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Effect of internet-based cognitive behaviour therapy for women with negative birth experiences on partner relationship and infant bonding: A randomised controlled trial
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(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Abstract [en]

Objective: To investigate the effect of internet-based cognitive behaviour therapy (iCBT) on partner relationships and bonding in women with negative birth experiences and/or at risk of posttraumatic stress disorder following childbirth.

Methods: In a superiority multicentre randomised controlled trial conducted in Sweden 2013–2018, 266 women were randomised to iCBT+treatment as usual (TAU) (n=132) or TAU (n=134). The outcome measures were 1) partner communication, 2) quality of partner relationship and 3) mother-infant bonding. Data were collected at baseline, 6 weeks, 14 weeks and one year after randomisation. Mixed-model repeated measures analysis was used.

Results: The trial suffered from a high dropout rate. About 45% (n=59) of women in the intervention group completed the iCBT. In the intention-to-treat analyses, women in both groups reported fewer positive feelings and attitudes toward their partner over time. Partner satisfaction and cohesion declined over time. Mother-infant bonding showed initial improvement, but this later changed into decline over time. In the completer analyses, similar significant time effects were found for both groups. However, there were no significant group or interaction effects on any of the outcome measures in the intention-to-treat or completer analyses. 

Conclusions: In this study, we could not identify any effect of iCBT. However, we observed changes over time for both the intervention and TAU group with decreased quality of partner relationship over time, and initial improvement in mother-infant bonding, which then decreased. 

Nyckelord [en]
ICBT, internet intervention, negative childbirth experience, PTSD FC, Randomised controlled trial
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Medicinsk vetenskap
Identifikatorer
URN: urn:nbn:se:uu:diva-500983OAI: oai:DiVA.org:uu-500983DiVA, id: diva2:1753830
Tillgänglig från: 2023-04-29 Skapad: 2023-04-29 Senast uppdaterad: 2023-05-04
Ingår i avhandling
1. Internet-based cognitive behaviour therapy for women with negative birth experiences following childbirth
Öppna denna publikation i ny flik eller fönster >>Internet-based cognitive behaviour therapy for women with negative birth experiences following childbirth
2023 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Childbirth can be associated with both positive and negative psychological reactions. The experience of labour and birth is subjective, multidimensional and complex including physiological and psychological factors. Distress from a negative birth experience can lead to various psychiatric disorders, such as postpartum depression and post-traumatic stress disorder following childbirth (PTSD FC) which both can have extensive consequences for the woman and her family members.  

The overall aim of this thesis was to develop and evaluate internet-based cognitive behaviour therapy (iCBT) compared to Treatment as usual (TAU) for women with negative birth experiences at risk for PTSD FC. The work is summarized in four papers originating from one randomised controlled trial (RCT). Paper I presents the study protocol of the RCT. Paper II investigated predictors for non-participation, pre-treatment dropout, treatment dropout and loss to follow-up in the RCT. Paper III and IV evaluated the effect of iCBT on mental health and quality of life (paper III) and partner relationship and mother-infant bonding (paper IV).  

Results from paper II showed that a majority of the eligible women never participated and those with no obstetric complications were more likely to not participate and/or dropout at different time points. Nonparticipation was predicted by several variables, both demographic, antepartum and obstetrical. Results from paper III showed that ICBT did not reduce PTSD FC or depressive symptoms and in paper IV we found that iCBT had no effect on different aspects of partner relationship or mother-infant bonding. However, both groups (ICBT and TAU) reported reductions of re-experiences of traumatic memories and depressive symptoms over time. Both groups also reported fewer positive feelings and attitudes toward their partner over time and mother-infant bonding showed initial improvement, but this later changed into decline over time. 

In summary, we could not demonstrate any clear effect of iCBT as compared to TAU, but changes over time in both groups indicate some level of natural recovery from birth related trauma, decreased quality of partner relationship and initial improvement in mother-infant bonding. The challenge in future research will be to develop interventions that are both well accepted and effective in supporting women with negative birth experiences at risk for PTSD FC. The next step should be to apply more narrow inclusion criteria in order to capture a more motivated population in need of psychological support.  

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2023. s. 58
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1952
Nyckelord
Internet-based cognitive behaviour therapy, negative birth experience, post-traumatic stress disorder (PTSD), PTSD following childbirth, randomised controlled trial
Nationell ämneskategori
Övrig annan medicin och hälsovetenskap
Forskningsämne
Medicinsk vetenskap
Identifikatorer
urn:nbn:se:uu:diva-500984 (URN)978-91-513-1825-7 (ISBN)
Disputation
2023-08-24, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 13:15 (Svenska)
Opponent
Handledare
Tillgänglig från: 2023-06-07 Skapad: 2023-05-04 Senast uppdaterad: 2023-06-07

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