There are significant health and psychological consequences associated with threatened abortion (TA). Women who lose desired pregnancies due to abortion are at risk of experiencing grief, anxiety, guilt, and self-blame. In Iranian society, psychological support for pregnant women is low, and as a result, women with TA experience high stress. This study aimed to investigate the experiences of pregnant women with TA and health providers in maternity healthcare services.

This exploratory-descriptive qualitative study was conducted using semi-structured interviews and purposive sampling. 13 pregnant women and seven key informants (husband and health care providers) were selected from February 2023 to July 2023. Data was analysed using qualitative content analysis with MAXQDA software (version 18).

The most critical causes of concern for women included medical, psychological, social, and financial issues and a lack of sufficient information about their current situation (spotting- bleeding). The participants used constructive coping strategies, such as regular visits to the doctor, and unconstructive coping strategies, like a lack of communication with others, to reduce their worries. Key informants proposed two methods for reducing the concerns of the women, including improving information sharing about abortion and therapeutic support available to pregnant women.

The study proposed that maternity healthcare providers, alongside medical care, should pay attention to techniques for improving the psychological support of women with TA.

Maternal depression is pregnancy and childbirth-related depression during pregnancy (prenatal depression (PND)) or after delivery (postpartum depression (PPD)). It is a recognized global public health concern with extensive repercussions adversely affecting women's well-being and the developmental progress of infants. Mindfulness-based interventions (MBIs) have been shown to be effective in maternal depression. Technology-supported MBI could be an effective preventive strategy for maternal depression, especially in low- and middle-income countries (LMICs) where lack of important resources limits the accessibility to standard care. However, the limited available studies assessing the effect of technology-supported MBIs for maternal depression might be insufficient to reach a definitive conclusion. This systematic review aimed to evaluate the pooled estimated effect of technology-supported MBIs for maternal depression, identify available studies, and reveal applicable health technologies with MBIs.

This study was conducted according to the PRISMA-P 2020 and the review protocol was registered in PROSPERO; CRD42024537853. The risk of bias was evaluated using the PEDro scale. The meta-analysis was done with R.

Data from 18 articles, none from low-income countries (LICs), were included in the systematic review, representing 2,481 participants, 15 studies were included in the meta-analysis. The pooled effect size indicated that technology-supported MBIs had a positive effect on maternal depression (SMD - 0.55, 95% CI [- 0.70; -0.40], p < 0.001). The sub-group analysis showed that this intervention was effective in both PND (SMD = - 0.57, 95% CI [- 0.74; -0.39], p < 0.001) and PPD (SMD - 0.53, 95% CI [- 0.91; -0.15], p = 0.014).

Integrating technology-supported MBIs into maternal care is recommended to enhance maternal mental health. However, the lack of trials in LMICs may limit the generalizability and external validity of this finding and it is crucial to conduct further research, in the area to tailor intervention and maximize its effectiveness. Context-specific trial studies are pivotal for successful program adoption.

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.

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.

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.

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.

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.

Psychological internet-based interventions have shown promise in preventing and treating perinatal depression, but their effectiveness can be hindered by low user engagement. This challenge often arises from a misalignment between technology attributes, user needs, and context. A user-centered, iterative approach involving all stakeholders is recommended.

In this paper, we aimed to develop a user-friendly psychological internet-based intervention aimed at addressing the symptoms of perinatal depression through an iterative, user-centered approach.

The development process followed the Center for eHealth Research and Disease Management Roadmap phases of contextual inquiry, value specification, and design. It involved a comprehensive literature review, 2 surveys, 10 focus groups, 5 usability interviews, and 1 technical pilot.

The contextual inquiry revealed a demand for accessible interventions for perinatal mental health, with internet-based solutions seen as viable options. Insights from the literature influenced intervention content and features. Stakeholders' openness to the intervention became evident during this phase, along with the integration of the first set of values. Initially, we assessed the broader perinatal context to identify the optimal period for the intervention. On the basis of the findings and practical considerations, we decided to specifically target postpartum depression symptoms. The value specification phase further defined the central values and translated them into requirements. In the design phase, feedback was obtained on the user experience of an early digital prototype and on the prototype's final version. The resulting intervention, named Mamá, te entiendo ("Mom, I get you"), is a guided web app based on cognitive behavioral therapy principles, integrating elements from attachment and mentalization theories. It aims to reduce depressive symptoms in women during the first months postpartum and consists of 6 core sequential modules, along with 3 additional modules, including 5 case examples illustrating depressive symptoms and therapeutic techniques. The intervention provides homework exercises and offers users the opportunity to receive feedback from an e-coach through the web app.

