Studies in the perinatal period: a systematic review of factors associated with treatment engagement and outcome for women receiving individual Cognitive Behavioural Therapy (CBT) for depression, anxiety, and trauma-related disorders; and a study of perceived social support and post traumatic stress symptoms.

Simon, Natalie 2024. Studies in the perinatal period: a systematic review of factors associated with treatment engagement and outcome for women receiving individual Cognitive Behavioural Therapy (CBT) for depression, anxiety, and trauma-related disorders; and a study of perceived social support and post traumatic stress symptoms. ClinPsy Thesis, Cardiff University. Item availability restricted.

	PDF (DClinPsy Thesis) - Accepted Post-Print Version Restricted to Repository staff only until 8 August 2025 due to copyright restrictions. Download (3MB)
	PDF (Publication Form) - Supplemental Material Restricted to Repository staff only Download (234kB)

Abstract

Untreated depression, anxiety, and post-traumatic stress symptoms in the perinatal period can impact maternal and infant wellbeing. A mother and their infant may come in to contact with a network of physical and mental health professionals during the perinatal period, offering opportunities to access psychological intervention when there is a need, and to mobilise psychosocial support. Despite this, mental health difficulties often go undetected or untreated during the perinatal period, not least because of overlapping symptoms with pregnancy itself. Paper One was a systematic review to understand factors associated with treatment engagement and outcome for women in the perinatal period receiving individual Cognitive Behavioural Therapy (CBT) for depression, anxiety, and trauma-related disorders. CBT is effective in the treatment of depression, anxiety, and trauma related disorders, and is recommended by the UK’s National Institute for Health and Care Excellence (NICE) in the treatment of antenatal and postnatal mental health. CBT is regularly adapted to meet the needs of new and expectant mothers, given the challenges they face, ranging from adapting CBT protocols to include perinatal specific modules, to providing CBT within a wider multi-component psychosocial intervention. Despite these efforts, treatment seeking has been found to be low, and there is a limited literature concerning treatment adherence. The review included 28 studies relating to 19 Randomised Controlled Trials (RCTs), with 2557 participants, where CBT was the active intervention. The review revealed an important relationship between CBT engagement and outcome. There was no difference in dropout for studies of CBT compared to treatment as usual, but there was greater dropout for CBT across four studies where the guiding therapist/coach had a minimal level of psychological therapy training and qualifications. Paper Two focused on disorders of traumatic stress in the perinatal period, which has received less attention than disorders of anxiety and depression. It was a cross-sectional investigation of perceived social support and post-traumatic stress symptoms (PTSS) in a trauma exposed perinatal sample with a sizeable proportion of individuals presenting with clinical levels of PTSS. Recognition, prevention, and treatment of disorders of post-traumatic stress may be particularly important in the perinatal period, where PTSS may develop following childbirth, or be re-activated. For example, the more complex symptoms, also known as the Disturbances in Self-Organisation (DSO), may be re-activated due to feelings of disempowerment and fear following loss of bodily control. The evidence for a consensus regarding the treatment of Post-Traumatic Stress Disorder (PTSD) in the perinatal period is limited, and it does not exist for CPTSD. Understanding factors associated with PTSD and CPTSD is therefore important, to identify targets for treatment. Perceived social support is widely cited as an important factor associated with PTSD. It has also more recently been demonstrated to be associated more strongly with CPTSD, though this had not been examined in a perinatal sample, until now. In a study of 426 participants recruited to the Maternal Wellbeing, Mental Health & Life Experiences (MWMHLE) study, evidence was found for an association between perceived social support and post-traumatic stress symptoms (PTSS), with higher levels of perceived social support from family and from friends found to be associated with a lower likelihood of presenting with clinical levels of PTSS. Lower levels of perceived social support were associated with the ICD-11 symptom clusters of a persistent sense of current threat, and disturbances in relationships, and with depressive symptoms. Conclusions: The findings add to a growing literature on the treatment of anxiety, depression, and trauma-related disorders in the perinatal period. Aligning with research elsewhere, engagement and outcome may be improved when CBT is adapted to meet the unique needs faced by women in the perinatal period, and when it is provided by therapists with at least a moderate amount of psychological therapy training and qualifications. Building on emerging evidence in the wider PTSD/CPTSD literature, the current findings implicate perceived social support as a potential target for treatment for women presenting with PTSS during the perinatal period. Treatments that can engage and enhance social support from family and friends could be beneficial for women presenting with PTSS during pregnancy and postpartum.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	8 August 2024
Last Modified:	08 Aug 2024 13:23
URI:	https://orca.cardiff.ac.uk/id/eprint/171251

Actions (repository staff only)

Edit Item