title: NICU-based Interventions To Reduce Maternal Depressive and Anxiety Symptoms: A Meta-analysis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  PubMed, Embase, PsychInfo, Cochrane, and CINAHL were searched for relevant studies. Reference lists from selected studies were reviewed.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Departments of Mental Health, and tmendel1@jhu.edu.
authors.forename: Tamar
authors.initials: T
authors.lastname: Mendelson
authors.affiliation: Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
authors.forename: Fallon
authors.initials: F
authors.lastname: Cluxton-Keller
authors.affiliation: Total Child Health, Inc, Baltimore, Maryland; and.
authors.forename: Genevieve C
authors.initials: GC
authors.lastname: Vullo
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: S Darius
authors.initials: SD
authors.lastname: Tandon
authors.affiliation: International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Sassan
authors.initials: S
authors.lastname: Noazin
mesh_terms: D001007:Anxiety / Q000517:prevention & control*; D015928:Cognitive Behavioral Therapy; D019052:Depression, Postpartum / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D060127:Kangaroo-Mother Care Method; D009035:Mothers / Q000523:psychology*; D010789:Phototherapy; D011613:Psychotherapy / Q000379:methods