Internet-delivered psychological interventions for clinical anxiety and depression in perinatal women: a systematic review and meta-analysis
Perinatal anxiety and depression are common and associated with negative outcomes if left untreated. Internet-delivered treatments can improve treatment accessibility and have demonstrated effectiveness in treating anxiety and depression in the general adult population. However, little is known about how effective and acceptable these interventions are for perinatal women. This paper describes a systematic review and preliminary meta-analysis of internet-delivered psychological interventions for the treatment of clinical anxiety and depression in perinatal women. A systematic search was carried out of seven electronic databases. Seven studies evaluating six distinct internet-delivered psychological interventions were identified. Of the seven studies included, two were open trials and five were randomized controlled trials with a total of 595 participants. Preliminary findings indicate large improvements in depression (Hedges g = 1.67; 95% CI 1.38–1.96) and anxiety (Hedges g = 1.08; 95% CI 0.80–1.36) from pre- to post-treatment. However, between-group differences between interventions and control conditions were only moderate for depression (Hedges g = 0.60; 95% CI 0.43–0.78) and anxiety (Hedges g = 0.54; 95% CI 0.24–0.85). While our preliminary findings are promising, this review identifies an area of research still in its early stages with significant gaps in the literature that need to be addressed. Further research is needed to establish the efficacy and acceptability of these interventions in this population, especially for antenatal depression and anxiety disorders.
KeywordsPregnancy Postpartum Anxiety Depression Internet
SL, JN, and GA designed the study and wrote the protocol and search strategy. SL, AJ, and AG conducted the searches, screened the titles, abstracts, and full-texts for eligibility for inclusion into the meta-analysis, and coded the risk of bias of all RCTs. SL extracted the data from the manuscripts, independently checked by AJ, and conducted the data analysis with supervision from JN. All authors contributed to and have approved the final version of the manuscript for publication.
This study was supported by the Australian Rotary Health and the David Henning Memorial Foundation in the form of a Ph.D. scholarship awarded to Siobhan Loughnan. Jill Newby is supported by an Australian National Health and Medical Research Council (NHMRC)/Medical Research Future Fund Career Development Fellowship (1145382).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Protocol and registration
The protocol for this systematic review was developed according to the Cochrane Handbook for Systematic Reviews of Interventions (Higgins and Green 2011) and was registered with PROSPERO [CRD42016038032]. All reporting of this systematic review follows the PRISMA guidelines (Moher et al. 2009).
NHMRC, Rotary Health Australia, and the David Henning Memorial Foundation had no role in the study design, collection, data analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
- Balk EM, Earley A, Patel K, Trikalinos TA, Dahabreh IJ (2012) Empirical assessment of within-arm correlation imputation in trials of continuous outcomes. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK115797/pdf/Bookshelf_NBK115797.pdf: Agency for Healthcare Research and Quality
- Beck AT, Steer RA, Brown GK (1996) Beck depression inventory (2nd edition) - manual. The Psychological Corporation, San Antonio, TXGoogle Scholar
- Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Earlbaum Associates, Hillsdale, NJGoogle Scholar
- Danaher BG, Milgrom J, Seeley JR, Stuart S, Schembri C, Tyler MS, … Kosty DB (2013) MomMoodBooster web-based intervention for postpartum depression: feasibility trial results. J Med Internet Res 15(11)Google Scholar
- Forsell E, Bendix M, Holländare F, von Schultz BS, Nasiell J, Blomdahl-Wetterholm M, … Söderberg E (2017) Internet delivered cognitive behavior therapy for antenatal depression: a randomised controlled trial. J Affect Disord 221:56–64Google Scholar
- Hedman E, Ljótsson B, Kaldo V, Hesser H, El Alaoui S, Kraepelien M, … Andersson G (2014) Effectiveness of internet-based cognitive behaviour therapy for depression in routine psychiatric care. J Affect Disord 155:49–58Google Scholar
- Higgins J, Green SM (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. Retrieved from www.handbook.cochrane.org
- Lau Y, Htun TP, Wong SN, Tam WSW, Klainin-Yobas P (2017) Therapist-supported internet-based cognitive behavior therapy for stress, anxiety, and depressive symptoms among postpartum women: a systematic review and meta-analysis. J Med Internet Res 19(4)Google Scholar
- Lovibond P, Lovibond (1995) Manual for the depression anxiety stress scales. In: The Psychology Foundation of Australia IncGoogle Scholar
- Milgrom J, Danaher BG, Gemmill AW, Holt C, Holt CJ, Seeley JR, … Ericksen, J. (2016) Internet cognitive behavioral therapy for women with postnatal depression: a randomized controlled trial of MumMoodBooster. J Med Internet Res 18(3)Google Scholar
- Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, … Pariante CM (2014) Effects of perinatal mental disorders on the fetus and child. Lancet 384(9956):1800–1819Google Scholar