Interventions for Perinatal Anxiety (PNA) in a general practice population: a systematic review and narrative synthesis
Problem
Perinatal anxiety (PNA) occurs during pregnancy or up to 12 months post-partum. Global prevalence of PNA is estimated to be >15%, at least as common as depression. PNA may negatively impact on pregnancy and neonatal outcomes, postnatal mental health, parenting behaviours and childhood development. Previous research has focused primarily on postnatal depression; there is limited evidence for the management of PNA in primary care. Studies that consider anxiety occurring outside of the perinatal period support the use of psychological therapies as treatment; however, evidence for the specific application of these therapies for PNA seems scarce. There is also limited evidence published around other non-pharmacological interventions such as peer/family support.The NHS Five Year Forward View for Mental Health aims to improve specialist and community Perinatal Mental Health (PMH) support across England and NICE guidelines for PMH state there is a need for further research to specifically develop interventions such as psychological therapies to treat PNA. This study will review the current evidence for non-pharmacological interventions for PNA and highlight gaps in the current literature around the management of PNA.
Approach
A systematic review and narrative synthesis will be undertaken, reported in line with PRISMA guidelines and registered on PROSPERO. Systematic searches will be conducted in MEDLINE, CINAHL, AMED, EMBASE, Web of Science and PsycINFO. All titles and abstracts will be independently screened by VS; 20% will be screened by a second independent reviewer (LB) according to pre-defined eligibility criteria. Discrepancies will be solved by discussion or a third reviewer. Both researchers will undertake full paper screening and data extraction.The review will include any primary qualitative, quantitative or mixed methods studies. Data will be extracted about study participants, methodology, and intervention design and context. Quality assessment will be performed alongside data extraction using the Cochrane Risk of Bias tool. A grey literature scoping review will be conducted to identify reports from organisations involved in PMH care such as third sector organisations. A narrative synthesis will be performed as per the Popay guidelines to identify patterns across the data in order to draw informative conclusions. An established patient advisory group was involved in the concept and development of this systematic review and will be involved throughout.
Findings
Initial systematic literature searches are underway and results will be available for presentation at Conference in July.
Consequences
This review will identify and summarise evidence on the effectiveness of current non-pharmacological interventions used in general practice to manage PNA. Insights gained will be used to make recommendations for future research, clinical implications and policy changes. It forms the first part of a PhD looking at optimal interventions for PNA, and will support the co-production of an intervention for PNA.