The Effectiveness of Mindfulness-Based Therapy in Pregnant Women with Depression, Anxiety, and Stress: A Systematic Review

Abstract

Introduction Pregnancy is a vulnerable period that can lead to significant depression, anxiety, and stress in pregnant women. Research has shown that mindfulness-based cognitive therapy can alleviate these symptoms in pregnant women. While mindfulness-based cognitive therapy has started to be applied in Thailand for patients with depression, there is no literature review available on the effects of mindfulness-based cognitive therapy in reducing depression symptoms in pregnant women in Thailand. 

Objective This study aimed to evaluate the effectiveness of mindfulness-based therapy in pregnant women experiencing depression, anxiety, and stress. 

Design Systematic review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines 

Methodology The criteria for selecting research articles are based on the PICO framework. Population: pregnant women. Intervention: mindfulness-based intervention (MBI). Comparison: other therapeutic programs designed to reduce depression symptoms in pregnant women. Outcomes: reduction of depression symptoms. The selected research articles have the following characteristics: 1) Studies that investigate the effects of mindfulness-based therapy on depression, stress, or anxiety in pregnant women; 2) Experimental or quasi-experimental studies testing the effectiveness of MBI in reducing depression, anxiety, and stress in pregnant women; 3) Comparison groups are control groups using other psychotherapies, such as cognitive-based therapy or routine care; and 4) Outcome measures include at least one of the following: reduction in depressive symptoms, anxiety, or stress. Research articles are searched using both Thai and English databases, including PubMed, PsycINFO, CINAHL, Embase, ThaiJo, and ThaiLIS. The scope of the research is set between January 1, 2013, and December 31, 2023. Thai search keywords include (mindfulness* OR mindfulness-based intervention* OR meditation) AND (pregnancy OR prenatal) AND (depression* OR anxiety OR stress). Research selection is based on inclusion criteria from titles and abstracts, and full-text articles. The quality of the research is assessed using the Joanna Briggs Critical Appraisal Tools. Two researchers work independently, and studies that do not meet the inclusion criteria or are of low quality are excluded. A third researcher is consulted to conclude if there is a disagreement between the two researchers. Data from selected articles are extracted into a data extraction table and synthesized using a narrative summary. 

Results A search yielded 650 research articles, of which 19 met the inclusion criteria. These included 17 randomized controlled trials and 2 quasi-experimental studies, all conducted internationally. Mindfulness-based interventions (MBIs) were delivered both face-to-face and digitally, effectively reducing depression, anxiety, and stress in pregnant women. The effects of face-to-face mindfulness-based cognitive therapy were systematically reviewed. It was found that pregnant women who received traditional face-to-face mindfulness-based cognitive therapy showed more significant reductions in depression, anxiety, and stress compared to other depression, anxiety, or stress reduction interventions. Online mindfulness-based interventions for pregnant women to reduce depression, anxiety, and stress were delivered through various methods, predominantly via mobile applications, which are easily accessible and convenient for pregnant women. Pregnant women who participated in mindfulness interventions were better able to adapt to stress and manage their emotions compared to those who did not participate in mindfulness-based interventions. 

Recommendation Mindfulness-based cognitive therapy is more effective in reducing depression and stress symptoms compared to other mindfulness interventions. Nurses can apply mindfulness-based cognitive therapy to alleviate depression in pregnant women both during the prenatal and postnatal periods, whether in hospitals or health service units. When applying mindfulness-based cognitive therapy in different contexts and addressing the specific issues of pregnant women, it is crucial to maintain the key principles of cognitive therapy, whether delivered online or face-to-face. This approach helps participants become aware of the present moment and distinguish themselves from old thought patterns and emotions. Further research is needed to test the effectiveness of these mindfulness-based cognitive therapies in reducing depression, anxiety, and stress in pregnant women with varying levels of depression. Additionally, meta-analyses should be conducted to evaluate the effectiveness of mindfulness-based cognitive therapy in reducing depressive symptoms in both prenatal and postnatal periods and among pregnant women with different severity levels of depression.