Mobile interventions targeting common mental disorders among pregnant and postpartum women: An equity-focused systematic review

Abstract

Introduction Pregnant and postpartum women face major psychological stressors that put them at higher risk of developing common mental disorders, such as depression and anxiety. Yet, their limited access to and uptake of traditional mental health care is inequitable, especially during the COVID-19 pandemic. Mobile interventions emerged as a potential solution to this discontinued healthcare access, but more knowledge is needed about their effectiveness and impact on health equity. This equity-focused systematic review examined the effectiveness and equity impact of mobile interventions targeting common mental disorders among pregnant and postpartum women. Methods and results We systematically searched MEDLINE, EMBASE, PsychINFO and 3 other databases, from date of database inception and until January 2021, for experimental studies on mobile interventions targeting pregnant and postpartum women. We used pooled and narrative synthesis methods to analyze effectiveness and equity data, critically appraised the methodological rigour of included studies using Cochrane tools, and assessed the certainty of evidence using the GRADE approach. Our search identified 6148 records, of which 18 randomized and non-randomized controlled trials were included. Mobile interventions had a clinically important impact on reducing the occurrence of depression (OR = 0.51 [95% CI 0.41 to 0.64]; absolute risk reduction RD: 7.14% [95% CI 4.92 to 9.36]; p<0.001) and preventing its severity perinatally (MD = -3.07; 95% CI -4.68 to -1.46; p<0.001). Mobile cognitive behavioural therapy (CBT) was effective in managing postpartum depression (MD = -6.87; 95% CI -7.92 to -5.82; p<0.001), whereas other support-based interventions had no added benefit. Results on anxiety outcomes and utilization of care were limited. Our equity-focused analyses showed that ethnicity, age, education, and being primiparous were characteristics of influence to the effectiveness of mobile interventions. Conclusion As the COVID-19 pandemic has increased the need for virtual mental health care, mobile interventions show promise in preventing and managing common mental disorders among pregnant and postpartum women. Such interventions carry the potential to address health inequity but more rigorous research that examines patients’ intersecting social identities is needed.

What innovations can address inequalities experienced by women and girls due to the COVID-19 pandemic across the different areas of life/domains: work, health, living standards, personal security, participation and education?

“…Health: Six (n = 6) included papers were within the domain of health (Banati & Idele, 2021; Das et al, 2021; Davic et al, 2021; Figueroa, Luo, Aguilera, & Lyles, 2021; Ray et al, 2021; Saad et al, 2021; Steinert, Alacevich, Steele, Hennegan, & Yakubovich, 2021)…”

“…Reviews: Seven (n = 7) included papers were reviews (Andermann et al, 2021; Banati & Idele, 2021; Bray & McLemore, 2021; Perri et al, 2021; Saad et al, 2021; Steinert et al, 2021) (see Table 3).…”

“…One systematic review on mobile interventions targeting common mental disorders among pregnant and postpartum women was rated as high quality (Saad et al, 2021). The overall confidence in the strength of evidence was rated as ‘low’ due to study designs .…”

Mental Health Screening Approaches for Resettling Refugees and Asylum Seekers: A Scoping Review

“…Finally, women of a reproductive age often encounter their own unique challenges, and assessments should also factor in refugee lived experiences of pregnancy, childbirth, and raising children [ 21 ]. A recent review of mobile applications for women during pregnancy showed that technology-assisted approaches may improve timely access to mental health support and facilitate successful mental health care across different ethnicities [ 122 ]. Assessment tools for children may also need to include a broader spectrum of conditions and assess social determinants of health, developmental delays, family separation, and trauma [ 123 ].…”

Scaling Up Patient-Centered Psychological Treatments for Perinatal Depression in the Wake of a Global Pandemic

“…Telemedicine and web-based interventions may offer a promising alternative for perinatal patients in terms of flexibility, efficiency, and cost, potentially increasing the accessibility and scalability of treatment ( 28 ). Remote psychotherapy can also be offered in patient-centered settings and schedules (i.e., at home and during weekends), while practical barriers (i.e., wait times and costs for parking or transportation) can be minimized, including for perinatal populations ( 29 ). There nonetheless remain questions that are critical to examine from a health equity lens.…”