| 摘要: | Objectives: Parents of new babies often face psychological and physical challenges in the transition to parenthood. Despite the close relations between mothers and fathers, most existing studies focus on mothers’ emotional distress and sleep with limited attention to fathers’ psychological health. Recent studies on anxiety and depressive symptoms among parents of preterm infants are available but inconsistent estimates. Notably, relations of self-efficacy, an important modifiable parenting factor, with emotional symptoms are less known in developing countries like Vietnam. Finding effective interventions to tackle postpartum mood and sleep problems among parents are in need. This study aimed to (1) determine the prevalence of and factors associated with postpartum depression and anxiety among parents of premature infants, and examine the association between maternal and paternal symptoms (study 1); (2) examine the relationship between parenting self-efficacy, sleep quality, postpartum depression, and anxiety, and their associated factors among parents in Vietnam (study 2); (3) investigate the effectiveness of non-pharmacological interventions on postpartum sleep and depression (study 3).
Methodology: Study 1: A systematic review and meta-analysis was conducted on observational studies reporting prevalence of postpartum depression or anxiety among mothers and/or fathers of preterm infants. A random-effects model was used to pool the prevalence, subgroup analyses and meta-regression models were performed. Study 2: A cross-sectional study was conducted at a national hospital in Vietnam. We recruited postpartum parents of full-term and preterm infants. The Parenting Sense of Competence Scale, the Breastfeeding Self-Efficacy Scale-Short Form, the Edinburgh Postnatal Depression Scale, the Zung's Self-rated Anxiety Scale, and the Pittsburgh Sleep Quality Index were measured. Data was analyzed using descriptive and linear mixed effects modelling (LMM). Study 3: We conducted a systematic review and network meta-analysis of randomized controlled trial (RCT) on non-pharmacological interventions for postpartum sleep quality (primary outcome) and depression (secondary outcome). Random-effects models and subgroup analysis was performed.
Results: Study 1: A total of 79 studies were included. The pooled prevalence of postpartum depression was 29.2 % (95 % CI: 21.8 %, 37.9 %) and that of anxiety was 37.7 % (95 % CI: 24.1 %, 53.6 %) for mothers of preterm infants. The estimates of fathers were 17.4 % (95 % CI: 12.5 %, 23.8 %) and 18.3 % (95 % CI: 8.1 %, 36.3 %) for depression and anxiety, respectively. The prevalences were significantly different in postpartum time points, measurement tools, and geographic continents. Study 2: A total of 336 mother-father-infant triads participated with 223 parents of full-term infants and 113 parents of preterm infants. Prevalences of poor sleep quality, depression, and anxiety were 26%, 42.4%, 30.7% for mothers, and 16.7%, 29.4%, 22.1% for fathers, respectively. The parents of full-term and preterm infants reported a similar levels of parenting self-efficacy, breastfeeding self-efficacy, sleep quality, depression, and anxiety symptoms (p > 0.05). Significant correlation was found between mothers and fathers on parenting self-efficacy, breastfeeding self-efficacy, sleep quality, depression and anxiety (p < 0.001). Compared to fathers, mothers experienced a significantly higher depression, anxiety and poorer sleep quality (p < 0.05). Parents’ social support was positively associated with parenting self-efficacy (p < 0.001), breastfeeding self-efficacy (p < 0.05), and negatively related with their sleep quality (p < 0.05), depression (p < 0.001) and anxiety (p < 0.001). Study 3: Twenty-one RCTs (n = 2548 participants) examining 11 types of non-pharmacological interventions were included. We identified the effective non-pharmacological interventions for improving mothers’ sleep including massage (standardized mean different [SMD]= -3.2]), multicomponent intervention (MI) (SMD = -3.2), exercise (SMD = -1.9), cognitive behavior therapy for insomnia (CBTi) (SMD = -1.7), behavioral sleep education (SMD = -1.8), beverage (SMD = -1.9), and aroma therapy (SMD = -0.8) than placebo measure (p < 0.05). Among them, massage and multicomponent intervention ranked as the best non-pharmacological interventions than other methods. For depression outcome, beverage showed a better effect than basic sleep information (SMD = -1.1) and CBTi (SMD = -1.0) (p < 0.05).
Conclusion: Sleep disturbance, depression and anxiety were highly prevalent among postpartum parents. Significant correlations were found between mothers and fathers in self-efficacy, sleep quality, depression and anxiety. Social support was strongly associated with self-efficacy, sleep and mood outcomes in Vietnamese parents. The non-pharmacological interventions were effective on improving postpartum sleep quality and depression, with massage and multicomponent ranked as the best interventions. Promptly assessment of parents’ self-efficacy, sleep, depression and anxiety, and providing effective intervention tailored to family context are warranted. |