This study emphasizes the importance of a user-centered and iterative development process for psychological internet-based interventions. This process helps clarify user needs and provides valuable feedback on service design and quality, ultimately having the potential to enhance the utility and, presumably, the effectiveness of the intervention. The Discussion section shares valuable insights from the project, such as the value of the requirement sessions.

Pregnant women and new mothers within 1 year after delivery are at a high risk of depression, yet many do not get the help they need due to wide reasons heralding stigma, access, cost, time, and shortage of human resources. Hence, compelling the exploration of alternate and potentially cost-effective means of delivering care, including the leverage of digital tools. This review aimed to evaluate the effectiveness of digital health interventions in reducing depressive symptoms among perinatal women. Literatures were sought from seven academic databases alongside the references of previous reviews. Included studies were all quantitative study types involving the use of digital health interventions for perinatal women not more than 1-year post-delivery. Standardized mean difference and standard error were used to perform random-effect model meta-analysis. Sensitivity and subgroup analyses were performed to determine certainty and modifiers of the findings, respectively. Forty-eight studies were included in this review with 28 studies used for meta-analyses. Numerous digital channels were identified; however, none specified the use of a digital health theory in its development. The digital health interventions showed a small positive significant effect over the controls (standardized mean difference = 0.29, P = 0.003, I 2 = 34%), and this was significantly influenced by intervention delivery and facilitation modes, time of initiation of the intervention, and period covered by the intervention. Although digital health interventions may hold some potential for perinatal depression, scaling the interventions may be challenging sequel to overlooked influences from the interactions within the human-computer-society complex.

Two key parental reflective capacities-mindful parenting (MP) and parental reflective functioning (PRF) - have been shown to promote healthy parent-child relationships through parents' increased sensitivity and responsiveness to their children's needs in spite of parenting stressors. Despite the theoretical overlap between these two constructs, researchers have continued to examine them independently. Therefore, the purpose of this scoping review was to review the overlapping and distinctive outcomes and correlates in the empirical MP and PRF literatures.

A comprehensive literature search across the MP and PRF literature for studies published from 2005 through early 2020 (pre-COVID-19 pandemic) was conducted.

A review of 301 articles (n = 180 MP and n = 121 PRF) revealed overlapping study outcomes and correlates, including improvement in parent and child well-being, parenting behaviors, and attachment. Both MP and PRF literatures suggest MP and PRF are amenable to intervention-induced changes, although mostly documented in White mothers, which results may not be generalizable to diverse populations.

Researchers should consider the impact MP and PRF have on positive family relationships. Results suggest that scholars should consider investigating and intervening on MP and PRF simultaneously. Specifically, results identified MP and PRF convergent associations and perhaps synergistic impacts on positive parenting behaviors. Limitations and future directions are discussed.

This review was not preregistered.

Perinatal depression (PND) is a common mental health problem, and eHealth interventions may provide a strategy for alleviating PND.

This meta-analysis aimed to determine the effect of eHealth interventions on PND.

Six databases were searched to retrieve published randomized controlled trials (RCTs) on the effect of eHealth interventions on PND. A meta-analysis was performed on the data of these studies using a random effects model.

A total of 21 RCTs were included in the meta-analysis, which revealed that eHealth interventions significantly reduced antenatal depression (WMD = -1.64, 95 % CI [-2.92, -0.35], P = .013), postpartum depression (SMD = -0.41, 95 % CI [-0.52, -0.29], P < .001), anxiety (SMD = -0.39, 95 % CI [-0.51, -0.28], P < .001), stress (WMD = -2.93, 95 % CI [-4.58, -1.27], P = .001), and improved self-efficacy (SMD = 0.42, 95 % CI [0.21, 0.63], P < .001) compared with the control group. However, eHealth interventions did not significantly improve social support (SMD = 0.27, 95 % CI [-0.01, 0.56], P = .058). For antenatal depression, significant subgroup differences were observed in the digital platform and material presentation format. In addition, for postpartum depression, significant subgroup differences were found in the type of therapy.

The meta-analysis results suggest that eHealth interventions can relieve depression, anxiety, and stress symptoms and improve self-efficacy in perinatal women. However, these interventions did not improve social support. Additional high-quality studies on eHealth interventions in PND are needed to validate these results.

