Parent‐training programmes for improving maternal psychosocial health
Abstract
Background
The prevalence of mental health problems in women is 1:3 and such problems tend to be persistent. There is evidence from a range of studies to suggest that a number of factors relating to maternal psychosocial health can have a significant effect on the mother‐infant relationship, and that this can have consequences for the psychological health of the child. It is now thought that parenting programmes may have an important role to play in the improvement of maternal psychosocial health.
Objectives
The objective of this review is to address whether group‐based parenting programmes are effective in improving maternal psychosocial health including anxiety, depression and self‐esteem.
Search methods
A range of biomedical, social science, educational and general reference electronic databases were searched including MEDLINE, EMBASE CINAHL, PsychLIT, ERIC, ASSIA, Sociofile and the Social Science Citation Index. Other sources of information included the Cochrane Library (SPECTR, CENTRAL), and the National Research Register (NRR).
Selection criteria
Only randomised controlled trials were included in which participants had been randomly allocated to an experimental and a control group, the latter being either a waiting‐list, no‐treatment or a placebo control group. Studies had to include at least one group‐based parenting programme, and one standardised instrument measuring maternal psychosocial health.
Data collection and analysis
A systematic critical appraisal of all included studies was undertaken using the Journal of the American Medical Association (JAMA) published criteria. The data were summarised using effect sizes but were not combined in a meta‐analysis due to the small number of studies within each group and the presence of significant heterogeneity.
Main results
A total of 22 studies were included in the review but only 17 provided sufficient data to calculate effect sizes. These 17 studies reported on a total of 59 outcomes including depression, anxiety, stress, self‐esteem, social competence, social support, guilt, mood, automatic thoughts, dyadic adjustment, psychiatric morbidity, irrationality, anger and aggression, mood, attitude, personality, and beliefs. Approximately 22% of the outcomes measured suggested significant differences favouring the intervention group. A further 40% showed differences favouring the intervention group but which failed to achieve conventional levels of statistical significance, in some cases due to the small numbers that were used. Approximately 38% of outcomes suggested no evidence of effectiveness.
Authors' conclusions
It is suggested that parenting programmes can make a significant contribution to the improvement of psychosocial health in mothers. While the critical appraisal suggests some variability in the quality of the included studies, it is concluded that there is sufficient evidence to support their use with diverse groups of parents. However, it is also suggested that some caution should be exercised before the results are generalised to parents irrespective of the level of pathology present, and that further research is still required.
Plain language summary
There is evidence from a range of studies to suggest that adverse maternal psychosocial health can have an impact on the parent‐infant relationship and potentially lead to adverse child outcomes in the longer term. Parenting programmes are increasingly being used for promoting family health. This review aims to establish whether parenting programmes can affect maternal psycho‐social health in a positive way.
The findings of the review are based on a total of 23 studies and these have been classified into five groups according to the theoretical approach underpinning the programme ‐ behavioural, cognitive‐behavioural, multi‐modal, behavioural‐humanistic and rational‐emotive therapy. The 23 studies produced a total of 77 assessments of maternal health, including measures of maternal depression, anxiety, and self‐esteem. Due to the wide range of outcome measures which were used, it was not possible to combine the results to produce one overall measure of their effectiveness . However, the results suggest that parenting programmes can be effective in improving a range of aspects of maternal psychosocial functioning. While it was not possible to compare the effectiveness of the programmes in the five different categories, all of the programmes reviewed were successful in producing positive change in maternal psychosocial health.
Further research is needed to clarify some of the questions arising from this review.
