The efficiency of online cognitive-behavioral therapy for postpartum depressive symptomatology: a systematic review and meta-analysis

The Effects of Online Cognitive Behavioral Therapy on Postpartum Depression: A Systematic Review and Meta-Analysis

BACKGROUND/OBJECTIVES

Postpartum depression seriously affects the safety and health of mothers and children. Online cognitive behavioral therapy is considered to be a promising treatment; however, whether it is effective at improving postpartum depression is inconsistent and the specific intervention measures are not the same. The objectives of this study were to comprehensively review the effects of online cognitive behavioral therapy on postpartum depression and further explore the specific intervention measures.

METHODS

A literature search was conducted using thirteen electronic databases and two clinical trial registries from the establishment of the databases to 31 December 2023. The study selection and data extraction were independently performed by two researchers. The latest Cochrane Risk of Bias tool was selected to evaluate the quality of the included studies. Data were analyzed using Review Manager 5.4, and the certainty of the evidence was evaluated using the online GRADEpro tool. Eighteen studies involving 3689 women were included.

RESULTS

The results showed that online cognitive behavioral therapy was effective at improving postpartum depression. A subgroup analysis showed that the duration of online cognitive behavioral therapy with total intervention was 9 weeks and above, the total intervention number was 12 times or fewer, and using a website or Zoom online conference room as the intervention platform could more significantly improve postpartum depression. In particular, providing professional guidance could be more effective.

CONCLUSIONS

In summary, online cognitive behavioral therapy was effective for postpartum depression. Furthermore, this study found out how specific intervention measures of online cognitive behavioral therapy could be more effective. Finally, nurses can participate in the therapy to improve access to evidence-based treatment.

Transdiagnostic internet cognitive behavioural therapy for anxiety and depressive symptoms in postnatal women: protocol of a randomized controlled trial

BACKGROUND

Nearly 20% of women will be confronted with anxiety or depressive disorders during the perinatal period and this may lead to adverse outcomes for both mother and child. Cognitive behavioural therapy (CBT) is the psychological intervention with the most empirical support for the clinical management of anxiety and depressive disorders. Anxiety and depression frequently occur in women during the perinatal period, and there is growing evidence that internet-delivered CBT (iCBT) could be an acceptable and effective intervention. THIS WAY UP, an Australian digital mental health service, has developed a program for postnatal anxiety and depression. This study protocol aims to examine the acceptability and efficacy of a French-Canadian adaptation of the program.

METHODS/DESIGN

The research team propose to conduct a mixed hybrid type 1 pragmatic randomized clinical trial and implementation study to replicate the findings of the trial conducted in Australia by Loughnan et al. (2019), as well as explore barriers and facilitators to potential large-scale implementation. TREATMENT AND CONTROL CONDITIONS: a) postnatal anxiety and depression iCBT program with three lessons to complete in a six-week period, added to treatment-as-usual (TAU); b) TAU. Participants will include French-speaking women with probable postnatal depression or anxiety as per the Generalized Anxiety Disorder-7 (GAD-7) or the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome measures will be the GAD-7 and the EPDS. Secondary outcome measures will comprise self-reported instruments to evaluate psychological distress, quality of life, mother-child experience, and treatment experience. Qualitative interviews with participants and health professionals will provide insights on acceptability and delivery of the iCBT program.

STATISTICAL ANALYSIS

Statistical analysis will follow intent-to-treat principles. A mixed model regression approach will be used to account for between- and within-subject variations in the analysis of the effects of iCBT compared to TAU only intervention.

DISCUSSION

The study will generate important data of efficacy and acceptability to patients, clinicians, and decision-makers to inform the scaling-up of the postnatal iCBT intervention in Canada.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT06778096, prospectively registered on 2025/01/16.

Digital mental health interventions for the treatment of depression: A multiverse meta-analysis

BACKGROUND

The varying sizes of effects in published meta-analyses on digital interventions for depression prompt questions about their efficacy.

METHODS

A systematic search in Embase, PsycINFO, and PubMed identified 125 randomised controlled trials up to February 2023, comparing digital interventions for depression against inactive controls. The stability of results was evaluated with a multiverse meta-analysis, thousands of meta-analyses were conducted based on different combinations of analytical choices, like target populations, intervention characteristics, and study designs.

RESULTS

A total of 3638 meta-analyses were performed based on 125 randomised controlled trials and 263 effect sizes, with a total of 32,733 participants. The average effect size was Hedges' g = 0.43, remaining positive at both the 10th (g = 0.16) and 90th percentiles (g = 0.74). Most meta-analyses indicated a statistically significant benefit of digital interventions. Larger effects were observed in meta-analyses focusing on adults, low- and middle-income countries, guided interventions, comparing interventions with waitlist controls, and patients with major depressive or unipolar mood disorders. Smaller effects appeared when adjusting for publication bias and in assessments after 24 weeks.

