# A multi-component psychosocial intervention programme to reduce psychological distress and enhance social support for women undergoing termination of pregnancy for foetal anomaly in China: A randomised controlled trial

## TL;DR

A new psychosocial program helps women in China cope with emotional distress after ending a pregnancy due to fetal anomalies, improving social support and reducing PTSD symptoms.

## Contribution

The study introduces a tailored multi-component psychosocial intervention for women undergoing termination of pregnancy for fetal anomalies in China.

## Key findings

- The intervention significantly reduced PTSD-related avoidance symptoms and improved social support over three months.
- Women with initial depressive symptoms showed immediate and sustained improvements in depression and psychological flexibility.
- No adverse events were reported, suggesting the intervention is safe and feasible.

## Abstract

Termination of pregnancy for foetal anomaly causes significant psychological distress, yet evidence-based psychosocial interventions tailored to the needs of women experiencing termination of pregnancy for foetal anomalyremain limited.

To evaluate the effectiveness of a multi-component psychosocial intervention designed to reduce depression and post-traumatic stress disorder (PTSD) and enhance psychological flexibility and social support among women following termination of pregnancy for foetal anomaly.

A single-blinded, two-arm randomised controlled trial was conducted in two maternity hospitals in Hunan Province, China. Eighty-six participants were randomly allocated to the multi-component psychosocial intervention group (n = 41) or the control group (n = 45). The multi-component psychosocial intervention included informational support, Acceptance and Commitment Therapy, and social support involving an online peer support group and family engagement. Depression, PTSD, psychological flexibility and social support were assessed at baseline, immediately (T1), one-month (T2) and three-months (T3) post-intervention.

Although the intervention group showed greater reductions in depressive symptoms (EPDS: β = 0.92, 95 % CI: –1.38 to 3.21, p = 0.435) and post-traumatic stress symptoms (IES-R: β = 5.31, 95 % CI: –1.25 to 11.86, p = 0.113) compared to the control group, these differences did not reach statistical significance. Significant group-by-time effects emerged for PTSD-related avoidance symptoms (β = 2.98, 95 % CI: 0.27 to 5.70, p = 0.031; d = 0.49), perceived social support (β = –1.56, 95 % CI: –3.10 to –0.02, p = 0.047; d = 0.38) and utilisation of social support (-0.83, 95 % CI: -1.48 to -0.18, p = 0.013; d = 0.55) at T3. Participants with baseline EPDS > 9 (n = 54) showed stronger effects, with significant improvements in depression (β = 2.02, 95 % CI: 0.38 to 3.66, p = 0.016) and experiential avoidance (β = 2.54, 95 % CI: 0.30 to 4.78; p = 0.026) at T1, PTSD (β = 11.75, 95 % CI: 2.39 to 21.12, p = 0.014; d = 0.61) and utilisation of social support (β = -0.95, 95 % CI: -1.85 to -0.04; p = 0.040, d = 0.65) at T3. No adverse events occurred.

The multi-component psychosocial intervention programme reduced PTSD-related avoidance symptoms and enhanced social support. Participants with depressive symptoms experienced immediate improvements in depression and psychological flexibility, with sustained benefits in PTSD and utilisation of social support over three months. Tailoring the intervention components to individual needs may benefit women undergoing termination of pregnancy for foetal anomaly. Further research should compare women with and without baseline psychological distress to determine who benefits most from this intervention.

Chinese Clinical Trial Registry: ChiCTR2100047195.