Perinatal anxiety treatments: Programs, barriers, and recommendations

Numerous research studies indicate risk of a number of negative outcomes for unborn children when mothers are experiencing anxiety in the perinatal period. Thus, early intervention is recommended. The primary aim of this  research was directed at evaluation supporting the early identification of women and effective prevention for children who are at risk of developing anxiety disorders. It was anticipated that by treating anxious mothers, risk could be reduced for the newborn. In additon to difficulties, anxiety in pregnancy is noteworthy in itself, with risk for subsequent health problems, postnatal depression, and the other difficulties for the mother, infant, and family.

Firstly, the literature was reviewed and a meta -analysis was conducted to assess the efficacy of interventions used to treat anxiety during pregnacy. Superior outcomes were found for interventions that contained relaxation aspects, for individual (versus group) therapy programs, and for interventions that included follow-up versus those that did not. The second study in this dissertation sought to determine the efficacy of an intervention for women who were pregnant and experiencing anxiety by way of an experimentally-based single case methodology. The program had both antenatal and postnatal components. During the antenatal period, a Cognitive-Behavioural Therapy approach was designed to reduce the level of anxiety for the mother. For the postnatal component, an Interpersonal Therapy approach with the inclusion of parenting intervention was used.

Results indicated significant improvements for the five participants who completed the program. However, this study was first designed as a group comparison design, and a number of difficulties were found in the recruitment of participants. In fact, despite a comprehensive outreach and recruitment strategy, low numbers of women were referred and, of those referred, low numbers took up the program. Given low numbers referred or taking up the program, the PhD dissertation was extended in two additional ways.

First, eight key Australian researchers were contacted to determine if the recruitment difficulties found in this study were limited or universal in nature. Second, following this effort, and in consultation with a literature review and experts, a survey was developed to assess the experiences of women during pregnancy and the first twelve months thereafter. This allowed for the determination of barriers to treatment and aspects important to the uptake and development of programs designed to assist women in this lifephase. Across Australia 127 women, either currently pregnant or pregnant within the past 12 months, participated in the online survey.

Taken together, the findings of this study point out a number of obstacles to recruitment and engagement that are evident, and based on expert and expecting mother reports. These include the convenience of accessing services, the costs associated, and the relationship with the service provider influencing the likelihood of reporting honestly about experiences, and of service uptake. Findings also pointed to a way forward in addressing those obstacles. In addition to universal screening, an emphasis on the provider-mother relationship is supported, including gentle, therapeutic conversations as a basis for fostering connection, providing information, and marking perinatal mental health services less daunting and more attractive. Both the meta-analytic findings and the outcome evaluation of the intervention indicated that when obstacles to recruitment and engagement are dealt with effectively, pregnant women can get assistance both prior to and following birth, reduce their anxiety, and reduce risk for the infant. Limitations of the current study and future directions are considered, including a focus in future research on evaluating not only the direct intervention itself, but also various "interventions", or ways, to improve recruitment and engagement.