LIMITATIONS

While multiverse meta-analysis aims to exhaustively investigate various analytical decisions, some subjectivity remains due to the necessity of making choices that affect the methodology. Additionally, the quality of the included primary studies was low.

CONCLUSIONS

The analytical decisions made during performing pairwise meta-analyses result in vibrations from small to medium effect sizes. Our study provides robust evidence for the effectiveness of digital interventions for depression while highlighting important factors associated with treatment outcomes.

Post-traumatic change and resilience after childhood maltreatment: Impacts on maternal mental health over the postpartum period

BACKGROUND

Mothers with a history of childhood maltreatment (CM) are particularly vulnerable to postpartum mental health changes. Variability in mental health trajectories is present over the first 18-months postpartum. Little is known about the potentially unique impacts of post-traumatic change or resilience on later postpartum mental health.

METHODS

Participants (N = 97) completed questionnaires over the first 18-months postpartum measuring demographic risk, mental health symptoms, traumatic experiences, and resilience. Mothers also completed an interview measure coded for post-traumatic changes at 6-months postpartum. Multinomial logistic regression models examined post-traumatic change and resilience factors as predictors of mothers' longitudinal latent mental health trajectory.

RESULTS

Three classes of latent postpartum mental health emerged: low-symptom, vulnerable, and chronic high-risk. Mothers reporting stronger positive post-traumatic changes were more likely to be in the low-symptom class than the chronic high-risk class (B = -1.082, p = .01). Mothers reporting stronger negative post-traumatic changes were more likely to be in the vulnerable class (B = 0.778, p = .006) or chronic high-risk class (B = 0.906, p = .046) than the low-symptom class. Resilience was not predictive of mental health class.

LIMITATIONS

Findings are correlational, and causal effects between post-traumatic growth and mental health symptoms cannot be assumed. Mothers who consented to the interview may not be fully representative of all women who have experienced CM, limiting generalizability of findings.

CONCLUSIONS

Positive post-traumatic change is associated with reduced psychopathology. These findings may assist in identification of mothers at greater risk of adverse postpartum outcomes and futher inform interventions focused on enhancing positive changes in post-traumatic cognitions.

Smartphone-based intervention for postpartum depressive symptoms (Smart-e-Moms): study protocol for a randomized controlled trial

BACKGROUND

Postpartum depression constitutes a significant public health issue, with prevalence rates ranging between 8 and 19% in high-income nations. Nevertheless, numerous barriers, including time constraints, societal stigmatization, and feelings of shame, contribute to the limited utilization of healthcare services during the postpartum period. Digital interventions offer an opportunity to enhance care for women experiencing postpartum depressive symptoms.

METHODS

We will conduct a two-arm randomized controlled trial to assess the effectiveness of a smartphone-based intervention in comparison to a treatment-as-usual control group in Germany. Our aim is to randomize 556 participants in a 1:1 ratio. Participants in the intervention group will be provided access to a preventive smartphone-based intervention called "Smart-e-Moms," which incorporates therapeutic support and comprises 10 concise modules rooted in cognitive-behavioral therapy. For the intervention group, evaluations will take place at baseline (t0), prior to sessions 4 and 8 (intermediate assessments), and upon completing the intervention 6 weeks after baseline (t1). The control group's assessments will be at baseline (t0) and 6 weeks after baseline. Follow-up assessments are scheduled at 12 and 24 weeks from baseline to examine the short-term stability of any observed effects. We anticipate that participants in the intervention group will exhibit improvements in their postpartum depressive symptoms (as measured with the Edinburgh Postnatal Depression Scale). Additionally, we will analyze secondary outcomes, including maternal bonding, stress levels, self-efficacy, satisfaction with the intervention, and healthcare utilization.

DISCUSSION

If Smart-e-Moms proves to be effective, it has the potential to play a significant role in postpartum depression care within German-speaking regions. Ideally, this intervention could not only benefit maternal well-being but also improve the prospects for healthy child development.

TRIAL REGISTRATION

German clinical trials registry DRKS00032324. Registered on January 26, 2024.

The economic evaluation of an Internet-based parental wellbeing intervention

BACKGROUND

Internet-based parental programmes may improve parental wellbeing and mitigate the burden of mental health issues during the perinatal period. However, few studies have explored the cost and clinical impacts of such interventions. In the present study, we sought to evaluate the cost-effectiveness associated with an online cognitive behaviour therapy intervention (Baby Steps Wellbeing) to an information-only programme (Baby Care).

