Efficacy of psychosocial interventions for psychological distress among women undergoing termination of pregnancy for fetal anomaly: a systematic review.

Abstract

Accumulating evidence shows that women experience serious psychological distress after terminating their pregnancy for fetal anomaly (TOPFA). Although the number of studies on psychosocial interventions (PSIs) for TOPFA women has increased, access to evidence-based support for medical staff who provide care to TOPFA women remains limited. A systematic review was conducted to provide an overview of available PSIs. Nine major electronic databases in available in English and Chinese languages were searched to identify articles published from the databases' inception to November 2021. Our participants were TOPFA women; interventions were PSIs; the comparison was no limits; outcomes were psychological distress including depression, anxiety, and post-traumatic stress (PTSD); and study designs were experimental studies including randomized controlled trials (RCTs) and quasi-experimental studies. The Joanna Briggs Institute Critical Appraisal Checklist for RCTs and quasi-experimental studies was used to assess the quality of evidence. Subsequently, synthesis without meta-analysis of the findings was completed. A total of 1,730 studies were identified from the initial database, 37 of which were included in this research. The interventions tested included cognitive therapy, mindfulness, sandplay therapy, psychological counseling, family support, peer support, empathy nursing, bereavement care, solution-focused psychological nursing, and staged psychological nursing. Four of these studies were RCTs. Most interventions were implemented in hospitals in China by nurses. However, few studies reported details on implementation procedures, and the studies presented substantial heterogeneity. Most of the included studies were judged to be of high risk of bias. Although this review was limited by search strategies and most of the included studies were of low quality, it still provided some tentative support for PSIs for the treatment of TOPFA women. Further research is warranted to investigate the effects of specific components on TOPFA women by using randomized controlled designs and reporting intervention manuals based on psychotherapeutic theory.