Table 1.
Design, measurement, hypotheses and results of reviewed studies.
| References | Intervention (a) format, (b) treatment modality, (c) # sessions, attendance, (d) provider (and provider education), (e) setting | Study design | Results main effects | Cultural factors | Acceptability |
|---|---|---|---|---|---|
| Efficacy studies | |||||
| Lenz and Potts (36) | (a) individual (b) IPT (c) 9 sessions (one ethnographic introductory session + 8 IPT sessions); plus maintenance treatment session if participant finish all nine sessions (d) Clinical Psychologists, master's level clinicians (e) research clinic, participant homes, or other community locations | RCT | Women in both the intervention and enhanced prenatal care groups did not show significant reductions in anxiety symptoms (STAI-Brief). | Not reported | Participants assigned to brief-IPT reported high scores on the Client Satisfaction Questionnaire at the 37–39 weeks assessment (IPT M = 30.60, SD = 1.89, range 25–32) |
| Ruiz et al. (37) | (a) individual (b) ACT and Problem-Solving Therapy (c) six sessions (d) Nurse practitioners (NPs) or certified nurse midwives (e) primary clinic, OBGYN office | Pilot Pre-Post design | Women in the intervention group showed significant reductions in anxiety symptoms (BAI) between baseline and post-intervention (d = 0.31, small to medium effect). | Yes: “considerations for family roles and hierarchies, culturally relevant metaphors/mindfulness exercise” | High satisfaction ratings (M = 7 out of 7) for satisfaction, relevance and recommendation to other pregnant people. |
| Randomized controlled trial study protocols | |||||
| Atif et al. (38) | (a) individual OR group (b) CBT (c) six sessions, time client dependent ~1 h, option for up to six booster sessions (d) Para-professionals (bachelor's level volunteers with no prior mental health training with nursing backgrounds) (e) hospital | RCT | Primary hypothesis: The intervention will address symptoms of anxiety as measured by the HADS before these become chronic, severe, and debilitating, and therefore will be preventative, allowing women to learn strategies for stress management and problem solving before the symptoms become ingrained. | Yes: “The intervention used culturally appropriate illustrations and examples of healthy activities to set tasks in collaboration with women to encourage engaging unhelpful behaviors” | An initial sample of five women rated the intervention as helpful and acceptable to them and their family members; resulting in greater awareness of their feelings, stress management and strategies to improve wellbeing. |
| Bright et al. (39) | (a) individual (b) online IPT (c) six 30-min sessions (d) none, self -guided (e) online | RCT | Primary hypothesis: Participants randomized to the intervention will have clinical levels of anxiety at lower percentages post-treatment than women randomized to routine care as measured by the DASS-21. | None stated. | Planned assessment of percentage of participants who report the modules and activities in the intervention as easily understood and navigated to measure acceptability. |
| Challacombe et al. (40) | (a) individual (b) CBT (c) Fout to five 2-h sessions vs. 8–10 1-h sessions (d) “experienced therapists” (e) national publicly funded healthcare setting | RCT | Primary hypothesis: Participants with clinical diagnoses of OCD, PTSD, Social Anxiety or Panic Disorder randomized to time intensive or standard weekly intervention will show reductions in anxiety as measured by the GAD-7 or disorder specific measures (e.g., OCI for OCD, MI for Panic Disorder, IES for PTSF, SPIN for Social Anxiety). | None stated. | Planned qualitative interviews to assess acceptability of recruitment methods, assessment measures, intervention mode, and delivery. |
| Jackson et al. (41) | (a) individual (b) CBT (c) eight sessions (d) Perinatal clinical nurse specialist (e) hospital-based perinatal outpatient program | RCT | Primary hypothesis: Participants randomized to the intervention will show less anxiety than those in the control condition, as measured by the STAI. We also hypothesize this study will be feasible in terms of fidelity and deliverability, as well as be highly acceptable to participants. | None stated. | Four open-ended qualitative questions planned to assess acceptability. |
| Loughnan et al. (42) | (a) individual (b) iCBT (c) three sessions, time client dependent ~1 h (d) None- self-guided (e) client's choice (remote, online) | RCT | Primary hypothesis: Participants randomized to the intervention will show significantly fewer symptoms of anxiety compared to those in usual care, as measured by the GAD-7. | None stated. | – |
| Melnyk et al. (43) | (a) group (b) CBT + positive parenting (c) six 2-h sessions (d) advanced practice nurses (e) prenatal clinic | RCT | Primary Hypothesis: Participants randomized to the intervention will show significantly less anxiety at 4–6 weeks postpartum (3months post-intervention), and at 6 moths postpartum (8 months post-intervention) than will participants in the attentional control condition as measured by the GAD-7. | Yes: “sessions that are culturally sensitive, readable at the sixth grade reading level and focused on empowering pregnant minority women to engage in healthy lifestyle behaviors”. Prior delivery with ethnic/racial minority women. | – |
| O'Brien et al. (44) | (a) group (b) Enhanced Triple P for Baby (positive parenting program); Mellow Bumps (reflective functioning, self-care, parenting) (c) four 2-h sessions (ETPB); six 2-h sessions (MB) (d) facilitators with health visiting or midwifery backgrounds (e) multiple | RCT | Primary Hypothesis: Women randomized to either intervention will show reduced anxiety as compared to women receiving usual care. | Yes: Planned interviews with the Heads of Midwifery planned delivery settings to gain further insights into the ways in which the local context and organizational culture might have impacted recruitment | Documented acceptability in high deprivation contexts in prior research studies. |
| Zuccolo et al. (45) | (a) individual (b) Motherly app (behavioral activation) plus brief online CBT (c) four sessions (d) Psychologists certified in CBT (e) online | RCT | Primary Hypothesis: Participants receiving the Motherly app plus brief online CBT will show significantly greater reduction in symptoms of anxiety (secondary outcome) as compared with participants who receive only psychoeducation in addition to brief online CBT as measured by the GAD-7. | Yes: Treatment targets (e.g., physical activity, nutrition) were specifically selected based on research findings regarding risk factors for individuals from low-income countries. Intervention uses recommendations based on those from Brazilian Ministry of Health. Online delivery of CBT selected due to dearth of human and financial resources in Brazil. | – |
ACT, Acceptance and Commitment Therapy; CBT, Cognitive Behavioral Therapy; iCBT, internet-delivered Cognitive Behavioral Therapy; ETPB, Enhanced Triple P for Baby; IPT, Interpersonal Therapy; MB, Mellow Bumps; RCT, Randomized Control Trail; BAI, Beck Anxiety Inventory; GAD-7, Generalized Anxiety Disorder- 7item; HADS, Hospital Anxiety and Depression Scale; STAI, State-Trait Anxiety Inventory; DASS-21, Depression, Anxiety and Stress Scale-21; OCI, Obsessive Compulsive Inventory-Revised; MI, Mobility Inventory; IES, Impact of Events Scale; SPIN, The Social Phobia Inventory.