METHODS

An alongside-trial cost-effectiveness analysis was undertaken using data from a randomised clinical trial comparing the Baby Steps Wellbeing intervention to Baby Care. Direct healthcare costs, as well as indirect costs attributed to income loss, were considered. The Assessment of Quality of Life-8 Dimensions multi-attribute utility instrument was used to estimate participant utilities, and subsequently calculate quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios were calculated to assess the cost-effectiveness of the intervention. The economic evaluation adopted a societal perspective.

RESULTS

In total, 496 parents were randomised to either the Baby Steps Wellbeing intervention or the Baby Care control arm. No significant differences in costs (-$27, 95% confidence interval (CI): -$1189-$1134) or QALYs (0.051, 95% CI: -0.097-0.200) were identified. Bootstrapped results showed that the Baby Steps Wellbeing programme was cost-saving and health improving in 38% of simulations and cost-effective in another 37% of simulations.

CONCLUSIONS

The Baby Steps Wellbeing programme was slightly cost-saving with slightly improved health outcomes compared with Baby Care. Bootstrapped results indicate the Baby Steps Wellbeing was cost-effective in 75% of simulations. Overall, the Baby Steps Wellbeing programme is an online programme that is cost-effective.

TRIAL REGISTRATION

Australian & New Zealand Clinical Trials Registry: ANZCTR12614001256662.

Current state and practical recommendations on reproductive mental health: a narrative review

Emotional disorders (EDs) are highly prevalent during the reproductive period, including pregnancy, postpartum, and women undergoing fertility treatments. International guidelines are increasingly suggesting the need to evaluate, prevent, and treat EDs in those women. The main aim of this narrative review is to summarize current practice in the field of EDs management during fertility treatments, pregnancy, and the postpartum and to propose a new technology-based model of care that helps to provide psychological care to all women who are in these periods. Four different databases (Pubmed, Scopus, Science Direct, Web of Science) were consulted. Selected keywords were related with infertility, pregnancy, postpartum, EDs, assessment, prevention, treatment, and technologies. We identified 1603 studies and 43 were included in this review. According to these studies, different face-to-face protocols already exist to manage EDs in women undergoing fertility treatments, pregnant or at the postpartum. We noticed an increased interest in developing technology-based solutions to overcome the limitations of traditional mental healthcare services. However, we also detected some issues in the use of technologies (i.e. increased attention to the postpartum or the lack of transdiagnostic approaches). Our results evidenced that there is still a need to develop modern, well-designed, and conceptually-relevant ICT-based programs to be used in women undergoing fertility treatments, pregnant or at the postpartum.

Evaluating cognitive behavioral therapy as a solution for postnatal depression in economically disadvantaged regions

PURPOSE

Postnatal depression (PND) impacts numerous women after childbirth, leading to various impairments in their lives. Mental health interventions, such as cognitive behavioral therapy (CBT), need further evaluation in low- and middle-income countries (LMICs) where resources may be scarce. This study aimed to assess the effectiveness of CBT in treating PND in women from LMICs, comparing it to standard care.

METHODS

A systematic review and meta-analysis were conducted following the PRISMA Statement 2020 guidelines. Databases such as PubMed, CINAHL Plus, Cochrane Library, and PsycINFO were searched until September 2022. A modified Delphi process was employed to identify relevant studies. The primary outcome was mean depression scores, measured by the Edinburgh postnatal depression scale at baseline and post-intervention.

RESULTS

Out of 487 studies identified, five trials were included, totaling 1056 participants (520 in the intervention group and 536 in the comparator group). At baseline, a minor, insignificant positive effect size was found (Cohen's d = 0.1, 95% CI =  - 0.15, 0.35). Post-CBT, the intervention group showed significant improvements in depression scores (Cohen's d =  - 1.9, 95% CI =  - 3.8, 0). When accounting for the influence of one study, (Ngai et al., Psychother Psychosom 84:294-303, 2015), which held substantial weight in the initial analysis, the effect size was adjusted to d = 0.5, highlighting a lesser but still significant difference.

CONCLUSIONS

CBT appears to be effective in improving PND symptoms among women in LMICs and may be considered a first-line treatment for at-risk mothers, including those who are displaced. However, the significant impact of one study on the results emphasizes the need for more rigorous research. The study also highlights the challenges and limitations of providing psychotherapies across LMICs, emphasizing the need for culturally adapted and contextually appropriate interventions to ensure successful implementation and sustainability of mental health care for postnatal women in these settings.

