Mental health outcomes for parents of twins compared with singletons : a systematic review and meta-analysis

Due to the commercialisation of assisted reproductive technology in 1980, twin birth has significantly increased. Being a caregiver of twins is associated with higher functional, financial, and psychological demaFnds compared with those for singleton caregivers. Therefore, it is unsurprising that twin birth has been found to be associated with mental health challenges such as depression, anxiety, and stress. To date, there has only been one systematic review that investigated the mental health outcomes of parents of twins by Wenze et al. (2015), which included 27 studies. However, there is currently no quantitative synthesis available. To address this limitation, the current study aimed to statistically compare depression, anxiety, and stress scores between mothers and fathers of twins and singletons. A systematic database search of PubMed/Medline, PsycINFO, and CINAHL identified 19,209 search results for screening, with a total of 8 studies eligible for inclusion in the meta-analysis including samples of mothers, and 2 studies in the systematic review including samples of fathers. Using Cohen’s d as the measure of effect size, mothers of twins had significantly higher scores for depression (d=0.16, Standard Error [SE]=0.07, 95% Confidence Interval [CI; 0.02-0.31], p=0.03, I2=0.00) and anxiety (d=0.28, SE=0.13, 95% CI [0.02-0.54], p=0.03, I2=0.64) compared with mothers of singletons. No significant difference was found for stress (d=0.97, SE=0.60, 95% CI [0.21-2.15], p=0.11, I2=0.95). The systematic review highlighted inconsistencies regarding the mental health outcomes of twin fathers. These findings have implications for informing policy and the monitoring and surveillance of twin families following hospital discharge.