Nonpharmacological interventions for childbirth-related post-traumatic stress disorder and accompanying symptoms: A network meta-analysis of randomized controlled trials

Abstract

Background

Childbirth-related post-traumatic stress disorder (CB-PTSD) often coexists with depression and anxiety, but there's a lack of tailored, comparative non-pharmacological treatments.

Objective

This study investigated the efficacy of non-pharmacological interventions in the prevention and alleviation of symptoms associated with CB-PTSD and its accompanying symptoms.

Methods

A comprehensive literature search was conducted across multiple databases, including PubMed, the Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang, and China Biology Medicine, up to September 2024. The study included all randomized controlled trials (RCTs) that reported on non-pharmacological interventions for CB-PTSD. Two reviewers independently extracted data, assessed the risk of bias, evaluated the quality of the evidence, and conducted the sub-group analysis and meta-regression. The effectiveness of the intervention strategies was analyzed using a network meta-analysis, with the primary outcome being childbirth-related PTSD and its associated symptoms. The protocol of this study was registered on PROSPERO (ID: CRD42024588020).

Results

This study included a total of 42 RCTs, encompassing 18 distinct intervention types, categorized into three prevention levels: primary prevention during pregnancy (n = 5), aimed at eliminating or mitigating risk factors for CB-PTSD; secondary prevention (n = 26), targeting the reduction of CB-PTSD symptoms following a traumatic birth; and tertiary prevention (n = 11), focusing on the management of women already diagnosed with CB-PTSD.

Comprehensive analysis revealed that in the primary prevention stage, the Birth plan intervention was most effective in reducing CB-PTSD symptom scores compared to conventional postpartum care, while Nurse-led peer support was most effective in reducing depression symptom scores. In the secondary prevention stage, Couples' self-disclosure intervention showed superior efficacy in alleviating CB-PTSD symptoms, and Counseling was most effective for depression and anxiety. At the tertiary prevention stage, Counseling emerged as the most effective intervention for managing CB-PTSD symptoms, whereas Expressive Writing was most effective for depression and anxiety compared to conventional postpartum care.

Conclusions

Non-pharmacological interventions represent a crucial and viable approach for alleviating the symptoms of CB-PTSD. It is imperative to select appropriate and efficacious intervention measures for women during the tertiary prevention phase. Future research can further explore the underlying psychopathology, and relevant clinical guidelines on perinatal mental health may also serve as a valuable reference.