We synthesized the effects of mindfulness-based interventions (MBIs) on depression in pregnant women.

Ten electronic databases were searched from inception to September 2022. We reviewed studies on outcomes for pregnant women with depression receiving mindfulness-based interventions. We only reviewed studies written in English. A random-effects model was used to compute the effect size. Funnel plot, Q statistics, and I2 were used to test the heterogeneity across studies. We examined moderators to explore sources of heterogeneity.

Across 19 included studies (N = 1480), 717 pregnant women participated in mindfulness interventions; 763 served as controls. Mean age ranged from 25.3 to 33.6 years. Overall, mindfulness-based interventions showed reduced depression compared to control groups (g = 0.457, 95%CI 0.254, 0.659, I2 = 68 %). With subgroup analysis, mindfulness-based cognitive therapy had a greater effect on reducing depressive symptoms (g = 1.13) than mindfulness-based stress reduction (g = 0.64) and adapted mindfulness-based interventions (g = 0.31). No quality indicators moderated the ES of mindfulness-based interventions on depression.

Mindfulness-based interventions significantly improved depression among pregnant women, especially mindfulness-based cognitive therapy (MBCT). Clinicians and health providers should consider using MBIs as alternative complementary treatment for improving and preventing depression in pregnant women.

Digital intervention has been shown to be helpful in improving perinatal mental health. However, the design characteristics of such interventions have not been systematically reviewed. Considering that a lack of support-especially from a partner-is one of the major contributing factors to perinatal depression and anxiety, it is crucial to determine whether digital interventions have included partner participation. In this review, we systematically examined the design characteristics of digital interventions related to perinatal depression and anxiety and aimed to determine whether partner participation was incorporated as part of the interventions. Based on the PRISMA 2020 guidelines, five databases (PubMed, EBSCO, Cochrane, ProQuest, and Scopus) were searched. Narrative results of design characteristics were developed to provide a framework for the design and evaluation of the studies. A total of 12 intervention studies from China, Sweden, Australia, New Zealand, Singapore, Norway, and the United Kingdom were included. Across all studies, internet cognitive behavioral therapy and mindfulness therapy were overwhelmingly utilized as the major intervention approaches. While all studies reported reduced depressive symptoms after the intervention, only four studies reported subsequent decreased levels of both depressive and anxiety symptoms. Only one study included partner support in the intervention. Cognitive behavioral therapy and mindfulness therapy, two of the most common intervention approaches, were found to be effective in alleviating perinatal depression and anxiety. Partner participation should be prioritized in designing digital interventions to ensure comprehensive and easily accessible social support for persons in need.

College athletes are a group often affected by anxiety. Few interventional studies have been conducted to address the anxiety issues in this population.

We conducted a mobile-delivered mindfulness intervention among college athletes to study its feasibility and efficacy in lowering their anxiety level and improving their mindfulness (measured by the Five Facet Mindfulness Questionnaire [FFMQ]).

In April 2019, we recruited 290 college athletes from a public university in Shanghai, China, and 288 of them were randomized into an intervention group and a control group (closed trial), with the former (n=150) receiving a therapist-guided, smartphone-delivered mindfulness-based intervention and the latter receiving mental health promotion messages (n=138). We offered in-person instructions during the orientation session for the intervention group in a classroom, with the therapist interacting with the participants on the smartphone platform later during the intervention. We used generalized linear modeling and the intent-to-treat approach to compare the 2 groups' outcomes in dispositional anxiety, precompetition anxiety, and anxiety during competition, plus the 5 dimensions of mindfulness (measured by the FFMQ).

Our intent-to-treat analysis and generalized linear modeling found no significant difference in dispositional anxiety, precompetition anxiety, or anxiety during competition. Only the "observation" facet of mindfulness measures had a notable difference between the changes experienced by the 2 groups, whereby the intervention group had a net gain of .214 yet fell short of reaching statistical significance (P=.09). Participants who specialized in group sports had a higher level of anxiety (β=.19; SE=.08), a lower level of "nonjudgemental inner experience" in FFMQ (β=-.07; SE=.03), and a lower level of "nonreactivity" (β=-.138; SE=.052) than those specializing in individual sports.

No significant reduction in anxiety was detected in this study. Based on the participant feedback, the time availability for mindfulness practice and session attendance for these student athletes in an elite college could have compromised the intervention's effectiveness. Future interventions among this population could explore a more student-friendly time schedule (eg, avoid final exam time) or attempt to improve cognitive and scholastic outcomes.

