Perinatal anxiety disorders, affecting as many as one in five individuals during pregnancy and the postpartum period, pose a significant burden on the mother and her family. These disorders, which include Generalized Anxiety Disorder, Panic Disorder, and Obsessive Compulsive Disorder, can arise prior to, during, or after pregnancy. They have been associated with various adverse outcomes, such as birth complications, longer hospital stays, and lower Apgar scores for infants. Furthermore, offspring of individuals with perinatal anxiety have a higher likelihood of experiencing mental disorders in childhood. Despite their high prevalence and impact, perinatal anxiety disorders are often overlooked compared to perinatal depression.
Efforts have been made to screen for anxiety disorders in pregnant and postpartum individuals to improve identification and intervention.
While perinatal anxiety disorders are common, little is known about the extent to which targeted interventions can be used to prevent perinatal anxiety disorders. A recent systematic review and meta-analysis were conducted to examine whether psychological interventions prevent or reduce risk for perinatal anxiety disorders and which interventions are the most effective. The review included 36 studies that examined interventions focused on perinatal anxiety, as well as interventions designed to prevent perinatal depression. Studies varied regarding intervention approach and included CBT (10/36), mindfulness and relaxation (6/36), and psychoeducation (6/36).
The authors included all studies assessing perinatal anxiety symptom severity as an outcome, including interventions designed to prevent perinatal anxiety, to prevent perinatal depression, or to address risk factors associated with perinatal anxiety; for example, sleep quality and physical activity. While no significant effect was found in preventing the onset of perinatal anxiety disorders, psychological interventions were effective in reducing the severity of perinatal anxiety symptoms.
Mindfulness and cognitive behavioral therapy (CBT) approaches were particularly effective in this regard. Interventions specifically developed for perinatal anxiety were more effective than those focused on the prevention of perinatal depression. While anxiety and depression often occur together in the perinatal period, these findings suggest that relying on interventions developed to prevent depression may not be sufficient to prevent anxiety. Interventions developed for other mental health conditions may lack key active ingredients that are specific to preventing and treating anxiety disorders.
The study highlights the potential of psychological interventions in reducing perinatal anxiety and calls for the development of interventions that specifically target perinatal anxiety disorder prevention. The authors also emphasize the importance of including culturally relevant content and accessibility of intervention modalities in order to effectively reach marginalized populations. Overall, more research is needed to better understand the prevention and treatment of perinatal anxiety disorders.
Ruta Nonacs, MD PhD
Zimmermann M, Julce C, Sarkar P, McNicholas E, Xu L, Carr C, Boudreaux ED, Lemon SC, Byatt N. Can psychological interventions prevent or reduce risk for perinatal anxiety disorders? A systematic review and meta-analysis. Gen Hosp Psychiatry. 2023 Sep-Oct;84:203-214.
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