Table 4 Psychological interventions
Author | Intervention Description | Study Design / Analytical Approach | Intervention Delivery | Intervention Facilitator | Intervention Length | Data Time Points (PN = postnatal, GE = gestational) | Number of Participants (Intervention vs Control) | Retention Rate | Recruitment Sites and Methods | Mental Health Measures | Sleep Measures | Results Summary |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Avalos et al. (2020), USA [32] | Mindfulness meditations using Headspace™ | Single arm, pre-post | App based, self-delivered after instruction | No personal contact | 10–20 min per day for 6 weeks | • Baseline (0–6 months PN) • Intervention end | 27 enrolled 19 completed | 70% | Obstetrics and gynecology clinics | PHQ-8 | PSQI-19 | • Improved sleep quality • Reduced depressive symptoms |
Forsell et al. (2017), Sweden [46] | Self-guided internet delivered CBT program with readings, assessments, worksheets and written feedback and support | RCT, within and between groups | Online, self-guided with regular written feedback | CBT-trained therapist | 10 weeks | • Baseline (12–28 weeks GE) • Intervention end | 42 enrolled (22 vs 20) 39 completed (21 vs 18) | 93% | Social media advertisements and posters/ flyers in maternity clinics | MADRS-S-9 SCID-I EPDS-10 GAD-7 | ISI-7 | • No change within or between groups for insomnia symptoms • Reduced depressive and anxiety symptoms pre-post (MADRS and GAD) • Fewer depressive symptoms in intervention group post intervention (MADRS and SCID-I) but no difference between groups on the GAD and EPDS |
Kubo et al. (2021), USA [50] | Mindfulness meditations using Headspace™ | Single arm, pre-post | App based, self-delivered after instruction | No personal contact | 10–20 min per day for 6 weeks | • Baseline (9–30 weeks GE) • Intervention end | 27 enrolled 20 completed | 74% | Obstetrics and gynecology clinics | PHQ-8 | PSQI-19 | • Improved sleep quality • Reduced depressive symptoms |
Liu (H.) et al. (2021), China [31] | CBT including psychological evaluation, self-activity plan, mental health education, delivery and post-birth care and greater social support | RCT, within and between group | Not reported | Not reported | 1 hr. weekly sessions for 6 weeks | • Baseline (newly delivered) • Intervention end | 260 Enrolled (130 vs 130) 228 completed (113 vs 115) | 88% | Municipal hospital | EPDS-10 HAM-A HAM-D | PSQI-19 | • Improved sleep quality pre-post • Intervention group better sleep quality • Reduced depressive and anxiety symptoms pre-post (EPDS & HAM-D/A) • Intervention group fewer depressive and anxiety symptoms scores (EPDS & HAM-D/A) and less women with clinically relevant depression (EPDS) |
Manber et al. (2019), USA [30] | CBTi plus education on infant sleep development and elements from ‘Tips for Improving Postpartum Sleep’ program | RCT, between group | Face-to-face individual sessions | Trained CBT therapists | Weekly sessions for 5 weeks | • Baseline (18–32 weeks GE) • Intervention end | 194 enrolled (96 vs 98) 134 completed (71 vs 63) | 69% | University/county hospital–based obstetric clinics and community advertisements | EPDS-9 | ISI-7 TWT-A TWT-S | • Intervention groups greater reductions in insomnia severity, faster remission of insomnia disorder and less self-reported nocturnal wake time, but no difference in objective nocturnal wake time • Reduced EPDS scores in both groups |
Mendelson et al. (2018), USA [55] | Mindfulness intervention including a video introduction and four 5- and 10-min audio mindfulness practices | Single arm, pre-post | Audio recordings, self-delivered after instruction | No personal contact | 2 weeks | • Baseline (newly delivered) • Intervention end | 27 enrolled 24 completed | 89% | Hospital neonatal intensive care unit | PHQ-8 GAD-7 | PSQI-SQ PSQI-D PSQI-SL PSQI-SE PSQI-SM | • Improved sleep quality and sleep duration but not sleep efficiency or latency pre-post • Reduced depressive and anxiety symptoms scores |
Sun et al. (2021), China [64] | Self-guided mindfulness on custom built smartphone app | RCT, between group | App based, self-delivered after instruction | No personal contact | 15–25 min per day, 6 days a week for 8 weeks | • Baseline (12–20 weeks GE) • Mid intervention (4 weeks after allocation) • Intervention end (8 weeks after allocation) • Late pregnancy (18 weeks after allocation) • 6 weeks PN | 168 enrolled (84 vs 84) 92 completed (52 vs 40) | 55% | Hospital obstetric clinic | EPDS-10 GAD-7 | PSQI-19 | • Intervention group fewer depressive symptoms (EPDS) immediately post intervention and late pregnancy but not mid intervention or at 6 weeks postnatal • Intervention group lower anxiety scores (GAD-7) mid and immediately post intervention and at both follow-up timepoints • Intervention group had fewer depressive and anxiety symptoms compared to control • No difference between groups in sleep quality at any timepoint |
Swanson et al. (2013), USA [65] | Modified CBTi including stimulus control, sleep restriction, sleep hygiene, relaxation strategies and infant sleep | Single arm, pre-post | Face-to-face individual sessions | Clinical psychologist certified in behavioral sleep medicine | 45–60 min weekly session for 5 weeks | • Baseline (0-6 months PN) • Intervention end | 16 enrolled 12 completed | 75% | Mood Disorders Clinic | EPDS-9 QIDS-SR-16 | ISI-7 PSQI-19 TST-D TWT-D SE-D | • Improvements in sleep efficiency, total wake time, total sleep time, insomnia severity (ISI) and sleep quality (PSQI) • Reduced depressive symptoms |
Tomfohr-Madsen et al. (2017), Canada [68] | CBTi including review of sleep diary, sleep education, stimulus control, cognitive sleep strategies and relapse prevention | Single arm, pre-post | Face-to-face group sessions | Licensed, PhD-level clinical psychologist and a clinical psychology doctoral trainee | 90 min weekly sessions for 5 weeks | • Baseline (12–28 weeks GE) • Intervention end | 14 enrolled 13 completed | 93% | Physicians’ offices, midwifery services and childbirth education classes | EPDS-10 EPDS-9 PSA-40 | ISI-7 PSQI-19 TIB-A TST-A SOL-A SE-A WASO-A Awak-A TIB-D TST-D SE-D SOL-D Awak-D | • Improved insomnia symptoms (ISI) and sleep quality (PSQI) • Less actigraphic TIB, shorter SOL and increased SE, and increased sleep diary TST and SE, but no change in actigraphic WASO and TST or sleep diary TIB, SOL and awakenings • Reduced depressive symptoms (EPDS) and pregnancy-specific anxiety symptoms (PSA) |