Effectiveness of expressive writing therapy for postpartum women with psychological distress: Meta-analysis and narrative review.

IF 2.6 3区 医学 Q2 OBSTETRICS & GYNECOLOGY
Xueying Lim, Mei Qi Ang, Audrey Foo, Kimberly Kai Yi Chng, Serena Siew Lin Koh
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引用次数: 0

Abstract

Background: The increasing prevalence of psychological distress among mothers is outpacing the effectiveness of conventional coping methods like cognitive behavioral therapy. The efficacy of alternatives such as writing therapy for maternal psychological well-being remains uncertain due to a lack of extensive research and inconsistent findings.

Objective: The aim of this study was to evaluate the effectiveness of expressive writing therapy in comparison to standard postpartum care for alleviating psychological distress, encompassing symptoms of depression, anxiety, or stress, in postpartum women.

Search strategy: For this purpose, seven bibliographic databases, including CINAHL, Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science, and gray literature were examined up to December 27, 2022 for randomized controlled trials, comparing expressive writing against standard care or controlled writing among postpartum women with psychological distress.

Data collection and analysis: Data was collected using a random effect model for meta-analysis.

Results: A meta-analysis of five studies with 483 participants found that expressive writing therapy was more effective than standard care or controlled writing in reducing postpartum depression and stress among women with psychological distress. Expressive writing resulted in a significant reduction in initial depression with standard mean difference (SMD) = -0.65%, 95% confidence interval (CI) = -1.08 to -0.22, Z = 2.96, P = 0.003, in comparison to controlled writing as an intervention. Regarding expressive writing versus standard care, a narrative review was conducted due to an I2 above 75%. The results showed significant improvements compared to the baseline at the seventh day and third month post-intervention. In terms of stress scores, there was a significant difference favoring expressive writing over standard care at the first month (SMD = -0.80%, 95% CI = -1.35 to -0.24, Z = 2.81, P = 0.005) and third month (SMD = -0.53%, 95% CI = -0.86 to -0.20, Z = 3.13, P = 0.002) post-intervention. Stress scores are also greatly reduced for expressive writing versus controlled writing with SMD = -0.79%, 95% CI = -1.03 to -0.55, Z = 6.48, P < 0.00001. However, the effectiveness of expressive writing on postpartum anxiety should be interpreted cautiously due to low certainty.

Conclusion: Expressive writing serves as an effective alternative for non-pharmacological intervention for postpartum women with depression and stress, but more research is needed for postpartum anxiety. As substantial heterogeneity was detected, results must be interpreted cautiously. Postpartum women with psychological distress are encouraged to use expressive writing as an affordable way to promote maternal mental health for the benefit of both the mother and the child.

表达性写作治疗产后女性心理困扰的效果:meta分析与叙事回顾。
背景:心理困扰在母亲中日益普遍,其效果超过了传统的应对方法,如认知行为疗法。由于缺乏广泛的研究和不一致的发现,诸如写作疗法等替代疗法对母亲心理健康的功效仍然不确定。目的:本研究的目的是评估表达性写作治疗在减轻产后妇女心理困扰(包括抑郁、焦虑或压力症状)方面与标准产后护理相比的有效性。检索策略:为此目的,我们对截至2022年12月27日的七个书目数据库,包括CINAHL、Cochrane Library、EMBASE、PsycINFO、PubMed、Scopus和Web of Science,以及灰色文献进行随机对照试验,比较产后心理困扰妇女的表达性写作与标准护理或对照写作。数据收集与分析:采用随机效应模型进行meta分析。结果:一项包含483名参与者的5项研究的荟萃分析发现,表达性写作疗法在减轻产后抑郁和心理困扰女性的压力方面比标准治疗或控制写作更有效。与对照写作干预相比,表达性写作导致初始抑郁显著减少,标准平均差(SMD) = -0.65%, 95%置信区间(CI) = -1.08至-0.22,Z = 2.96, P = 0.003。关于表达性写作与标准护理,由于I2高于75%,进行了叙述性审查。结果显示,与干预后第7天和第3个月的基线相比,有显著改善。在压力评分方面,在干预后的第一个月(SMD = -0.80%, 95% CI = -1.35至-0.24,Z = 2.81, P = 0.005)和第三个月(SMD = -0.53%, 95% CI = -0.86至-0.20,Z = 3.13, P = 0.002),表达性写作优于标准治疗。与对照的SMD组相比,表达性写作组的压力得分也显著降低= -0.79%,95% CI = -1.03 ~ -0.55, Z = 6.48, P结论:表达性写作是产后抑郁和压力女性的一种有效的非药物干预选择,但对产后焦虑的治疗还需要更多的研究。由于检测到实质性的异质性,结果必须谨慎解释。鼓励有心理困扰的产后妇女使用表达性写作作为一种经济实惠的方式来促进母亲的心理健康,从而使母亲和孩子都受益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.80
自引率
2.60%
发文量
493
审稿时长
3-6 weeks
期刊介绍: The International Journal of Gynecology & Obstetrics publishes articles on all aspects of basic and clinical research in the fields of obstetrics and gynecology and related subjects, with emphasis on matters of worldwide interest.
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