NICU-based Interventions To Reduce Maternal Depressive and Anxiety Symptoms: A Meta-analysis

Pediatrics. 2017 Mar;139(3):e20161870. doi: 10.1542/peds.2016-1870. Epub 2017 Feb 21.


Context: Parents whose infants are being treated in the NICU are at high risk for depression and anxiety, with negative implications for parenting and infant development.

Objective: We conducted a systematic review and meta-analysis of NICU-based interventions to reduce maternal depressive or anxiety symptoms.

Data sources: PubMed, Embase, PsychInfo, Cochrane, and CINAHL were searched for relevant studies. Reference lists from selected studies were reviewed.

Study selection: Inclusion criteria included randomized controlled design, a parent-focused intervention delivered in the NICU, valid maternal depressive or anxiety symptom measures at pre- and postintervention, and publication in a peer-reviewed journal in English.

Data extraction: Data extraction was conducted independently by 2 coders.

Results: Twelve studies met inclusion criteria for qualitative review; 2 were excluded from quantitative analyses for high risk of bias. Fixed- and random-effects models, with 7 eligible studies assessing depressive symptoms, indicated an effect of -0.16 (95% confidence interval [CI], -0.32 to -0.002; P < .05) and, with 8 studies assessing anxiety symptoms, indicated an effect of -0.12 (95% CI, -0.29 to 0.05; P = .17). The subset of interventions using cognitive behavioral therapy significantly reduced depressive symptoms (effect, -0.44; 95% CI, -0.77 to -0.11; P = .01).

Limitations: The small number and methodological shortcomings of studies limit conclusions regarding intervention effects.

Conclusions: Combined intervention effects significantly reduced maternal depressive but not anxiety symptoms. The evidence is strongest for the impact of cognitive behavioral therapy interventions on maternal depressive symptoms.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Anxiety / prevention & control*
  • Cognitive Behavioral Therapy
  • Depression, Postpartum / prevention & control*
  • Female
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal*
  • Kangaroo-Mother Care Method
  • Mothers / psychology*
  • Phototherapy
  • Psychotherapy / methods