Group‐based parent training programmes for improving parental psychosocial health

This Cochrane‐Campbell systematic review examines the effects of group‐based parenting programmes on parents' psychosocial health. The review summarise findings from 48 studies conducted in various countries and settings including the USA, Canada, Australia, U.K., China, Germany, Japan, New Zealand and The Netherlands. The participants were adult parents with the parental responsibility for day‐to‐day care of children. A total of 4,937 participants were included in the studies. What are the main results? Parent training has positive short‐term effects on depression, anxiety, stress, anger, guilt, confidence and partner satisfaction. There was no effect on self‐esteem and none of the trials reported on aggression or adverse effects. However, after six months there are positive effects on only two outcomes (stress and confidence), and after one year there are no significant effects on any outcomes. The data refer primarily to mothers as there are limited data on fathers. Only one meta‐analysis was conducted for fathers, showing a statistically significant short‐term improvement in parental stress. There was no significant different in effects according to the type of programme or intervention duration. Abstract BACKGROUND Parental psychosocial health can have a significant effect on the parent‐child relationship, with consequences for the later psychological health of the child. Parenting programmes have been shown to have an impact on the emotional and behavioural adjustment of children, but there have been no reviews to date of their impact on parental psychosocial wellbeing. OBJECTIVES To address whether group‐based parenting programmes are effective in improving parental psychosocial wellbeing (for example, anxiety, depression, guilt, confidence). SEARCH METHODS We searched the following databases on 5 December 2012: CENTRAL (2011, Issue 4), MEDLINE (1950 to November 2011), EMBASE (1980 to week 48, 2011), BIOSIS (1970 to 2 December 2011), CINAHL (1982 to November 2011), PsycINFO (1970 to November week 5, 2011), ERIC (1966 to November 2011), Sociological Abstracts (1952 to November 2011), Social Science Citation Index (1970 to 2 December 2011), metaRegister of Controlled Trials (5 December 2011), NSPCC Library (5 December 2011). We searched ASSIA (1980 to current) on 10 November 2012 and the National Research Register was last searched in 2005. SELECTION CRITERIA We included randomised controlled trials that compared a group‐based parenting programme with a control condition and used at least one standardised measure of parental psychosocial health. Control conditions could be waiting‐list, no treatment, treatment as usual or a placebo. DATA COLLECTION AND ANALYSIS At least two review authors extracted data independently and assessed the risk of bias in each study. We examined the studies for any information on adverse effects. We contacted authors where information was missing from trial reports. We standardised the treatment effect for each outcome in each study by dividing the mean difference in post‐intervention scores between the intervention and control groups by the pooled standard deviation. RESULTS We included 48 studies that involved 4937 participants and covered three types of programme: behavioural, cognitive‐behavioural and multimodal. Overall, we found that group‐based parenting programmes led to statistically significant short‐term improvements in depression (standardised mean difference (SMD) ‐0.17, 95% confidence interval (CI) ‐0.28 to ‐0.07), anxiety (SMD ‐0.22, 95% CI ‐0.43 to ‐0.01), stress (SMD ‐0.29, 95% CI ‐0.42 to ‐0.15), anger (SMD ‐0.60, 95% CI ‐1.00 to ‐0.20), guilt (SMD ‐0.79, 95% CI ‐1.18 to ‐0.41), confidence (SMD ‐0.34, 95% CI ‐0.51 to ‐0.17) and satisfaction with the partner relationship (SMD ‐0.28, 95% CI ‐0.47 to ‐0.09). However, only stress and confidence continued to be statistically significant at six month follow‐up, and none were significant at one year. There was no evidence of any effect on self‐esteem (SMD ‐0.01, 95% CI ‐0.45 to 0.42). None of the trials reported on aggression or adverse effects. The limited data that explicitly focused on outcomes for fathers showed a statistically significant short‐term improvement in paternal stress (SMD ‐0.43, 95% CI ‐0.79 to ‐0.06). We were unable to combine data for other outcomes and individual study results were inconclusive in terms of any effect on depressive symptoms, confidence or partner satisfaction. AUTHORS' CONCLUSIONS The findings of this review support the use of parenting programmes to improve the short‐term psychosocial wellbeing of parents. Further input may be required to ensure that these results are maintained. More research is needed that explicitly addresses the benefits for fathers, and that examines the comparative effectiveness of different types of programme along with the mechanisms by which such programmes bring about improvements in parental psychosocial functioning. Plain language summary PARENT TRAINING FOR IMPROVING PARENTAL PSYCHOSOCIAL HEALTH Parental psychosocial health can have a significant effect on the parent‐child relationship, with consequences for the later psychological health of the child. Some parenting programmes aim to improve aspects of parental wellbeing and this review specifically looked at whether group‐based parenting programmes are effective in improving any aspects of parental psychosocial health (for example, anxiety, depression, guilt, confidence). We searched electronic databases for randomised controlled trials in which participants had been allocated to an experimental or a control group, and which reported results from at least one scientifically standardised measure of parental psychosocial health. We included a total of 48 studies that involved 4937 participants and covered three types of programme: behavioural, cognitive‐behavioural and multimodal. Overall, the results suggested statistically significant improvements in the short‐term for parental depression, anxiety, stress, anger, guilt, confidence and satisfaction with the partner relationship. However, only stress and confidence continued to be statistically significant at six month follow‐up, and none were significant at one year. There was no evidence of effectiveness for self‐esteem at any time point. None of the studies reported aggression or adverse outcomes. Only four studies reported the outcomes for fathers separately. These limited data showed a statistically significant short‐term improvement in paternal stress but did not show whether the parenting programmes were helpful in terms of improving depressive symptoms, confidence or partner satisfaction. This review shows evidence of the short‐term benefits of parenting programmes on depression, anxiety, stress, anger, guilt, confidence and satisfaction with the partner relationship. The findings suggest that further input may be needed to support parents to maintain these benefits. However, more research is needed that explicitly addresses the benefits for fathers, and that provides evidence of the comparative effectiveness of different types of programme and identifies the mechanisms involved in bringing about change.