Alya Al Sager MSc , Prof Sherryl H Goodman PhD , Joshua Jeong ScD , Paul A Bain PhD , Marilyn N Ahun PhD
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Eligible studies were randomised controlled trials of interventions explicitly targeting parenting behaviours and parental mental health antenatally or in children's first 3 years of life. Screening, extraction, and quality assessment were done independently by two authors. Primary outcomes were cognitive and social–emotional functioning in children and depressive symptoms in parents, meta-analysed as standardised mean differences (SMDs), relative to control. This study is registered with PROSPERO, CRD42022302848.</p></div><div><h3>Findings</h3><p>We found 5843 records. After screening 2636 (45·1%) titles and abstracts, we manually identified and screened three additional articles and excluded 2177 records. After screening 462 full-length articles, 25 articles, representing a sample size of 8520 children and caregivers, were included. At baseline, mean caregiver age was 27·7 years (SD 5·9) and mean child age (excluding those enrolled during pregnancy) was 14·4 months (8·0). 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引用次数: 0
摘要
背景为幼儿父母提供支持的干预措施通常分别针对养育子女或父母的心理健康。多成分育儿和父母心理健康干预措施有可能改善育儿实践、心理健康和幼儿发展。在这项系统性回顾和荟萃分析中，我们检索了从开始到 2024 年 1 月 23 日的 MEDLINE、Embase、Web of Science Core Collection、APA PsycINFO、CINAHL Complete、Cochrane Central Register of Controlled Trials 和 Global Health Database。符合条件的研究均为随机对照试验，这些试验明确针对产前或儿童出生后头三年的养育行为和父母心理健康进行干预。筛选、提取和质量评估由两位作者独立完成。主要结果是儿童的认知和社会情感功能以及父母的抑郁症状，相对于对照组，以标准化均值差异（SMDs）进行元分析。本研究已在 PROSPERO 注册，注册号为 CRD42022302848。在筛选了 2636 篇（45-1%）标题和摘要后，我们又人工识别并筛选了另外三篇文章，排除了 2177 条记录。在筛选了 462 篇长篇文章后，纳入了 25 篇文章，样本量为 8520 名儿童和照顾者。基线时，照顾者的平均年龄为 27-7 岁（SD 5-9），儿童的平均年龄为 14-4 个月（8-0）（不包括怀孕期间的儿童）。干预平均持续 14 个月（标准差 11），平均使用 3-7 种行为改变技术（2-0）。大多数干预措施在养育行为方面投入的时间多于在父母心理健康方面投入的时间。我们发现，相对于对照组，干预对儿童认知（SMD 0-19 [95% CI 0-04 to 0-34]；I2=69%）和社会情感（0-26 [0-17 to 0-34]；I2=47%）结果有明显影响，但对女性照顾者的抑郁症状（-0-18 [-0-36 to 0-002]；I2=86%）没有影响。各研究之间的偏倚风险为中等，我们发现了各研究结果之间的异质性。解释：多成分养育和心理健康干预对儿童的认知和社会情感结果有积极影响，但对父母的抑郁症状没有影响，这表明其他因素可能有助于取得积极的幼儿发展结果。干预措施可能对心理健康缺乏足够的关注，因而无法产生明显的影响，这就强调了今后的研究需要区分和评估养育和心理健康因素的贡献，以了解其对家庭结果的独立和集体影响。
Effects of multi-component parenting and parental mental health interventions on early childhood development and parent outcomes: a systematic review and meta-analysis
Background
Interventions supporting parents of young children often target parenting or parental mental health separately. Multi-component parenting and parental mental health interventions have the potential to improve parenting practices, mental health, and early childhood development. We aimed to examine their impact on child and parent outcomes.
Methods
In this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science Core Collection, APA PsycINFO, CINAHL Complete, the Cochrane Central Register of Controlled Trials, and the Global Health Database from inception to Jan 23, 2024. Eligible studies were randomised controlled trials of interventions explicitly targeting parenting behaviours and parental mental health antenatally or in children's first 3 years of life. Screening, extraction, and quality assessment were done independently by two authors. Primary outcomes were cognitive and social–emotional functioning in children and depressive symptoms in parents, meta-analysed as standardised mean differences (SMDs), relative to control. This study is registered with PROSPERO, CRD42022302848.
Findings
We found 5843 records. After screening 2636 (45·1%) titles and abstracts, we manually identified and screened three additional articles and excluded 2177 records. After screening 462 full-length articles, 25 articles, representing a sample size of 8520 children and caregivers, were included. At baseline, mean caregiver age was 27·7 years (SD 5·9) and mean child age (excluding those enrolled during pregnancy) was 14·4 months (8·0). Interventions lasted a mean of 14 months (SD 11) and used a mean of 3·7 behaviour change techniques (2·0). Most interventions dedicated more time to parenting behaviours than to parental mental health. We found significant intervention effects on children's cognitive (SMD 0·19 [95% CI 0·04 to 0·34]; I2=69%) and social–emotional (0·26 [0·17 to 0·34]; I2=47%) outcomes but not on depressive symptoms in female caregivers (–0·18 [–0·36 to 0·002]; I2=86%) relative to control conditions. Risk of bias across studies was moderate, and we found heterogeneity across results.
Interpretation
Multi-component parenting and mental health interventions had a positive effect on child cognitive and social–emotional outcomes, but not on depressive symptoms in parents, suggesting that other factors might contribute to positive ECD outcomes. Interventions might lack adequate focus on mental health to make a discernible impact, highlighting a need for future studies to differentiate and assess contributions of parenting and mental health components to understand independent and collective effects on family outcomes.
期刊介绍：
The Lancet Child & Adolescent Health, an independent journal with a global perspective and strong clinical focus, presents influential original research, authoritative reviews, and insightful opinion pieces to promote the health of children from fetal development through young adulthood.
This journal invite submissions that will directly impact clinical practice or child health across the disciplines of general paediatrics, adolescent medicine, or child development, and across all paediatric subspecialties including (but not limited to) allergy and immunology, cardiology, critical care, endocrinology, fetal and neonatal medicine, gastroenterology, haematology, hepatology and nutrition, infectious diseases, neurology, oncology, psychiatry, respiratory medicine, and surgery.
Content includes articles, reviews, viewpoints, clinical pictures, comments, and correspondence, along with series and commissions aimed at driving positive change in clinical practice and health policy in child and adolescent health.
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