Effects of digital health interventions on the psychological outcomes of perinatal women: umbrella review of systematic reviews and meta-analyses

Evidence about the effects of digital health interventions (DHIs) on the psychological outcomes of perinatal women is increasing but remains inconsistent. An umbrella review was conducted to (1) assess the effect of DHIs on depressive, anxiety and stress symptoms and (2) compare the effects of DHIs on different digital platforms and population natures. Ten databases were searched from inception until December 23, 2022. The Hartung-Knapp-Sidik-Jonkman random-effects meta-analyses were utilised. Methodological quality was evaluated using the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2). Twenty-four systematic reviews with 41 meta-analyses involving 45,509 perinatal women from 264 primary studies were included. The credibility of the evidence of meta-analyses was rated as highly suggestive (4.88%), suggestive (26.83%), weak (51.22%) or non-significant (17.07%) according to AMSTAR-2. Our findings suggest that DHIs are beneficial for reducing stress symptoms. However, conflicting effects were found on anxiety symptoms. Subgroup and meta-regression analyses suggested that DHIs effectively improve depressive symptoms in postnatal women, and DHIs using the website platform are highly effective in stress reduction. DHIs can be implemented adjuvant to usual obstetric care to improve depressive and stress symptoms. Additional well-designed RCTs with long-term follow-up are warranted.

Internet-delivered cognitive behaviour therapy for affective disorders, anxiety disorders and somatic conditions: An updated systematic umbrella review

Background

Internet-delivered cognitive behaviour therapy (ICBT), which can involve guidance from a clinician, continues to be a way to deliver psychological treatments. A previous umbrella review identified moderate-to-large effect sizes favouring ICBT compared to control conditions when treating major depression and anxiety disorders. Given the rapid developments in the field, an updated umbrella review of available meta-analyses can show other conditions and subpopulations for which ICBT is effective. The aim of the study was to provide an expanded overview of the efficacy of ICBT for a broader range of adult psychiatric and somatic conditions.

Methods

We conducted an updated search of the literature since the publication of the previous umbrella review back in 2019 and up until March 2024. Five different search engines were used (Medline (OVID), Scopus, Web of Science, Cochrane library and CINAHL). The search was expanded to include additional psychiatric conditions (e.g., suicidal ideation) and somatic conditions (e.g., tinnitus and chronic pain).

Results

Of the 6509 identified articles, 39 meta-analyses met the inclusion criteria. In these meta-analyses 19 unique outcomes were represented. The most common outcome was symptoms of major depressive disorder, followed by symptoms of anxiety. Effect sizes for the comparisons against control conditions ranged between small (e.g., SMD = 0.10 for stress in employees) to large (e.g., SMD = 1.20 for depressive symptoms among older adults).

Conclusions

ICBT can generally reduce symptoms of a wide range of conditions including both psychiatric and somatic conditions, as well as other mental health problems. This updated review of available meta-analyses also indicated that ICBT has been successful in treating symptoms in different subpopulations such as older adults and students. However, some knowledge gaps remain, including the use of ICBT for psychotic disorders, and the quality of the available meta-analyses' points to a need for more stringent methodological procedures.

The effectiveness of technology-based cognitive behavioral therapy on perinatal depression and anxiety: A systematic review and meta-analysis

BACKGROUND

Extensive literature has shown the effectiveness of cognitive behavioral therapy in treating perinatal depression, but little is known about the effectiveness of its technology-based version.

AIM

The aim of this review was to examine the effectiveness of technology-based cognitive behavioral therapy in reducing depressive and anxiety symptoms in women suffering from or at risk of experiencing perinatal depression.

METHODS

Six electronic databases were searched until February 2023 for articles published in English. Random-effect meta-analyses were conducted. Heterogeneity was assessed using the I2 statistics and Cochran's Q chi-squared test. Sensitivity analyses and subgroup analyses were also performed, and quality appraisals at the study and outcome levels were conducted.

RESULTS

A total of 16 randomized controlled trials were included in the review. Results from meta-analyses suggest that technology-based cognitive behavioral therapy has a medium effect in reducing perinatal depressive symptoms and a small effect in reducing perinatal anxiety symptoms. Overall, women suffering from or at risk of perinatal depression may benefit from technology-based cognitive behavioral therapy.

LINKING EVIDENCE TO ACTION

Future interventions can be improved by addressing both perinatal depression and anxiety, paying more attention to antenatal women to prevent postnatal mental health issues, and using self-guided mobile applications for accessibility.

