Effectiveness Of Psychosocial Intervention Program For Women Undergoing Termination Of Pregnancy For Fetal Anomalies

Objectives:（1）To explore the effects of a peri-induction psychosocial intervention program for women with fetal anomalies on women induced with fetal anomalies,using depression and post-traumatic stress symptoms as primary outcome indicators and psychological flexibility and social support as secondary outcome indicators.（2）To explore the effects of the peri-induction psychosocial intervention program for women with fetal anomalies on the intervention subjects and the possible reasons for the effects,as well as the obstacles and directions for improvement in clinical implementation.Methods:（1）A two-arm parallel design randomized controlled trial was used for the intervention effect evaluation part.Women induced with fetal malformations who were hospitalized and induced at two maternal and child specialty hospitals with genetic clinics in Changsha from August2021 to January 2022 were selected.Eighty-six women with induced fetal malformation who met the nadir criteria were screened and randomized into the intervention and control groups according to the mixed randomization method.The control group received standard clinical care;the intervention group received perinatal psychosocial intervention for women with fetal anomalies on the basis of standard care.The intervention effects were assessed before（T₁）,one day after（T₂）,one month after（T₃）,and three months after（T₄）using the self-administered General Information Questionnaire,Edinburgh Postpartum Depression Scale,Revised Event Impact Scale,Acceptance and Action Questionnaire（Version 2）,Cognitive Convergence Subscale,and Social Support Scale.Quantitative data were performed using SPSS 26.0 statistical software,following the principle of intentional analysis,and the intervention effects were analyzed using t-test,chi-square test,non-parametric test and repeated measures ANOVA.The test level was 0.05,and statistical hypothesis testing was performed using a two-sided test.（2）The process evaluation part of the intervention was performed by descriptive qualitative research method,and the intervention process was evaluated at the end of the intervention by self-administered satisfaction questionnaire,field observation and semi-structured interview for women who completed the intervention for fetal malformation induction,and the qualitative data were collated by applying NVivo version 11.0 and analyzed by traditional content analysis method.Results:（1）Forty-one participants were included in the intervention group before the intervention and four were lost to follow-up;45 participants were included in the control group and six were lost to follow-up.There were no statistically significant differences in socio-demographic information,depression,post-traumatic stress,psychological flexibility and social support scores at baseline between the two groups of women with fetal abnormality induction（P>0.05）.（2）For women with fetal abnormality induction,repeated measures ANOVA showed statistically significant differences in social support scores in the intervention group compared to the control group after the intervention（P≤0.05）;there was an interaction between intervention and time only in the avoidance symptom dimension（P≤0.05）;comparison between groups showed statistically significant differences in social support and avoidance symptom scores at time points T3 and T4 in the intervention group compared to the control group（P≤0.05）.（3）For women with depressive symptoms induced by fetal abnormality,repeated measures ANOVA showed statistically significant differences in depression,post-traumatic stress symptoms and social support scores in the intervention group compared to the control group after the intervention（P≤0.05）;there was no interaction between intervention and time（P>0.05）;between-group comparisons showed that the intervention group had statistically significant differences in depression at time point T2,avoidance at time point T3 and post-traumatic stress symptoms and social support scores in the intervention group compared with the control group were statistically significant（P≤0.05）.（4）The qualitative interview of intervention subjects analyzed 4themes and 15 sub-themes.（i）Changes brought about by the perinatal psychosocial intervention for women with fetal anomalies:change in mood,rational thinking,change in coping strategies,and strengthening of mobility.（ii）Useful components of an intervention program may include,but are not limited to:interventionist care,the power of confidences,positive thinking audio,emotional dissociation and acceptance techniques,value compass and growth pathways,and peer support.（iii）Hindrances to intervention programs in clinical practice:the environment in which the intervention is conducted and the establishment of trusting relationships.（iv）Future directions for improvement of the intervention program could be reflected in:online translation of the intervention,precision of information support,and diversification of peer support forms.Conclusion:（1）The psychosocial intervention program for women with fetal anomalies during the perinatal induction period can improve the avoidance symptoms and social support level of women with fetal anomalies induced by labor.（2）A perinatal psychosocial intervention program for women with fetal anomalies can improve depression,posttraumatic stress symptoms,and social support in women with fetal anomalies who are induced with depressive symptoms.（3）Women with fetal abnormality induction of labor can benefit from the intervention,and future studies can optimize the function and effect through online translation of the intervention.