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QUESTION: Are group based parenting programmes effective in improving maternal psychosocial health including anxiety, depression, and self esteem?
Data sources
Studies were identified by searching Medline, EMBASE/Excerpta Medica, CINAHL, PsycLIT, ERIC, ASSIA, Sociofile, Social Science Citation Index, National Research Register, and the Cochrane Library for the period January 1970 to July 2000 where possible; scanning the reference lists of identified articles and reviews; and by contacting leading independent charitable and voluntary childcare agencies in the UK.
Study selection
Studies were selected if they were randomised controlled trials comparing the effectiveness of a group based parenting programme with a control treatment (waiting list, no treatment, or placebo) using at least 1 standardised instrument measuring maternal psychosocial health.
Data extraction
Data were extracted on patient characteristics, intervention type, and maternal psychosocial health outcomes.
Main results
23 studies met the selection criteria of which 17 provided sufficient data to calculate effect sizes. A meta-analysis was done to determine the short term effectiveness of the programmes in improving 5 outcomes (depression, anxiety/stress, self esteem, social support, and mother's relationship with her partner). Effect sizes for the 5 outcomes were calculated by dividing the mean difference in post intervention scores for the intervention and control group by the pooled standard deviation. Only 14 studies provided data on the 5 outcomes of interest involving a total of 917 participants. The included studies evaluated programmes based on the following theoretical approaches: behavioural, cognitive behavioural, multimodal, behavioural humanistic, and rational emotive therapy. The meta-analyses showed short term effectiveness of the parenting programmes in improving depression (9 studies, effect size −0.3, 95% CI −0.4 to −0.1), anxiety/stress (8 studies, −0.5, CI −0.7 to −0.3), self esteem (5 studies, −0.4, CI −0.6 to −0.1), and mother's relationship with her partner (4 studies, −0.4, CI −0.7 to −0.2). The meta-analysis for social support showed no evidence of effectiveness (4 studies, −0.04, CI −0.3 to 0.2). Follow up data to evaluate long term improvement were available for only 3 of the 5 outcomes. The meta-analyses showed results favouring parenting programmes for self esteem (5 studies, −0.4, CI −0.7 to −0.2). Results for the mother's relationship with her partner (2 studies, −0.3, CI −0.8 to 0.1) and depression (5 studies, −0.2, CI −0.4 to 0.002) showed no evidence of effectiveness.
Conclusion
Group based parent training programmes are effective in the short term in improving maternal depression, anxiety/stress, self esteem, and the mother's relationship with her partner and in the long term in improving self esteem.
Commentary
This review by Barlow and Coren shows that some group based parent training programmes lead to short term benefits in maternal psychosocial health. Further evidence is required to determine their long term effectiveness. Because there were no individual data available in the primary studies concerning the level of pathology present at the onset, the review cannot help readers to determine which programmes are helpful for which mothers.
Any methodological limitations of the review result primarily from the quality of the research evidence. For example, there are no studies with low risk of bias and many with moderate to high risk (26%). The other major flaw, as acknowledged by the authors, is the high dropout rates (>20%) in many of the studies.
There are several cautions when applying the results of this review to a particular setting. Firstly, the study programmes focused on mothers with unknown and probably varying levels of pathology, as the authors acknowledge. Secondly, the programmes included mothers of children of all ages from infants to adolescents. It is possible that different strategies may be necessary for parents of different aged children. Thirdly, some studies included children from the community and others from clinical settings where they were being treated for diagnosed behaviour disorders. Again, there may be a relation between the presence and severity of child disorders and maternal psychosocial health. This relation could have an effect on programme outcomes.
A single study has suggested that parenting groups can be cost effective1; however, better quality research is required to determine which programmes are effective and which mothers benefit most.
References
Footnotes
Source of funding: no external funding.
For correspondence: Ms E Coren, Health Services Research Unit, University of Oxford, Institute of Health Sciences, Old Road, Headington, Oxford OX3 7LF, UK. Fax +44 (0)1865 226711.