Chinese Clinical Trial Registry ChiCTR1900024449; https://www.chictr.org.cn/showproj.html?proj=40865.

To determine the effectiveness of mindfulness interventions on anxiety through a systematic review.

Systematic review by searching articles through the PubMed, ProQuest, Science Direct, Wiley Library, Sage Journal, and Cochrane Library databases with publication years January 2012 to January 2022 RESULTS: Eleven articles met the inclusion criteria covering several countries, including Canada 1 article, Egypt 1 article, Taiwan 1 article, Amsterdam 2 articles, Iran 1 article, Austria 1 article, San Francisco 1 article, Germany 1 article, Sweden 1 article, China 1 article, and Spain 1 article.

Management of anxiety about childbirth is important for pregnant women. Mindfulness interventions are effective for reducing anxiety about labor and increasing comfort during labor. Mindfulness intervention mechanisms have the potential to reduce anxiety by increasing skills to regulate emotions.

This study aimed to investigate the relationship between pregnancy stress and mental health of the pregnant women, employing a positive psychology perspective. Specifically, the study sought to explore how the two positive psychological qualities of mindfulness and peace of mind may serve as potential mediators in the association between pregnancy stress and mental health of the pregnant women.

Seven hundreds and thirteen pregnant women seeking care at the First Affiliated Hospital of Sun Yat-Sen University were included in this study. The participants completed a self-report demographic questionnaire, as well as several validated scales including the Pregnancy Pressure Scale (PPS), Mindful Attention Awareness Scale (MAAS), Peace of Mind Scale (PoMS), and Chinese Health Questionnaire (CHQ). The Amos 23.0 system was utilized to construct structural equation models.

A total of 713 participants had an average age of 29.46 ± 4.81 years and an average gestational age of 24.26 ± 22.66 weeks. Out of the pregnant women, 163 (22.9%) experienced moderate or higher levels of pregnancy stress (PPS > 1), while 212 (29.7%) exhibited mental distress (CHQ > 3). Pregnancy stress exhibited a positive association with mental distress, while displaying negative associations with mindfulness and peace of mind. Mindfulness and peace of mind were negatively associated with mental distress. By employing structural equation modeling, the analysis revealed that mindfulness and peace of mind acted as partial mediators in the relationship between pregnancy stress and mental health. Furthermore, the identified models exhibited bidirectional sequential mediating pathways, suggesting that the pathways of mindfulness ↔ peace of mind mitigated the harmful influence of pregnancy stress on the mental health of pregnant women.

This study adds to the current body of knowledge by investigating the relationships among mindfulness, peace of mind, pregnancy stress, and mental health in pregnant women. From a positive psychology framework, it provides valuable understanding of the intricate dynamics between pregnancy stress and protective factors of mental health. Consequently, interventions aimed at bolstering positive psychological qualities in pregnant women should prioritize the cultivation of mindfulness to foster peace of mind, or alternatively, the cultivation of peace of mind to enhance mindfulness, ultimately leading to improved mental health outcomes.

There are previous meta-analyses on the efficacy of cognitive behavioral therapy or mindfulness-based therapies in the perinatal period, but no previous review has focused on contextual therapies as a whole. The aim of this study was to carry out a systematic review and meta-analysis of the efficacy of contextual therapies on depressive and anxious symptoms in women in the perinatal period.

A systematic search for randomized clinical trials has been carried out in the PUBMED, CINAHL, Psyc-INFO and Cochrane Library search engines. For the quantitative synthesis, the Morris effect size measure has been used.

A total of 34 RCTs have been found, of which 30 have been used for meta-analysis. The mean effect size of the studies on depression scores was dppc2 = -0.81 (95% CI = -1.12 to -0.50), while it was dppc2 = -1.04 (95% CI = -1.54 to -0.53) in the case of studies on anxiety scores. These effect sizes decreased to medium effect sizes when corrected for publication bias.

The main limitations are the quality of the included studies, publication bias, and the limited number of studies on contextual therapies other than mindfulness-based therapies.

In conclusion, this systematic review found a large number of efficacy studies on mindfulness-based therapies and a small number of studies on the other contextual therapies. The effect sizes found are consistent with previous meta-analyses in the perinatal period.

This study aimed to examine the effect of digital health interventions compared with treatment as usual on preventing and treating postpartum depression and postpartum anxiety.

Searches were conducted in Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov.

