Parent-training programmes for improving maternal psychosocial health (Review) Barlow J, Coren E, Stewart-Brown S This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2009, Issue 1 http://www.thecochranelibrary.com Parent-training programmes for improving maternal psychosocial health (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 BACKGROUND .................................... 3 OBJECTIVES ..................................... 3 METHODS ...................................... 3 RESULTS....................................... 5 DISCUSSION ..................................... 16 AUTHORS’CONCLUSIONS . 18 ACKNOWLEDGEMENTS . 20 REFERENCES ..................................... 20 CHARACTERISTICSOFSTUDIES . 26 DATAANDANALYSES. 42 ADDITIONALTABLES. 50 WHAT’SNEW..................................... 68 HISTORY....................................... 68 CONTRIBUTIONSOFAUTHORS . 68 DECLARATIONSOFINTEREST . 69 SOURCESOFSUPPORT . 69 NOTES........................................ 69 INDEXTERMS .................................... 69 Parent-training programmes for improving maternal psychosocial health (Review) i Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [Intervention Review] Parent-training programmes for improving maternal psychosocial health Jane Barlow2, Esther Coren1, Sarah Stewart-Brown2 1Social Work, Community and Mental Health, Canterbury Christ Church University, Canterbury, UK. 2Health Sciences Research Unit, Warwick Medical School, Coventry, UK Contact address: Esther Coren, Social Work, Community and Mental Health, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1QU, UK. [email protected]. Editorial group: Cochrane Developmental, Psychosocial and Learning Problems Group. Publication status and date: Edited (no change to conclusions), published in Issue 1, 2009. Review content assessed as up-to-date: 30 November 2002. Citation: Barlow J, Coren E, Stewart-Brown S. Parent-training programmes for improving maternal psychosocial health. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD002020. DOI: 10.1002/14651858.CD002020.pub2. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. ABSTRACT Background Mental health problems are common and there is evidence to suggest that the origins of such problems lie in infancy and childhood. In particular, research suggests that maternal psychosocial health can have a significant effect on the mother-infant relationship, and that this in turn can have consequences for both the short and long-term psychological health of the child. The use of parenting programmes is increasing and evidence of their effectiveness in improving outcomes for children has been provided. Evidence is now required of their effectiveness in improving outcomes for mothers. Objectives 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 electronic databases were searched including MEDLINE, EMBASE CINAHL, PsychLIT, ERIC, ASSIA, Sociofile and the Social Science Citation Index,the Cochrane Library (CENTRAL), and the National Research Register (NRR). Selection criteria Randomised controlled trials were included in which participants had been allocated to an experimental and a control group, the latter being a waiting-list, no-treatment or a placebo control group. Studies had to include at least one standardised instrument measuring maternal psychosocial health. Data collection and analysis A systematic critical appraisal of all included studies was undertaken using a modified version of the Journal of the American Medical Association (JAMA) published criteria. Treatment effect for each outcome was standardised by dividing the mean difference in post- intervention scores for the intervention and treatment group, by the pooled standard deviation, to produce an effect size. Where appropriate the results were combined in a meta-analysis using a fixed-effect model, and 95% confidence intervals were used to assess the significance of the findings. Parent-training programmes for improving maternal psychosocial health (Review) 1 Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Main results A total of 23 studies were included in the original review which was increased to 26 at the first update (2003). 20 provided sufficient data to calculate effect sizes, providing a total of 64 assessments of aspects of psychosocial functioning 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. Data sufficient to combine in meta-analysis existed for only five outcomes (depression; anxiety/stress; self-esteem; social support; and relationship with spouse/marital adjustment). Meta-analyses showed statistically significant results favouring the intervention group for depression; anxiety/stress; self-esteem; and relationship with spouse/marital adjustment. The meta-analysis of the social support data showed no evidence of effectiveness. Of remaining data, approximately 22% of outcomes measured showed significant differences between the intervention and the control group. A further 40% showed non-significant differences favouring the intervention group. Approximately one-third of outcomes showed no evidence of effectiveness. A meta-analysis of follow-up data on three outcomes - depression, self-esteem and relationship with spouse/marital adjustment - was conducted. Rresults suggest a continued improvement in self-esteem, depression, and marital adjustment at follow-up, although the latter two findings were not statistically significant. This review has been updated (2003) with three new included studies. The size of effect for the main outcomes has not been substantially altered by this update. Additional sensitivity analyses to assess the impact of quasi randomised studies on the result have also been added. Where the quasi randomised studies are excluded from the analysis, the result was found to be slightly more conservative. Authors’ conclusions It is suggested that parenting programmes can make a significant contribution to the short-term psychosocial health of mothers; however, longterm data are lacking. Whilst the results of this review are positive overall, some studies showed no effect. Further research is needed to assess which factors contribute to successful outcomes in these programmes with particular attention being paid to the quality of delivery. These results suggest that parenting programmes have a potential role to play in the promotion of mental health. PLAIN LANGUAGE SUMMARY Parent training for improving maternal psychosocial health Parenting programmes are increasingly being used to promote the well-being of parents and children, and this review aims to establish whether they can improve maternal psycho-social health in particular. The findings of the review are based on a total of 26 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-emo- tive therapy. The 23 studies produced a total of 64 assessments of maternal health, including measures of maternal depression, anxiety, and self-esteem. The combined data show 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. Parent-training programmes for improving maternal psychosocial health (Review) 2 Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. BACKGROUND nificant effect on parenting attitudes and practices, and on fac- tors such as marital relations and parenting stress (Todres 1993). A number of studies have shown that there may also be an im- Description of the condition pact on general aspects of maternal functioning, including levels While it is recognised that the prevalence of mental health prob- of anxiety, depression (Mullin 1994; Scott 1987), and self-esteem lems in women generally is high (Goldberg 1992), there is very lit- (Mullin 1994). tle published data on the prevalence of mental health problems in mothers in particular. The limited epidemiological evidence that is available, however, suggests that the prevalence in urban popula- Why it is important to do this review tions (as measured by the General Health Questionnaire) may be as high as 45% (Stevenson 1989). Epidemiological studies of spe- The aim of this review is to evaluate the effectiveness of group- cific conditions such as postnatal depression indicate a prevalence based parenting programmes in improving the psychosocial health of between 10-15% and also indicate that such episodes may mark of mothers, by appraising and collating the evidence from existing the