非药物干预对孕期抑郁症影响效果的网状Meta分析

Effects of non-pharmacological interventions on depression during pregnancy:a network Meta-analysis

目的:分析、评价孕期抑郁症的非药物干预效果,以期为改善孕期抑郁症护理实践提供参考依据。方法:检索中英文数据库中符合纳入标准的随机对照试验并溯源。检索时间为从建库至2023年9月。由2名课题组成员筛查文献、评价文献质量、提取相关数据后,采用Stata 17.0和Review Manager 5.3软件进行网状Meta分析。结果:共纳入34项研究,包含9种干预方式。网状Meta分析结果显示,与常规护理组相比,运动干预[SMD=-7.07,95%CI(-9.55,-4.60),P<0.001]、认知行为干预[SMD=-5.71,95%CI(-8.55,-2.87),P<0.001]、同伴支持干预[SMD=-5.31,95%CI(-11.64,-0.84),P<0.001]、音乐干预[SMD=-4.86,95%CI(-7.20,-2.52),P<0.001]对孕期抑郁症具有较好的效果。运动干预的SUCRA概率值最大,为91.7。结论:孕期抑郁症的最佳非药物干预方式为运动干预。在孕妇无运动禁忌证的情况下,推荐医护人员将运动作为干预孕期抑郁症的首选方案。医护人员须加强孕期运动的专业理论知识,根据不同孕期女性的身心特点,制定个性化的运动方案。结合多种干预措施构建综合性干预方案效果可能更佳,但仍需要进一步补充验证。

Objective:Analyze and evaluate the effectiveness of non-pharmacological interventions for depression during pregnancy,in order to provide reference for improving nursing practices for depression during pregnancy.Methods:Chinese and English databases were searched for Randomized Controlled Trials that met the criteria.The search time was from the establishment of the database to September 2023.Two members of the research group screened the articles,evaluated their quality,and extracted the relevant data.Stata 17.0 and Review Manager 5.3 software were used for network Meta-analysis.Results:A total of 34 studies were included,including 9 interventional methods.The results of network Metaanalysis showed that compared with the usual care group,exercise intervention[SMD=-7.07,95%CI(-9.55,-4.60),P<0.001],cognitive behavioral intervention[SMD=-5.71,95%CI(-8.55,-2.87),P<0.001],peer support intervention[SMD=-5.31,95%CI(-11.64,-0.84),P<0.001],music intervention[SMD=-4.86,95%CI(-7.20,-2.52),P<0.001]had good intervention effects on depression during pregnancy.The area under the SUCRA probability plot showed that exercise might be the best nonpharmacological intervention for depression during pregnancy.Conclusion:When pregnant women have no contraindications to exercise,exercise is recommended as the first choice for depression during pregnancy.Medical staff should strengthen the professional theoretical knowledge of exercise during pregnancy,and formulate personalized exercise programs according to the physical and mental characteristics of women in different pregnancy periods.A comprehensive intervention program combining multiple interventions may be more effective,but it still needs further verification.