Epidemiology, Etiology and Intervention Strategies for Peri-Partum Depression in Mothers

The prevalence of peri-partum depression (PPD) varies widely across countries, with rates ranging from 10% to 15% depending on the screening method used and the country studied [...].

Effectiveness of digital psychological interventions in reducing perinatal depression: a systematic review of meta-analyses

Digital psychological interventions have been widely used clinically in recent years, but the methodological quality and quality of evidence of related studies are unclear, thus interfering with the translation of practice outcomes and the application of clinical decisions. We searched for meta-analyses of randomized controlled trials in the PubMed, Web of Science, Embase, Cochrane Library, JBI Database, CINAHL, and PsycINFO databases as well as some databases containing gray literature up to 27 April 2022 using a combination of keywords. After two researchers independently screened and extracted data from the literature, the methodological quality of the included literature was evaluated by the AMSTAR 2 scale, and the evidence quality of the outcome index was graded by the Grading of Recommendations, Assessment, Development, and Evaluation system. A total of 12 meta-analyses reporting the positive impact of digital psychological interventions in the prevention and/or treatment of depressive symptoms in perinatal women were included, but the methodological quality and evidence level of the included studies were low. Digital psychological interventions are effective in reducing perinatal depression, but the methodological quality and reliability of outcome indicators are mostly low. Improving study designs, using higher-quality clinical evidence, conducting systematic evaluation studies strictly following the procedures, and standardizing the reporting of study results are recommended.

Depression and Suicide Risk Screening: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Importance

Depression is common and associated with substantial burden. Suicide rates have increased over the past decade, and both suicide attempts and deaths have devastating effects on individuals and families.

Objective

To review the benefits and harms of screening and treatment for depression and suicide risk and the accuracy of instruments to detect these conditions among primary care patients.

Data Sources

MEDLINE, PsychINFO, Cochrane library through September 7, 2022; references of existing reviews; ongoing surveillance for relevant literature through November 25, 2022.

Study Selection

English-language studies of screening or treatment compared with control conditions, or test accuracy of screening instruments (for depression, instruments were selected a priori; for suicide risk, all were included). Existing systematic reviews were used for treatment and test accuracy for depression.

Data Extraction and Synthesis

One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Findings were synthesized qualitatively, including reporting of meta-analysis results from existing systematic reviews; meta-analyses were conducted on original research when evidence was sufficient.

Main Outcomes and Measures

Depression outcomes; suicidal ideation, attempts, and deaths; sensitivity and specificity of screening tools.

Results

For depression, 105 studies were included: 32 original studies (N=385 607) and 73 systematic reviews (including ≈2138 studies [N ≈ 9.8 million]). Depression screening interventions, many of which included additional components beyond screening, were associated with a lower prevalence of depression or clinically important depressive symptomatology after 6 to 12 months (pooled odds ratio, 0.60 [95% CI, 0.50-0.73]; reported in 8 randomized clinical trials [n=10 244]; I2 = 0%). Several instruments demonstrated adequate test accuracy (eg, for the 9-item Patient Health Questionnaire at a cutoff of 10 or greater, the pooled sensitivity was 0.85 [95% CI, 0.79-0.89] and specificity was 0.85 [95% CI, 0.82-0.88]; reported in 47 studies [n = 11 234]). A large body of evidence supported benefits of psychological and pharmacologic treatment of depression. A pooled estimate from trials used for US Food and Drug Administration approval suggested a very small increase in the absolute risk of a suicide attempt with second-generation antidepressants (odds ratio, 1.53 [95% CI, 1.09-2.15]; n = 40 857; 0.7% of antidepressant users had a suicide attempt vs 0.3% of placebo users; median follow-up, 8 weeks). Twenty-seven studies (n = 24 826) addressed suicide risk. One randomized clinical trial (n=443) of a suicide risk screening intervention found no difference in suicidal ideation after 2 weeks between primary care patients who were and were not screened for suicide risk. Three studies of suicide risk test accuracy were included; none included replication of any instrument. The included suicide prevention studies generally did not demonstrate an improvement over usual care, which typically included specialty mental health treatment.

Conclusions and Relevance

Evidence supported depression screening in primary care settings, including during pregnancy and postpartum. There are numerous important gaps in the evidence for suicide risk screening in primary care settings.

Psychological treatment of perinatal depression: a meta-analysis

BACKGROUND

Depression during pregnancy and after the birth of a child is highly prevalent and an important public health problem. Psychological interventions are the first-line treatment and, although a considerable number of randomized trials have been conducted, no recent comprehensive meta-analysis has evaluated treatment effects.

