Assessing non-pharmacological interventions for perinatal anxiety (PNA) used in primary care: a systematic review of systematic reviews.

Problem

Perinatal anxiety (PNA) occurs during pregnancy and up to 12 months post-partum. Global prevalence of PNA is estimated to be >15% of women, making it as common as perinatal depression. PNA may impact negatively on pregnancy and neonatal outcomes, parenting behaviours and childhood development.

There is limited evidence to inform the management of women with PNA in primary care. Studies that consider anxiety occurring outside of the perinatal period support the use of non-pharmacological interventions, in particular psychological therapies. There is limited evidence focusing on non-pharmacological interventions, such as peer or family support, for the management of PNA and the 2014 NICE antenatal and postnatal mental health guidance recommended that further research is required in this area.

This study will therefore review the current evidence for non-pharmacological interventions for PNA and will highlight gaps in the current literature in the management of women with PNA.

Approach

A systematic review and narrative synthesis is currently being undertaken. It has been registered on PROSPERO (ID: CRD42021202611) and it will be reported in line with PRISMA guidelines.

Systematic searches are being conducted in twelve health-related databases. All titles and abstracts are being independently screened by the first author (VS); with 20% being screened by a second independent reviewer (LB) according to pre-defined eligibility criteria. Discrepancies are being resolved through discussion or a third reviewer. Both VS and LB are undertaking full paper screening and data extraction.

Systematic reviews that report results from randomised control trials, controlled clinical trials, cohort studies, case-control studies and qualitative studies are included. Data are being extracted about study participants, methodology, and intervention design and context. Quality assessment is being performed alongside data extraction using the AMSTAR2 and GRADE tools. A grey literature scoping review is also being conducted to identify reports from organisations involved in the care of women with PNA such as third sector organisations. A narrative synthesis will be performed following the Popay guidelines, to identify patterns across the data in order to draw informative conclusions.

An established maternal mental health patient and public involvement 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 the conference in July. Initial searches have found 4074 titles to be screened.

Consequences

This review will identify and summarise evidence on the effectiveness of current non-pharmacological interventions used in primary care to manage PNA. Insights gained will be used to make recommendations for future research, clinical implications and policy changes. This systematic review forms the first part of a PhD looking at optimal interventions for PNA, and will support the co-production of an intervention for PNA.