Effectiveness of digital psychotherapeutic intervention among perinatal women: A systematic review and meta-analysis of randomized controlled trials

Abstract

BACKGROUND The perinatal period is a challenging time of substantial emotional, physiological, social, and relational changes. Depression, anxiety, and stress symptoms are common, and co-exist in the perinatal period. Digital technology continues to grow at an unprecedented pace with wide application, including psychotherapeutic intervention. A growing number of meta-analyses supported the application of digital psychotherapeutic intervention across different populations, but relatively few meta- and meta-regression analyses have concentrated on perinatal women. AIM To evaluate the effectiveness of digital psychotherapeutic intervention on improving psychological outcomes among perinatal women and identify its essential features. METHODS Randomized controlled trials (RCTs) were obtained from eight databases, including Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, Scopus, PsycINFO, PubMed, Web of Science, and ProQuest Dissertation and Theses from inception up until November 24, 2020. Comprehensive Meta-analysis 3.0 software was used to conduct meta- and meta-regression analyses. The Cochrane risk-of-bias tool and the Grading of the Recommendation, Assessment, Development, and Evaluation system were adopted to assess the individual and overall qualities of the evidence, respectively. RESULTS A total of 25 RCTs that included 3239 women were identified. Meta-analyses revealed that intervention significantly improved depression (Hedges’s g = 0.49), anxiety ( g = 0.25), and stress ( g = 0.47) symptoms compared to the control. Subgroup analyses demonstrated that a website platform with ≥ eight therapist-guided sessions using the theoretical principle of cognitive behavioral therapy was more effective than other treatments in improving depression symptoms in postnatal women. Meta-regression analyses observed that the age of perinatal women and the type of psychotherapy also had statistically significant effects on depression symptoms. Egger’s regression asymmetry tests suggested that no publication biases occurred, but the overall quality of the evidence was very low. CONCLUSION This review suggests that digital psychotherapeutic intervention may be a potential solution to reduce psychological problems in perinatal women. Further high-quality RCTs with large sample sizes are needed.

Effectiveness of mobile application-based perinatal interventions in improving parenting outcomes: A systematic review

“… Sawyer et al (2019) reported sustained improvement in depression and parent-child bonding at four months follow-up while Shorey et al (2019) reported sustained improvement in parenting self-efficacy, anxiety, depression, social support, and parent-child bonding at two-months follow-up. A similar lack of follow-up assessments was reported by previous reviews ( Daly et al, 2018 ; Dol et al, 2020 ; Lau et al, 2021 ). While the currently limited data suggested the possibility of sustained positive effects of mobile application-based interventions on parents’ well-being for 2-4 months, the long-term effects of these interventions require further evaluation.…”

“…This review found that studies that reported a significant improvement in anxiety or depression had included some form of psychotherapeutic element in their interventions such as mindfulness-based modules ( Prasad, 2018 ), cognitive behavioural therapy ( Jannati et al, 2020 ), and education about emotional health ( Sawyer et al, 2019 ; Shorey et al, 2019 ). Similarly, a previous review also reported the effectiveness of digital psychotherapeutic perinatal interventions in improving depression, anxiety, and stress among women ( Lau et al, 2021 ). Only two interventions that included a psychotherapeutic component reported no significant improvement in parents’ psychological well-being ( Baumel et al, 2018 ; Kim et al, 2021 ).…”

“…The 11 available reviews that investigated the effectiveness of using mobile phones to deliver perinatal interventions only focused on maternal outcomes ( Chan & Chen, 2019 ; Colaci et al, 2016 ; Daly et al, 2018 ; Dol et al, 2020 ; Feroz et al, 2017 ; Hussain-Shamsy et al, 2020 ; Hussain et al, 2020 ; Lau et al, 2021 ; Nair et al, 2018 ; Sondaal et al, 2016 ; Zhou et al, 2020 ), and neglected to examine paternal outcomes which could also significantly affect their children's health. Five reviews restricted their scope according to the income statuses of countries and hence could not obtain a global view of perinatal interventions that utilized mobile phones ( Colaci et al, 2016 ; Dol et al, 2020 ; Feroz et al, 2017 ; Hussain et al, 2020 ; Sondaal et al, 2016 ), while another five reviews did not focus on the use of mobile applications and could not provide specific insights regarding the effectiveness of mobile application-based perinatal interventions ( Chan & Chen, 2019 ; Hussain-Shamsy et al, 2020 ; Lau et al, 2021 ; Nair et al, 2018 ; Zhou et al, 2020 ). While the remaining study focused on mobile application-based perinatal interventions for mothers globally, it examined limited outcomes ( Daly et al, 2018 ); the study only examined outcomes related to maternal knowledge or behaviour during pregnancy and failed to examine mothers’ parenting self-efficacy, psychological well-being, social support, and parent-child bonding.…”

Prenatal Selective Serotonin Reuptake Inhibitor Exposure, Depression and Brain Morphology in Middle Childhood: Results from the ABCD Study

“…Empirically-supported psychotherapies represent another first-line treatment option for pregnant women and mothers (35). Digital administration of psychotherapy, which was recently shown to reduce depression, anxiety, and stress during pregnancy and the postpartum period in a meta-analysis of randomized controlled trials, may increase accessibility and reduce barriers (36).…”

A Comparison of Functional Features of Chinese and US Mobile Apps for Pregnancy and Postnatal Care: A Systematic App Store Search and Content Analysis

“…Meanwhile, systematic reviews of RCTs on maternal apps described the information for software and hardware, intervention content and delivery, and limitations. They still highlighted the risks of RTCs, such as unclear allocation concealment, no evaluation of objective quality in intervention apps, and no published protocols (20)(21)(22). Furthermore, studies reviewing apps that cover children's first 1,000 days of life (from conception to the age of 24 months) have exclusively focused on the prenatal or postnatal phases, ignoring the continuity between the two periods and their combined effect on the health of the mother and child (23,24).…”