We performed the first meta-analysis of clinical studies by investigating the effects of eye-movement desensitization and reprocessing (EMDR) therapy on the symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, and subjective distress in PTSD patients treated during the past 2 decades. We performed a quantitative meta-analysis on the findings of 26 randomized controlled trials of EMDR therapy for PTSD published between 1991 and 2013, which were identified through the ISI Web of Science, Embase, Cochrane Library, MEDLINE, PubMed, Scopus, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature electronic databases, among which 22, 20, 16, and 11 of the studies assessed the effects of EMDR on the symptoms of PTSD, depression, anxiety, and subjective distress, respectively, as the primary clinical outcome. The meta-analysis revealed that the EMDR treatments significantly reduced the symptoms of PTSD (g = −0.662; 95% confidence interval (CI): −0.887 to −0.436), depression (g = −0.643; 95% CI: −0.864 to −0.422), anxiety (g = −0.640; 95% CI: −0.890 to −0.390), and subjective distress (g = −0.956; 95% CI: −1.388 to −0.525) in PTSD patients. This study confirmed that EMDR therapy significantly reduces the symptoms of PTSD, depression, anxiety, and subjective distress in PTSD patients. The subgroup analysis indicated that a treatment duration of more than 60 min per session was a major contributing factor in the amelioration of anxiety and depression, and that a therapist with experience in conducting PTSD group therapy was a major contributing factor in the reduction of PTSD symptoms.

Childbirth fear is a health concern in women living in high-income countries; however, little is known about childbirth fear among women living in low-income countries like Malawi. In this study, we explored childbirth fear and associated factors among pregnant and postpartum women in Malawi. A cross-sectional study of 152 pregnant and 153 postpartum women was conducted at a district hospital in Malawi. Participants were assessed for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ). Demographic and obstetric variables were collected using a structured questionnaire. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure social support. Using a multinomial logistic regression, factors related to childbirth fears were examined, namely demographic and obstetric characteristics, and social support. The mean age of participants was 26 (standard deviation: 6.4) years. During pregnancy, 39% women reported a low level of fear, 41% reported moderate fear, and 20% reported high fear; while after birth, 49, 41, and 10% women reported low, moderate, and high fear, respectively. Pregnant women who were illiterate (odds ratio (OR): 5.0, p < 0.01) or unemployed (OR: 12.6, p < 0.01) were more likely to report moderate and high fear. Postpartum mothers who were illiterate (OR: 4.2, p < 0.01) or unemployed (OR: 11.8, p < 0.01) were more likely to have moderate and high fear. Furthermore, postpartum women who sustained perineal tears had significantly higher odds of experiencing moderate (OR: 5.3, p < 0.01) or high (OR: 19.9, p < 0.01) fear than their counterparts. Childbirth fear is common in Malawi, and pregnant women are more likely to experience high levels of fear than postpartum women. This study highlighted the connection between childbirth fear with mother’s education, employment, and perineal tears during delivery. Identifying and developing interventions for women with these associated characteristics is of clinical importance for the reduction of childbirth fear before and after childbirth in Malawi.

Depression and anxiety are important mood changes in childbearing women. However, changes in depression and anxiety over time in women who undergo an elective cesarean section (CS) have not yet been elucidated. We aimed to characterize the trajectories of depressive and anxiety symptoms, and patterns of co-occurrence, and examined the associated predictors of depression and anxiety courses. A prospective longitudinal study of childbearing women (N = 139) who underwent a CS was conducted. Depressive and anxiety symptoms were respectively assessed using the Edinburgh Postnatal Depression Scale and State Anxiety Inventory, in the third trimester and at 1 day, 1 week, and 1 and 6 months postpartum. Group-based modeling identified three distinct trajectories of depressive symptoms: group 1 (low, 30.9%), group 2 (mild, 41.7%), and group 3 (high, 27.3%). Four group trajectories of anxiety symptoms were identified: group 1 (low, 19.4%), group 2 (mild, 44.6%), group 3 (high, 28.8%), and group 4 (very high, 7.2%). Mild symptoms of both depression and anxiety were the most common joint trajectory. Depression trajectories were significantly related to anxiety trajectories (p<0.001). Predictors of the joint trajectory included the pre-pregnant body mass index (odds ratio (OR): 2.42, 95% confidence interval (CI): 1.1∼6.3) and a poor sleep score (OR: 3.2, 95% CI: 1.4∼7.3) in the third trimester. Distinctive trajectories and co-occurrence patterns of depressive and anxiety symptoms were identified. Our findings suggest a need for greater attention to continuous assessment of psychological well-being among women who undergo an elective CS.