The systematic review included full-text randomized controlled trials comparing digital health interventions with treatment as usual for preventing or treating postpartum depression and postpartum anxiety.

Two authors independently screened all abstracts for eligibility and independently reviewed all potentially eligible full-text articles for inclusion. A third author screened abstracts and full-text articles as needed to determine eligibility in cases of discrepancy. The primary outcome was the score on the first ascertainment of postpartum depression or postpartum anxiety symptoms after the intervention. Secondary outcomes included screening positive for postpartum depression or postpartum anxiety --as defined in the primary study --and loss to follow-up, defined as the proportion of participants who completed the final study assessment compared with the number of initially randomized participants. For continuous outcomes, the Hedges method was used to obtain standardized mean differences when the studies used different psychometric scales, and weighted mean differences were calculated when studies used the same psychometric scales. For categorical outcomes, pooled relative risks were estimated.

Of 921 studies originally identified, 31 randomized controlled trials-corresponding to 5532 participants randomized to digital health intervention and 5492 participants randomized to treatment as usual-were included. Compared with treatment as usual, digital health interventions significantly reduced mean scores ascertaining postpartum depression symptoms (29 studies: standardized mean difference, -0.64 [95% confidence interval, -0.88 to -0.40]; I2=94.4%) and postpartum anxiety symptoms (17 studies: standardized mean difference, -0.49 [95% confidence interval, -0.72 to -0.25]; I2=84.6%). In the few studies that assessed screen-positive rates for postpartum depression (n=4) or postpartum anxiety (n=1), there were no significant differences between those randomized to digital health intervention and treatment as usual. Overall, those randomized to digital health intervention had 38% increased risk of not completing the final study assessment compared with those randomized to treatment as usual (pooled relative risk, 1.38 [95% confidence interval, 1.18-1.62]), but those randomized to app-based digital health intervention had similar loss-to-follow-up rates as those randomized to treatment as usual (relative risk, 1.04 [95% confidence interval, 0.91-1.19]).

Digital health interventions modestly, but significantly, reduced scores assessing postpartum depression and postpartum anxiety symptoms. More research is needed to identify digital health interventions that effectively prevent or treat postpartum depression and postpartum anxiety but encourage ongoing engagement throughout the study period.

Stress and anxiety during pregnancy are extremely prevalent and are associated with numerous poor outcomes, among the most serious of which are increased rates of preterm birth and low birth weight infants. Research supports that while in-person mindfulness training is effective in reducing pregnancy stress and anxiety, there are barriers limiting accessibility.

The aim of this paper is to determine if mindfulness meditation training with the Headspace app is effective for stress and anxiety reduction during pregnancy.

A longitudinal, single-arm trial was implemented with 20 pregnant women who were instructed to practice meditation via the Headspace app twice per day during the month-long trial. Validated scales were used to measure participant's levels of stress and anxiety pre- and postintervention. Physiological measures reflective of stress (heart rate variability and sleep) were collected via the Oura Ring.

Statistically significant reductions were found in self-reported levels of stress (P=.005), anxiety (P=.01), and pregnancy anxiety (P<.0001). Hierarchical linear modeling revealed a statistically significant reduction in the physiological data reflective of stress in 1 of 6 heart rate variability metrics, the low-frequency power band, which decreased by 13% (P=.006). A total of 65% of study participants (n=13) reported their sleep improved during the trial, and 95% (n=19) stated that learning mindfulness helped with other aspects of their lives. Participant retention was 100%, with 65% of participants (n=13) completing about two-thirds of the intervention, and 50% of participants (n=10) completing ≥95%.

This study found evidence to support the Headspace app as an effective intervention to aid in stress and anxiety reduction during pregnancy.

Adult women of reproductive age are highly engaged with social media, suggesting its utility for conveying health information to this population, at scale. This scoping review aimed to describe health promotion interventions conducted via social media and assess their effectiveness to improve health outcomes, engagement and acceptability in adult women of reproductive age.

Six databases were searched on 13 May 2022. Two reviewers independently screened studies. Data were extracted and risk of bias assessed using the Joanna Briggs Critical Appraisal Tools.

Eligible studies conducted an intervention primarily via social media, with or without a comparison intervention, and reported health-related outcomes/behaviours pre- and post-intervention. Results were presented in narrative form.

Adult women (mean age 18-45 years).

