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Internet-delivered psychological interventions for clinical anxiety and depression in perinatal women: a systematic review and meta-analysis

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Abstract

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.

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Funding

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).

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Authors and Affiliations

  1. Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry, Level 4, O’Brien Centre, St Vincent’s Hospital, 394 Victoria Street, Sydney, New South Wales, 2010, Australia

    Siobhan A. Loughnan, Amy E. Joubert, Ashlee Grierson, Gavin Andrews & Jill M. Newby

  2. School of Psychiatry, University of New South Wales, Sydney, Australia

    Siobhan A. Loughnan, Ashlee Grierson & Gavin Andrews

  3. School of Psychology, University of New South Wales, Sydney, Australia

    Amy E. Joubert & Jill M. Newby

Authors
  1. Siobhan A. Loughnan
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  2. Amy E. Joubert
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  3. Ashlee Grierson
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  4. Gavin Andrews
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  5. Jill M. Newby
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Contributions

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.

Corresponding author

Correspondence to Siobhan A. Loughnan.

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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).

Disclaimer

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.

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Appendix

Appendix

PsychINFO Search

  1. 1.

    (Perinatal OR peripartum OR antenatal OR antepartum OR prenatal OR pregnan* OR postnatal OR postpartum OR birth OR (after birth)).mp. [mp = title, abstract, heading word, table of contents, key concepts, original title, tests & measures]

  2. 2.

    (Well-being OR (mental health) OR (mental disorder) OR psychopathology OR (psychological disorder) OR anxiety OR (anxiety disorder) OR stress OR depression OR (major depressive disorder) OR (major depression) OR affective OR mood OR emotion* OR unipolar OR (baby blues) OR psychosocial) mp. [mp = title, abstract, heading word, table of contents, key concepts, original title, tests & measures]

  3. 3.

    (Intervention OR treatment OR therap* OR (treatment outcome) OR self-help OR counsel$ing OR psychotherapy* OR bibliotherapy OR (behave$ change) OR CBT OR (cognitive behave$ therapy) OR (cognitive therapy) OR (interpersonal psychotherapy) OR (psychodynamic therapy) OR relaxation).mp. [mp = title, abstract, heading word, table of contents, key concepts, original title, tests & measures]

  4. 4.

    (Internet OR computer OR computer* OR online OR web OR e-therapy OR e-mental OR e-health OR telehealth OR telecare OR teletherapy OR telemedicine OR telemental OR technolog* OR virtual OR cyber OR cyberpsychology OR cybertherapy OR iCBT OR cCBT OR web-based OR web-guided OR web-supported OR web-delivered OR web-assisted OR web-aided OR web-facilitated OR computer-based OR computer-guided OR computer-supported OR computer-delivered OR computer-assisted OR computer-aided OR computer-facilitated OR internet-based OR internet-guided OR internet-supported OR internet-delivered OR internet-assisted OR internet-aided OR internet-facilitated OR online-based OR online-supported OR online-delivered OR online-assisted OR online-aided OR online-facilitated). mp. [mp = title, abstract, heading word, table of contents, key concepts, original title, tests & measures]

  5. 5.

    1 and 2 and 3

  6. 6.

    limit 4 to (human, adulthood, and English language)

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Loughnan, S.A., Joubert, A.E., Grierson, A. et al. Internet-delivered psychological interventions for clinical anxiety and depression in perinatal women: a systematic review and meta-analysis. Arch Womens Ment Health 22, 737–750 (2019). https://doi.org/10.1007/s00737-019-00961-9

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