Promoting Mental Health in Parents of Young Children Using eHealth Interventions: A Systematic Review and Meta-analysis

Abstract

Parent stress and mental health problems negatively impact early child development. This study aimed to systematically review and meta-analyze the effect of eHealth interventions on parent stress and mental health outcomes, and identify family- and program-level factors that may moderate treatment effects. A search of PsycINFO, Medline, CINAHL, Cochrane and Embase databases was conducted from their inception dates to July 2020. English-language controlled and open trials were included if they reported: (a) administration of an eHealth intervention, and (b) stress or mental health outcomes such as self-report or clinical diagnosis of anxiety and depression, among (c) parents of children who were aged 1–5 years old. Non-human studies, case reports, reviews, editorials, letters, dissertations, and books were excluded. Risk of bias was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Random-effects meta-analyses of standardized mean differences (SMD) were conducted and meta-regressions tested potential moderators. 38 studies were included ( N = 4360 parents), from 13 countries (47.4% USA). Meta-analyses indicated eHealth interventions were associated with better self-reported mental health among parents (overall SMD = .368, 95% CI 0.228, 0.509), regardless of study design ( k = 30 controlled, k = 8 pre-post) and across most outcomes ( k = 17 anxiety, k = 19 depression, k = 12 parenting stress), with small to medium effect sizes. No significant family- or program-level moderators emerged. Despite different types and targets, eHealth interventions offer a promising and accessible option to promote mental health among parents of young children. Further research is needed on moderators and the long-term outcomes of eHealth interventions. Prospero Registration: CRD42020190719. Supplementary Information The online version contains supplementary material available at 10.1007/s10567-022-00385-5.

Building Emotional Awareness and Mental Health (BEAM): A Pilot Randomized Controlled Trial of an App-Based Program for Mothers of Toddlers

“…The discrepancy between the linear mixed modeling and clinical significance results for anxiety may reflect the large point reduction required for the GAD-7. Nonetheless, the pattern of change for the BEAM program aligns with meta-analyses indicating larger effects of digital interventions for anxiety than for depression or parenting stress among parents of young children (25). Together this evidence suggests that parental anxiety may be more responsive to digital health interventions, whereas the cyclical nature of depression and related anhedonia may impede improvement and motivation to engage in a treatment with limited clinical contact.…”

“…In terms of acceptability, the MAUQ findings in the current study indicated slightly lower usability than those for a similar App prototype which targeted parent feeding practices with their infants and toddlers (71). Although engagement and attrition in the BEAM program was comparable to other digital interventions that target parent mental health, parenting skills, or child behavior (25), the lower rate of retention in the intervention compared to the control group may suggest program feasibility issues. Indeed, feasibility challenges in the design process and budget available (as is the case with almost any grant-based project) resulted in a non-optimal digital health platform, which may have impacted user experience, engagement, and ultimately mental health.…”

“…For example, a meta-analysis of MoodGYM, a webbased program for depression and anxiety, indicated that user completion may be as low as 10% (24). A recent meta-analysis by our team suggested that digital interventions (including videoconferencing, App-based, and Web-based) targeting parent mental health, parenting skills or behavior were associated with improvements in a range of symptoms among parents of children aged 1-5 years old, with effects sizes comparable to in-person interventions (25). Other research highlights the promise of delivering mental health and parenting services through mobile applications with studies revealing App-based intervention programs can improve parent-child interactions (26), mental well-being, sleep, and resilience, and decrease anxiety (27).…”

Recruitment and Retention Strategies for Parents Experiencing Vulnerability: Lessons from an Online Parenting Program

“…Families with low incomes in the United States ( N = 89) participated in a pilot study of an internet-based parenting program and 74% were retained at one month; participants received cash honoraria at appointments (McGoron et al, 2018), but additional retention strategies were not described. In a meta-analysis of 37 studies on eHealth interventions for parents of children aged 1–5 years, 21 (55%) studies reported <20% attrition (MacKinnon et al, 2022); study retention strategies were not a focus of this review paper. Overall, digital research and programs may improve retention in parenting research, but without other strategies they do not appear to provide a panacea for high attrition.…”

Virtual care delivery of whole family assessment and intervention with infants and preschoolers: a thematic analysis of clinician and family experiences

“…Currently, there is limited literature on the virtual delivery of whole family work using the LTP and RFP in terms of implementation, feasibility, and acceptability. Although several play‐based interventions for dyads have transitioned to virtual care using VTC (Gurwitch et al., 2020; MacKinnon et al., 2022) and evidence has progressed on efficacy and enhanced access to mental health services for families with infants and young children (McLean et al., 2021; Sossong et al., 2019), there is a pressing need for more research in this area. This is essential to ensure effective delivery of evidence‐based interventions with the very young that incorporate both coparents and siblings.…”