The Effective Interventions of Psychological Intervention on Fostering Resilience in Families of Premature Neonates: A Network Meta-Analysis

Introduction: The birth of a premature infant presents significant psychological challenges for families, often leading to increased stress, anxiety, and diminished resilience. While various psychological interventions have been implemented to support these families, their comparative effectiveness remains unclear. This network meta-analysis (NMA) systematically evaluates the efficacy of different psychological interventions in fostering resilience among families of preterm neonates. Methods: We conducted a comprehensive search of PubMed, Sciencedirect, Cochrane Library, and Googleschoolar up to October ۲۰۲۴, identifying ۱۸ randomized controlled trials (RCTs) involving ۲,۱۴۵ participants. Included studies compared Cognitive-Behavioral Therapy (CBT), Mindfulness-Based Stress Reduction (MBSR), Family-Centered Care (FCC), Peer Support, and Psychoeducation. Resilience outcomes were measured using validated scales (Connor-Davidson Resilience Scale, Family Resilience Assessment Scale). A frequentist NMA was performed using R (netmeta package), with interventions ranked via surface under the cumulative ranking curve (SUCRA). Subgroup analyses examined timing of intervention (NICU vs post-discharge) and parent gender differences. Results: CBT demonstrated superior efficacy (SUCRA=۸۹%, SMD=۰.۷۵, ۹۵% CI [۰.۶۲-۰.۸۸]), followed by MBSR (SUCRA=۷۸%, SMD=۰.۶۴ [۰.۵۱-۰.۷۷]). FCC (SUCRA=۶۵%, SMD=۰.۵۲ [۰.۴۰-۰.۶۴]) and Peer Support (SUCRA=۵۸%, SMD=۰.۴۵ [۰.۳۲-۰.۵۸]) showed moderate effectiveness, while Psychoeducation was least effective (SUCRA=۴۲%, SMD=۰.۳۰ [۰.۱۸-۰.۴۲]). Subgroup analyses revealed significantly greater effects for in-NICU interventions versus post-discharge programs (p<۰.۰۱) and for mothers versus fathers (SMD difference=۰.۲۱, p=۰.۰۳). Complementary studies showed Kangaroo Mother Care improved resilience scores from ۵۷.۶۲ ±۱۳.۹۵ to ۷۶.۹۶ ±۸.۰۷ (p<۰.۰۵), while virtual education programs increased CD-RISC scores by ۱۹.۳۴ points (p<۰.۰۰۱). Conclusion: CBT and MBSR emerge as the most effective interventions for enhancing family resilience in the NICU setting, particularly when implemented during hospitalization. These findings support the integration of structured, skill-based psychological support into routine NICU care, with particular attention to maternal needs. Future research should investigate long-term outcomes and cost-effectiveness to optimize clinical implementation and policy development.

کلیدواژه ها:

premature infants ، psychological interventions ، resilience ، network meta-analysis ، neonatal intensive care ، family support