Effect of Acceptance and commitment therapy on mental health and breastfeeding self-efficacy in mothers with preterm infant: a randomized controlled trial

Abstract

Abstract Introduction: Preterm infants’ mothers experience more anxiety and depression and are more prone to postpartum depression compared to the mothers of term infants. Further, this stress and anxiety at the beginning and continuation of the breastfeeding process cause disorders. Given that psychological interventions can reduce individuals’ problems, the present study aimed to investigate the effect of acceptance and commitment therapy (ACT) on mental health and breastfeeding self-efficacy (BSE) of preterm infants’ mothers. Methods: This randomized controlled trial was performed on 90 mothers of preterm infants admitted to the neonatal ward and neonatal intensive care unit (NICU) of two university affiliated hospitals in Tabriz in 2021. The inclusion criteria were mothers of preterm infants admitted to the NICU or neonatal ward following preterm birth before 37 weeks old, ability to breastfeed, and obtaining anxiety score ≤ 7 (mild and moderate anxiety), depression score ≤ 10 (mild and moderate depression), stress score ≤ 12 (mild and moderate stress) in the DASS-21 questionnaire. The exclusion criteria included the use of psychotropic substances, antidepressants, barbiturates, narcotics, amphetamines, and cocaine according to the mother, and contraindications to breastfeeding. sample size was obtained 45 in each group. Participants were assigned into the intervention and control groups using stratified block randomization method. The intervention group received group counseling on ACT in eight 60-minute sessions and the control group received routine care. The Depression Anxiety Stress Scale-21 (DASS-21) and the Breastfeeding Self-Efficacy Scale (BSES) were completed by the participants before and immediately after the intervention. ANCOVA test with adjustment of confounding variables was used to compare the outcomes between two groups. Results: There was no significant difference between two groups in terms of socio-demographic characteristics. The total mean score of BSE in the intervention group was significantly higher than that in the control group (Mean difference (MD): 5.7; 95% CI: 4.6 to 6.8, p<0.001). Additionally, the mean score of all subscales of mental health, including anxiety, stress, and depression, in the intervention group was significantly lower than that in the control group (P <0.001). Conclusion: Given that preterm birth is very stressful for mothers and may increase their anxiety, stress, and depression, reduce their breastfeeding self-efficacy, and disrupt exclusive breastfeeding, applying ACT-based counseling can improve breastfeeding self-efficacy and the mental health of preterm infants’ mothers.