METHODS

We used an existing database of randomized controlled trials of psychotherapies for adult depression and included studies aimed at perinatal depression. Random effects models were used in all analyses. We examined the effects of the interventions in the short and long term, and also examined secondary outcomes.

RESULTS

Forty-three studies with 49 comparisons and 6270 participants between an intervention and control group were included. The overall effect size was g = 0.67 [95% confidence interval (CI) 0.45~0.89; numbers needed-to-be-treated = 4.39] with high heterogeneity (I2 = 80%; 95% CI 75~85). This effect size remained largely unchanged and significant in a series of sensitivity analyses, although some publication bias was found. The effects remained significant at 6-12 months follow-up. Significant effects were also found for social support, anxiety, functional limitations, parental stress and marital stress, although the number of studies for each outcome was low. All results should be considered with caution because of the high levels of heterogeneity in most analyses.

CONCLUSIONS

Psychological interventions are probably effective in the treatment of perinatal depression, with effects that last at least up to 6-12 months and probably also have effects on social support, anxiety, functional impairment, parental stress, and marital stress.

Effectiveness of cognitive behavioural therapy-based interventions for maternal perinatal depression: a systematic review and meta-analysis

BACKGROUND

Depression during the perinatal period (during pregnancy and the year after childbirth) is common and associated with a range of negative effects for mothers, infants, family members, and wider society. Although existing evidence suggests cognitive behavioral therapy (CBT) based interventions are effective for perinatal depression, less is known about the effect of CBT-based interventions on important secondary outcomes, and a number of potential clinical and methodological moderators have not been examined.

METHODS

A systematic review and meta-analysis primarily examined the effectiveness of CBT-based interventions for perinatal depression on symptoms of depression. Secondary aims examined the effectiveness of CBT-based interventions for perinatal depression on symptoms of anxiety, stress, parenting, perceived social support, and perceived parental competence; and explored clinical and methodological moderators potentially associated with effectiveness. A systematic search of electronic databases and other sources was performed up to November 2021. We included randomized controlled trials comparing CBT-based interventions for perinatal depression with control conditions allowing for the isolation of the effects of CBT.

RESULTS

In total, 31 studies (5291 participants) were included in the systematic review and 26 studies (4658 participants) were included in the meta-analysis. The overall effect size was medium (hedges g = - 0.53 [95% CI - 0.65 to - 0.40]); with high heterogeneity. Significant effects were also found for anxiety, individual stress, and perceived social support, however few studies examined secondary outcomes. Subgroup analysis identified type of control, type of CBT, and type of health professional as significant moderators of the main effect (symptoms of depression). Some concerns of risk of bias were present in the majority of studies and one study had a high risk of bias.

CONCLUSIONS

CBT-based interventions for depression during the perinatal period appear effective, however results should be interpreted with caution given high levels of heterogeneity and low quality of included studies. There is a need to further investigate possibly important clinical moderators of effect, including the type of health professional delivering interventions. Further, results indicate a need to establish a minimum core data set to improve the consistency of secondary outcome collection across trials and to design and conduct trials with longer-term follow-up periods.

TRIAL REGISTRATION

CRD42020152254 .

Mother-infant bonding screening in a sample of postpartum women: comparison between online vs offline format

AIMS

We aim to study the the reliability and factorial structure of the Postpartum Bonding Questionnaire (PBQ)administered through two different formats, offline (paper-and-pencil) and online. We also compared clinical, obstetrical, reproductive, and psychopathological variables related to poor mother infant bonding (MIB).

METHODS

A cross-sectional study was conducted on 1,269 mothers. The offline group included 812 women who attended a 40-day postpartum clinical appointment. The online group consisted of 457 women recruited during admission for delivery who volunteered to carry out the online protocol 40 days postpartum. All the participants individually completed the PBQ, the Edinburg Postnatal Depression Scale (EPDS) and other clinical and sociodemographic variables.

RESULTS

The 4-factor solution proposed in the PBQ and its Spanish validation showed good model fit for both samples. Online participants reported higher levels of stress, depressive symptoms, and poor bonding, specifically on PBQ scores and the Rejection and Anger subscales. No differences were found in both samples regarding the type of statistical associations between PBQ and sociodemographic, reproductive, obstetric and psychological outcomes.

CONCLUSION

Online assessment may be an appropriate option for detecting possible alterations in MIB due to the reduction of desirability bias, the increased perception of anonymity, and being a more cost-effective method.

