目的:女性可以发展创伤后应激障碍(PTSD),以应对经历或感知的创伤,通常是医学上复杂的,分娩;美国这些事件的患病率仍然很高。目前,在预防或减轻产妇分娩相关PTSD(CB-PTSD)的常规护理中,没有推荐的治疗方法.我们对任何预防或治疗CB-PTSD的疗法的临床试验进行了系统评价和荟萃分析。
方法:PsycInfo,Psycarticles,PubMed(MEDLINE),ClinicalTrials.gov,CINAHL,ProQuest,社会学文摘,谷歌学者,Embase,WebofScience,ScienceDirect,Scopus,和CENTRAL被搜索到2023年9月之前发表的符合条件的试验.
方法:如果是介入试验,评估了CB-PTSD的任何治疗方法,症状的指示或PTSD发作之前,用英语写的.
方法:独立编码人员提取了符合条件的研究的样本特征和干预信息,并使用Downs和Black的质量检查表和Cochrane的偏倚风险方法评估了试验。
结果:41项研究(32项随机对照试验,9项非随机试验)进行了综述。他们测试了简短的心理治疗,包括汇报,以创伤为中心(包括认知行为疗法和表达性写作),记忆巩固/再巩固阻塞,以母婴为中心,和教育干预。试验针对二级预防缓冲CB-PTSD通常在创伤性分娩后(n=24),可能患有CB-PTSD的妇女的三级预防措施(n=14),和怀孕期间的一级预防(n=3)。联合随机二级预防的荟萃分析显示,与常规治疗相比,降低CB-PTSD症状的效果中等(标准化平均差异,SMD=-0.67;95%CI-0.92,-0.42)。产后96小时内的单次治疗是有帮助的(SMD=-0.55)。简短的结构化创伤聚焦疗法和半结构化助产士主导的基于对话的心理咨询显示出最大的效果(SMD=-0.95和SMD=-0.91)。其他治疗方法(例如,俄罗斯方块游戏,正念,以母婴为中心)需要更多的研究。三级预防代表较小的影响与次要,但具有潜在的临床意义(SMD=-0.37(-0.60;-0.14))。产前教育方法可能会有所帮助,但经验证据不足。
结论:在创伤分娩后的早期实施的以创伤为中心和非创伤为中心的短期心理治疗为缓解与分娩相关的创伤后应激障碍的症状提供了关键和可行的机会。整合诊断和生物学措施的未来研究可以为治疗效用和工作机制提供信息。
Women can develop posttraumatic stress disorder in response to experienced or perceived traumatic, often medically complicated, childbirth; the prevalence of these events remains high in the United States. Currently, no recommended treatment exists in routine care to prevent or mitigate maternal childbirth-related posttraumatic stress disorder. We conducted a systematic
review and meta-analysis of clinical trials that evaluated any therapy to prevent or treat childbirth-related posttraumatic stress disorder.
PsycInfo, PsycArticles, PubMed (MEDLINE), ClinicalTrials.gov, CINAHL, ProQuest, Sociological Abstracts, Google Scholar, Embase, Web of Science, ScienceDirect, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for eligible trials published through September 2023.
Trials were included if they were interventional, if they evaluated any therapy for childbirth-related posttraumatic stress disorder for the indication of symptoms or before posttraumatic stress disorder onset, and if they were written in English.
Independent coders extracted the sample characteristics and intervention information of the eligible studies and evaluated the trials using the Downs and Black\'s quality checklist and Cochrane\'s method for risk of bias evaluation. Meta-analysis was conducted to evaluate pooled effect sizes of secondary and tertiary prevention trials.
A total of 41 studies (32 randomized controlled trials, 9 nonrandomized trials) were reviewed. They evaluated brief psychological therapies including debriefing, trauma-focused therapies (including cognitive behavioral therapy and expressive writing), memory consolidation and reconsolidation blockage, mother-infant-focused therapies, and educational interventions. The trials targeted secondary preventions aimed at buffering childbirth-related posttraumatic stress disorder usually after traumatic childbirth (n=24), tertiary preventions among women with probable childbirth-related posttraumatic stress disorder (n=14), and primary prevention during pregnancy (n=3). A meta-analysis of the combined randomized secondary preventions showed moderate effects in reducing childbirth-related posttraumatic stress disorder symptoms when compared with usual treatment (standardized mean difference, -0.67; 95% confidence interval, -0.92 to -0.42). Single-session therapy within 96 hours of birth was helpful (standardized mean difference, -0.55). Brief, structured, trauma-focused therapies and semi-structured, midwife-led, dialogue-based psychological counseling showed the largest effects (standardized mean difference, -0.95 and -0.91, respectively). Other treatment approaches (eg, the Tetris game, mindfulness, mother-infant-focused treatment) warrant more research. Tertiary preventions produced smaller effects than secondary prevention but are potentially clinically meaningful (standardized mean difference, -0.37; -0.60 to -0.14). Antepartum educational approaches may help, but insufficient empirical evidence exists.
Brief trauma-focused and non-trauma-focused psychological therapies delivered early in the period following traumatic childbirth offer a critical and feasible opportunity to buffer the symptoms of childbirth-related posttraumatic stress disorder. Future research that integrates diagnostic and biological measures can inform treatment use and the mechanisms at work.