BackgroundA growing number of meta-analyses have supported the application of therapist-supported Internet-based cognitive behavior therapy (iCBT) for psychological disorders across different populations, but relatively few meta-analyses have concentrated on postpartum women.ObjectiveThis meta-analysis evaluated the efficacy of therapist-supported iCBT in improving stress, anxiety, and depressive symptoms among postpartum women.MethodsA total of 10 electronic databases were used to search for published and unpublished trials. Cochrane Collaboration tool for assessing risk of bias was utilized to measure methodological quality. Meta-analysis was performed using the RevMan software (Review Manager version 5.3 for Windows from the Nordic Cochrane Centre, the Cochrane Collaboration, 2014). Among the 789 studies identified, 8 randomized controlled trials were selected, involving 1523 participants across 6 countries.ResultsMore than half (65%) of the eligible studies had a low risk of bias with no heterogeneity. Results revealed that therapist-supported iCBT significantly improved stress (d=0.84, n=5), anxiety (d=0.36, n=6), and depressive symptoms (d=0.63, n=8) of the intervention group compared with those of the control group at post-intervention.ConclusionsThis review revealed that therapist-supported iCBT significantly improves stress, anxiety, and depressive symptoms among postpartum women with small to large effects. Future effectiveness studies should establish the essential components, format, and approach of iCBT with optimal levels of human support to maximize a long-term effect.

Background The frenzy of postbirth events often takes a toll on mothers’ mental well-being, leaving them susceptible to postpartum psychological disorders such as postnatal depression (PND). Social support has been found to be effective in restoring the emotional well-being of new mothers. Therefore, mothers need to be supported during the crucial postpartum period to buffer the negative after effects of childbirth and to promote healthier maternal well-being. Objective This study aimed to evaluate the effectiveness of a technology-based peer-support intervention program (PIP) on maternal outcomes during the early postpartum period. Methods A randomized, parallel-armed controlled trial was conducted. The study recruited 138 mothers (69 in intervention group, 69 in control group) at risk of PND from a tertiary hospital in Singapore. To support these mothers, 20 peer volunteers were recruited by word of mouth and trained by a psychiatrist in social support skills before the intervention commenced. The 4-week–long intervention included a weekly follow-up with a peer volunteer through phone calls or text messages. The intervention group received peer support in addition to the standard care offered by the hospital. The control group only received postnatal standard care. Maternal outcomes (PND, postnatal anxiety [PNA], loneliness, and perceived social support) were measured with reliable and valid instruments. Data were collected immediately postpartum, at 1 month postpartum and at 3 months postpartum. The general linear model was used to compare the groups for postpartum percentage changes in the outcome variables at first and third months, and the linear mixed model was used to compare the trend over the study period. Results There was a statistically significant difference in Edinburgh Postnatal Depression Scale scores (d=–2.11; 95% CI −4.0 to −0.3; P=.03) between the intervention and control groups at 3 months postpartum after adjusting for covariates. The intervention group had a significant change over time compared with the control group. Conclusions The technology-based PIP was found to be effective in reducing the risk of PND among new mothers and showed a generally positive trend in reducing PNA and loneliness and increasing perceived social support. This study highlights the importance of training paraprofessionals to provide needed support for new mothers postpartum. A further long-term evaluation of the PIP on maternal and family outcomes and its cost-effectiveness is needed to inform clinical practices. Trial Registration ISRCTN Registry ISRCTN14864807; https://www.isrctn.com/ISRCTN14864807 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.9416