Online and Offline Intervention for the Prevention of Postpartum Depression among Rural-to-Urban Floating Women: Study Protocol for a Randomized Control Trial

Background: As a higher-risk group of postpartum depression (PPD), rural to urban floating women urgently require effective and accessible mental health care after childbirth to prevent PPD. Even though there were various interventions, only a small number of women have sought professional help to reduce their depressive symptoms after childbirth, suggesting the need for an innovative intervention delivery to overcome women’s help-seeking barriers. Online and offline (OTO) interventions, which combine face-to-face and internet-based interventions, provide apparent benefits. As a result, the protocol for a randomized controlled study (RCT) was designed to examine the effectiveness and acceptability of OTO intervention on psychosocial outcomes for Chinese rural-to-urban floating women including the reduction of PPD symptoms and PPD stigma, and the improvement of social support and quality of life. Methods: A double blind, multicenter, RCT will be used and a total of 226 participants will be recruited. The OTO intervention called the “Hi, Mom” program will integrate two face-to-face consulting sessions with online sessions comprising an information module, a communication module, an ask-the-expert module, and a peer story module over a period of three months. The control group will receive routine postpartum care. Outcome measures including PPD symptoms, PPD stigma, social support, quality of life, mother–child bonding, and satisfaction with health care received will be conducted at baseline, postintervention, and three-month follow-up. Results and Discussion: If the intervention is effective, it will provide a convenient and effective intervention program on postpartum mental well-being for rural-to-urban floating women. As the first study to test the effects of an OTO intervention for the prevention of PPD in China, the outcomes gained from this study will provide evidence-based knowledge for clinical practice on PPD prevention based on online and offline health technologies. Moreover, it could be used to plan a culturally appropriate OTO intervention for migrant mothers from different countries.

Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review

BACKGROUND

The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions.

OBJECTIVE

To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions.

METHODS

We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care.

RESULTS

Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence.

CONCLUSIONS

Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.

Effectiveness of web-based and mobile-based psychological interventions to prevent perinatal depression: Study protocol for a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Perinatal depression is one of the most common complications during pregnancy and one year following childbirth. A negative impact on the mental and physical health of women, their children, partners, or significant others has been associated with this disease. Web-based and Mobile-based psychological interventions can reduce the burden of the disease through prevention of new cases of depression. It is crucial to know the effectiveness of these interventions to implement them around the globe. This systematic review and meta-analysis aims to assess the effectiveness of Web-based and Mobile-based psychological interventions to prevent depression during the perinatal period.

METHOD AND ANALYSIS

A systematic review and meta-analysis will adhere to the PRISMA guidelines. Studies will be identified through MEDLINE, PsycINFO, Web of Science, Scopus, CINAHL, CENTRAL, Opengrey, Australian New Zealand Clinical Trial Registry, National Institute for Mental Health Research at the Australian National University, clinicaltrial.gov, beacon.anu.edu.au, and evidencebasedpsychotherapies.org from inception until 31 March 2021. We will also search the reference lists provided in relevant studies and reviews. The selection criteria will be as follows: 1) pregnant women or women who have given birth in the last 12 months and who were non-depressive at baseline; 2) Web-based and Mobile-Based psychological interventions; 3) comparators will be usual care, attention control, waiting list or no intervention; 4) outcomes will be the incidence of new cases of perinatal depression and/or the reduction of depressive symptoms as measured by validated instruments; and 5) the design of the studies will be randomized controlled trials. No restrictions regarding the year or language of publication will be considered. Pooled standardized mean differences and 95% confidence intervals will be calculated. The risk of bias of the studies will be assessed through the Cochrane Collaboration risk of bias 2.0 tool. Heterogeneity and publication bias will be estimated. Sensitivity and sub-group analyses will also be conducted. Random effects meta-regression will be performed.

ETHICS AND DISSEMINATION

As a systematic review, ethical approval is not required. The results from this study will be presented at international conferences and disseminated through peer-reviewed publications. Patients and the public will be involved in the dissemination plans.

PROSPERO REGISTRATION NUMBER

230,089 (submitted).

The Baby Steps Web Program for the Well-Being of New Parents: Randomized Controlled Trial

Background

New parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents.

Objective

This study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information (Baby Care) and information plus an interactive program (Baby Steps Wellbeing) were compared from the third trimester baseline to 3 and 6 months subsequently.

Methods

The study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks’ gestation), using web-based registration. Most (337/388, 86.8%) were obtained from prenatal hospital classes. Couples’ randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50% couples scored high if either mother >7, father >5). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes; relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples.

