Stress management interventions among socioeconomically disadvantaged parents: A meta-analysis and moderation analysis

• Published in: International journal of nursing studies 2021-08, Vol.120, p.103954-103954, Article 103954
• Main Authors: Ling, Jiying, Zahry, Nagwan R., Liu, Cheng-Ching
• Format: Article
• Language: English
• Subjects: Analysis; Anxiety; Behavior modification; Cognitive behavioral therapy; Cognitive-behavioral factors; Depression; Developed countries; Developing countries; Intervention; LDCs; Long term; Low socioeconomic; Low-income; Medical screening; Mental depression; Meta-analysis; Mindfulness; Moderation; Moderators; Nursing; Parental stress; Parents; Parents & parenting; Poverty; Quasi-experimental methods; Self care; Socioeconomically disadvantaged; Stress; Stress management; Systematic review
• ISSN: 0020-7489; 1873-491X
• DOI: 10.1016/j.ijnurstu.2021.103954

Socioeconomically disadvantaged parents experience high levels of stress, anxiety, and depression. Many interventions have been tested to reduce parental stress, but no meta-analysis has been conducted to quantitatively summarize the effects and explore the moderators of intervention effects among socioeconomically disadvantaged parents. This meta-analysis aimed to (1) quantitatively examine the intervention effects of prior stress management interventions among socioeconomically disadvantaged parents on reducing stress, depression, and anxiety; and (2) explore the potential moderators of intervention effects. Six databases, including CINAHL, PubMed, PsycINFO, Sociological Abstracts, Web of Science, and Cochrane, were searched in February 2021. After a two-step literature screening by two independent reviewers, 45 eligible articles were retained. Two evaluators independently assessed each eligible study's quality using the Evidence Project risk of bias tool. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guided the report. Meta-analyses (random-effects model) and moderation analyses (mixed-effects model) were performed. Previous stress management interventions had a small effect of -0.24 in reducing parental stress (95% confidence interval [CI]: -0.33, -0.15) with a 7.6-month follow-up effect of -0.12 (95% CI: -0.27, 0.04). The pooled effects on reducing depression were -0.15 (95% CI: -0.26, -0.04) with a 9-month follow-up effect of 0.02 (95% CI: -0.21, 0.26). Two studies measured anxiety, and the average effects were -0.03 (95% CI: -0.16, 0.11). Intervention effects on stress were significantly moderated by country (p = .005), study design (p < .001), and intervention duration (p = .030). Interventions conducted in developing countries (g = -0.52) had a significantly larger effect in reducing stress than those conducted in developed countries (g = -0.19). Studies using a quasi-experimental design (g = -0.47) resulted in a significantly greater effect in reducing stress than RCTs (g = -0.12). Interventions with a duration of 1–3 months (g = -0.36) had a greater effect in reducing stress than those with a longer duration (g = -0.11 for 3–6 months, -0.20 for >6 months). Intervention effects on reducing depression were significantly moderated by intervention component (p = .030). Cognitive behavioral therapy (g = -0.20) and mindfulness-based interventions (g = -0.16) resulted in greater effects in reducing depression than int