Parent-training programmes for improving maternal psychosocial health.
BACKGROUND
Mental health problems are common, and there is evidence from a range of studies to suggest that a number of factors relating to maternal psychosocial health can have a significant effect on the mother-infant relationship, and that this can have consequences for both the short and long-term psychological health of the child. The use of parenting programmes is increasing in the UK and evidence of their effectiveness in improving outcomes for mothers is now required.


OBJECTIVE
The objective of this review is to address whether group-based parenting programmes are effective in improving maternal psychosocial health including anxiety, depression, and self-esteem.


METHODS
A range of biomedical, social science, educational and general reference electronic databases were searched including MEDLINE, EMBASE CINAHL, PsychLIT, ERIC, ASSIA, Sociofile and the Social Science Citation Index. Other sources of information included the Cochrane Library (SPECTR, CENTRAL), and the National Research Register (NRR).


METHODS
Only randomised controlled trials were included in which participants had been randomly allocated to an experimental and a control group, the latter being either a waiting-list, no-treatment or a placebo control group. Studies had to include at least one group-based parenting programme, and one standardised instrument measuring maternal psychosocial health.


METHODS
A systematic critical appraisal of all included studies was undertaken using a modified version of the Journal of the American Medical Association (JAMA) published criteria. The treatment effect for each outcome in each study was standardised by dividing the mean difference in post-intervention scores for the intervention and treatment group, by the pooled standard deviation, to produce an effect size. Where appropriate the results were then combined in a meta-analysis using a fixed-effect model, and 95% confidence intervals were used to assess the significance of the findings.


RESULTS
A total of 23 studies were included in the review but only 17 provided sufficient data to calculate effect sizes. The 17 studies provided a total of 59 assessments of outcome on a range of aspects of psychosocial functioning including depression, anxiety, stress, self-esteem, social competence, social support, guilt, mood, automatic thoughts, dyadic adjustment, psychiatric morbidity, irrationality, anger and aggression, mood, attitude, personality, and beliefs. There was only sufficient data, however, on five outcomes (depression; anxiety/stress; self-esteem; social support; and relationship with spouse/marital adjustment) to combine the results in a meta-analysis. The meta-analyses show statistically significant results favouring the intervention group as regards depression; anxiety/stress; self-esteem; and relationship with spouse/marital adjustment. The meta-analysis of the social support data, however, showed no evidence of effectiveness. These results suggest that parenting programmes, irrespective of the type (or content) of programme, can be effective in improving important aspects of maternal psycho-social functioning. Of the data summarising the effectiveness of the different types of parenting programmes, which it was not possible to combine in a meta-analysis, approximately 22% of the outcomes measured, showed significant differences between the intervention group and the control group. A further 40% showed medium to large non-significant differences favouring the intervention group. Approximately one-third of outcomes showed small non-significant differences or no evidence of effectiveness. A meta-analysis of the follow-up data on three outcomes was also conducted - depression, self-esteem and relationship with spouse/marital adjustment. The results show that there was a continued improvement in self-esteem, depression and marital adjustment at follow-up, although the latter two findings were not statistically significant.


CONCLUSIONS
It is suggested that parenting programmes can make a significant contribution to short-term psychosocial health in mothers, and that the limited follow-up data available suggest that these are maintained over time. However, the overall paucity of long-term follow-up data points to the need for further evidence concerning the long-term effectiveness of parenting programmes on maternal mental health. Furthermore, it is suggested that some caution should be exercised before the results are generalised to parents irrespective of the level of pathology present, and that further research is still required.
Barlow
J
J
Health Services Research Unit, University of Oxford, Institute of Health Sciences, Old Road, Headington, Oxford, UK, OX3 7LF. esther.coren@public-health.oxford.ac.uk
Coren
E
E
D001007:Anxiety / Q000628:therapy; D003863:Depression / Q000628:therapy; D005260:Female; D006801:Humans; D008425:Maternal Behavior / Q000523:psychology*; D008429:Maternal Welfare; D009034:Mother-Child Relations; D016487:Parenting; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D012649:Self Concept