Results

Selection criteria were met by 63.9% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6%), tertiary educated (324/496, 65.3%), employed full time (407/496, 82%), and born in Australia (337/496, 67.9%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9% (18/248) of men, and 16.1% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92% ≥50). Only 37.3% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6%) than fathers (52/248, 20.9%; P<.001). The EPDS, quality of life, and social support did not show differential improvements between programs, but Baby Steps Wellbeing gave a greater linear increase in self-efficacy for support provision (P=.01; Cohen d=0.26) and lower reduction in relationship satisfaction (P=.03; Cohen d=0.20) than Baby Care alone. Mothers had greater linear benefits in parenting self-efficacy over time than fathers after receiving Baby Steps Wellbeing rather than Baby Care (P=.01; Cohen d=0.51). However, the inclusion of program type in analyses on parenting self-efficacy and relationship satisfaction did not improve model fit above analyses with only parent gender and time.

Conclusions

Three secondary outcomes showed differential benefits from Baby Steps Wellbeing, but for one (parenting self-efficacy), the effect only occurred for mothers, perhaps reflecting their greater program use. Increased engagement will be needed for more definitive testing of the potential benefits of Baby StepsWellbeing for perinatal adjustment.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12614001256662; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367277

Appraisal of systematic reviews on interventions for postpartum depression: systematic review

BACKGROUND

Postpartum depression (PPD) is a highly prevalent mental health problem that affects parental health with implications for child health in infancy, childhood, adolescence and beyond. The primary aim of this study was to critically appraise available systematic reviews describing interventions for PPD. The secondary aim was to evaluate the methodological quality of the included systematic reviews and their conclusions.

METHODS

An electronic database search of MEDLINE, Embase, and the Cochrane Library from 2000 to 2020 was conducted to identify systematic reviews that examined an intervention for PPD. A Measurement Tool to Assess Systematic Reviews was utilized to independently score each included systematic review which was then critically appraised to better define the most effective therapeutic options for PPD.

RESULTS

Of the 842 studies identified, 83 met the a priori criteria for inclusion. Based on the systematic reviews with the highest methodological quality, we found that use of antidepressants and telemedicine were the most effective treatments for PPD. Symptoms of PPD were also improved by traditional herbal medicine and aromatherapy. Current evidence for physical exercise and cognitive behavioural therapy in treating PPD remains equivocal. A significant, but weak relationship between AMSTAR score and journal impact factor was observed (p = 0.03, r = 0.24; 95% CI, 0.02 to 0.43) whilst no relationship was found between the number of total citations (p = 0.27, r = 0.12; 95% CI, - 0.09 to 0.34), or source of funding (p = 0.19).

CONCLUSION

Overall the systematic reviews on interventions for PPD are of low-moderate quality and are not improving over time. Antidepressants and telemedicine were the most effective therapeutic interventions for PPD treatment.

Current Resources for Evidence-Based Practice, November 2020

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of diversity in the maternity care workforce and commentaries on reviews focused on burnout in midwifery and a cross-national comparison of guidelines for uncomplicated childbirth.

The Clinical Effectiveness of Cognitive Behavioral Therapy for Patients with Insomnia and Depression: A Systematic Review and Meta-Analysis

BACKGROUND

Insomnia and depression often co-occurr. However, there is lack of effective treatment for such comorbidity. CBT-I has been recommended as the first-line treatment for insomnia; whether it is also effective for comorbidity of insomnia and depression is still unknown. Therefore, we conducted this meta-analysis of randomized controlled trials to assess the clinical effectiveness and safety of CBT-I for insomnia comorbid with depression. Data Sources. Seven electronic databases, including China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science Technology Journal Database, SinoMed Database, PubMed, the Cochrane Library, and EMBASE, as well as grey literature, were searched from the beginning of each database to July 1, 2019. Study Eligibility Criteria. Randomized controlled trials that compared CBT-I to no treatment or hypnotics (zopiclone, estazolam, and benzodiazepine agonist) for insomnia comorbid with depression and reported both insomnia scales and depression scales. Study Assessment and Synthesis Methods. Cochrane Reviewer's Handbook was used for evaluating the risk of bias of included studies. Review Manager 5.3 software was used for meta-analysis. Online GRADEpro was used to assess the quality of evidence.

RESULTS

The pooled data showed that CBT-I was superior to no treatment for insomnia, while it was unsure whether CBT-I was better than no treatment for depression. And the effectiveness of CBT-I was comparable to hypnotics for both insomnia and depression. CBT-I was likely to be safe due to its noninvasive nature. The methodological quality varied across these trials. The evidence quality varied from moderate to very low, and the recommendation level was low.

CONCLUSIONS

Currently, findings support that CBT-I seems to be effective and safe for insomnia comorbid with depression to improve the insomnia condition, while it is unsure whether CBT-I could improve depression condition. More rigorous trials are needed to confirm our findings.