants. Effective strategies in these programs should be integrated into routine care to optimize outcomes. Future studies assessing outcomes for parents of preterm infants, particularly from the perspective of fathers, are urgently needed.

Registration: The protocol of this study has been registered in the database PROSPERO (registration ID: CRD42023447039).

Keywords: Anxiety; Depression; Meta-analysis; Parenting; Premature birth; Self-efficacy.