This study aims to determine relationships between intrapartum factors, neonatal characteristics, skin-to-skin contact (SSC), and early breastfeeding initiation after spontaneous vaginal and Caesarean section or operative vaginal birth. A total of 915 mother-newborn dyads were considered in a hypothetical model based on integrated concepts of breastfeeding initiation model, infant learning framework, and attachment theory. Multiple-group path analysis was used to determine whether differences exist between effects of immediate SSC (≤30 min) on early breastfeeding initiation in different modes of birth. SSC, mode of birth, labour duration, and neonatal intensive care unit admission were significantly associated with early breastfeeding initiation, as indicated by the path analysis model, which included all samples. Women with immediate SSC were more likely to initiate early breastfeeding in different modes of birth. In the spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and presented an Apgar score of <7 at 1 min. Multiple-group analysis showed no significant difference between effects of immediate SSC on early breastfeeding initiation in different modes of birth (critical ratio = −0.309). Results showed that models satisfactorily fitted the data (minimum discrepancy divided by degrees of freedom = 1.466-1.943, goodness of fit index = 0.981-0.986, comparative fit index = 0.947-0.955, and root mean square error of approximation = 0.023-0.032). Our findings emphasize the crucial importance of prioritizing promotion of immediate SSC under different modes of birth. Key messages• Skin-to-skin contact (SSC), mode of birth, duration of labour, and neonatal intensive care unit admission show significant effects on early breastfeeding initiation during path analysis.• Immediate SSC was consistently and more likely to initiate early breastfeeding in different modes of birth.• In spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and an Apgar score of <7 at 1 min.• Multiple-group analysis showed no significant difference between spontaneous vaginal birth and Caesarean section or operative vaginal birth concerning effects of immediate SSC on early breastfeeding initiation. of 11 LAU ET AL.bs_bs_banner Given the well-known benefits of early breastfeeding initiation (Sharma & Byrne, 2016), our team investigated factors associated with exclusive breastfeeding initiation within 1 hr in intrapartum women.Considering our lack of existing knowledge on intrapartum factors, infant characteristics, SSC, and early breastfeeding initiation, this study attempts to fill research gaps in literature. | Conceptual framework and hypothetical modelA hypothetical model (Figure 1 | MeasuresOn the basis of previous literature review ( Moore et al., 2016;Patel et al., 2015), our study used a structured ...

Our review explores the effectiveness of resilience interventions on improving resilience, reducing depressive symptoms, and overcoming stress symptoms among higher education students. We conducted a systematic search in 10 electronic English and Chinese language databases. Twenty-nine randomized, controlled trials (RCTs) met the inclusion criteria and were included in this review. Effect sizes from 25 RCTs were calculated for meta-analysis and metaregression. The results of a random effects model reveal that resilience interventions are effective in improving resilience with small effect size (g = .32, 95% CI [.15, .49]), reducing depressive symptoms with small effect size (g = .25, 95% CI [.06, 44]), and overcoming stress (g = .22, 95% CI [.08, .32]). Subgroup analyses conclude that effect sizes of resilience interventions comprising skills that enhance social competency are statistically significantly larger than those of interventions without. In addition, the effect sizes are larger when resilience interventions used synchronous communication and delivered through a mixture of didactic and dialectic approaches. Metaregression reveals that trials rated with low scores in the Medical Education Research Study Quality Instrument considerably influence scores in resilience. Our meta-analysis supports the use of resilience interventions as a universal prevention strategy among higher education students. This review ends with implications for practice and directions for further research on developing resilience interventions. Educational Impact and Implications StatementThe results of this meta-analysis concluded that resilience interventions can potentially build resilience and reduce depressive and stress symptoms among higher education students. Interventions were more effective when they focused on building students' social competency, used synchronous communication, and delivered through a mixture of didactic and dialectic approaches.

Resilience has been documented as an essential component in managing stress. However, understanding how undergraduate students with different sociodemographic characteristics perceive resilience remains understudied. This study aimed to explore how undergraduate students in one university define and build resilience during the COVID-19 pandemic. Students’ perception and preferences for receiving resilience training were additionally solicited. A descriptive qualitative cross-sectional study was conducted. Twenty-seven students were interviewed using a semi-structured interview guide via Skype instant messaging. The thematic analysis generated five themes: resilience as enduring and withstanding; the building blocks of resilience; resilience: learning or earning; pedagogical considerations for resilience training; and a blended platform for resilience training. Participants described resilience as an enduring and withstanding trait essential for university students. Resilience can be built from intrinsic and extrinsic factors. Intrinsic factors that enhanced resilience included desire to succeed and motivation. Extrinsic factors were relational in nature, and friends, family, teachers, and religion were found to boost resilience. Students had several recommendations in designing resilience training, and they recommended the use of a blended platform. Further, students suggested the use of videos, narratives from resilient individuals, and using reflective practice as a pedagogy in resilience training. Future resilience training should consist of personal and interpersonal factors and should be introduced early during the academic term of students’ university life. As the COVID-19 pandemic compounds an already challenging academic climate, this study lends it findings to expand the resilience literature and develop future resilience training.