Nine eligible studies were identified: six randomised control trials, two quasi-experimental studies and one cross-sectional study. Interventions focused on prenatal, antenatal or postpartum health or physical activity. Seven studies utilised Facebook for intervention delivery, one conducted a digital campaign across four platforms and one used WeChat. Studies reported significant improvements in a range of outcomes, including increased parenting competence, longer duration of breast-feeding and higher rates of physical activity. Social media interventions had greater engagement than control interventions.

We identified nine diverse health promotion interventions conducted via social media, which appear acceptable and effective for improving various health outcomes in adult women of reproductive age. While this supports the utility of social media to convey health information, further research is required to prove effectiveness and superiority over other intervention strategies.

The COVID-19 pandemic, with its multidimensional consequences, is the most serious threat of the 21st century affecting the mental health of women in the perinatal period around the world. Resilience, which assumes the flexible use of an individual's resources in facing adversity, is an important, protective factor influencing mental well-being. The presented study aimed to determine to what extent psychological resilience, mitigates the relationship between adverse consequences of the COVID-19 pandemic and symptoms of depression and anxiety in women in the perinatal period.

We recruited pregnant women from 17 February to 13 October 2021, using social media, the parenting portal, and the snowball method. To assess mental well-being, we used: The Edinburgh Postnatal Depression Scale (EPDS), The Beck Depression Inventory (BDI-2), Self-report Labour Anxiety Questionnaire-LAQ and the self-developed COVID-19 Pandemic Anxiety Questionnaire (CRAQ). Resilience was measured usingthe Resilience Measure Questionnaire (KOP26). Multiple Correspondence Analysis (MCA), an independent t-test, and a Pearson correlation analysis were performed.

Low resilience was significantly associated with depressive symptoms (r = -0.46; p < 0.05) and anxiety related to childbirth (r = -0.21; p < 0.05). No associations were found for resilience and pandemic-related stress. Very high and high perinatal anxiety along with the lowest level of resilience clustered with EPDS and BDI-2 scores indicating depression.

Our study provides evidence that lower levels of resilience during pregnancy may be a significant predictor of increased severity of depressive symptoms and higher levels of anxiety related to childbirth among the perinatal population.

Introduction. Pregnancy is a unique time in a woman's life that can be both exciting and challenging. It is also a period that can be associated with significant stress, anxiety, and depression, which can have negative consequences for both the mother and the baby. Mindfulness interventions are known to be a well-suited treatment and prevention method for psychiatric symptoms in pregnancy, and web-based applications have been explored. We here present an up-to-date systematic review and meta-analysis of randomized-controlled trials to investigate the effect of digital-based mindfulness interventions on depressive, anxiety, and stress symptoms during pregnancy. Methods. The systematic literature search and data extraction was performed by two independent raters. It resulted in 13 eligible studies overall comprising 1373 participants. We conducted random-effects meta-analyses for depressive, anxiety, and stress symptoms after completion of a digital mindfulness intervention (compared to a control group). Results. Digital mindfulness intervention methods were significantly able to reduce depression (g = -0.47, 95% CI [-0.9; -0.09]) and anxiety symptoms (g = -0.41, 95% CI [-0.77; -0.05]), but not stress symptoms. These effects were moderated by the attrition rate (βDepression = 0.025, pDepression < 0.01; βAnxiety = 0.022, pAnxiety < 0.01; βStress = 0.022, pStress < 0.01). Primiparity also had a significant influence on the intervention effect regarding depression symptoms (β = 0.033, p = 0.024). Conclusions. Digital mindfulness interventions are a promising method to reduce mental health symptoms in pregnant women. We identified certain parameters moderating this effect, for example, primiparity and the attrition rate.

An increasing number of studies have documented the effectiveness on various types of face-to-face and online mindfulness-based interventions (MBIs) in reducing anxiety among general population, but there is a scarcity of systematic reviews evaluating evidence of online MBIs on anxiety in adults. Therefore, we examined the effects of online mindfulness-based interventions (MBIs) on anxiety symptoms in adults and explored the moderating effects of participant, methods, and intervention characteristics.

We systematically searched nine databases through May 2022 without date restrictions. Inclusion criteria were primary studies evaluating online mindfulness-based interventions with adults with anxiety measured as an outcome, a comparison group, and written in English. We used random-effects model to compute effect sizes (ESs) using Hedges' g, a forest plot, and Q and I² statistics as measures of heterogeneity; we also examined moderator analyses.

Twenty-six primary studies included 3,246 participants (39.9 ± 12.9 years old). Overall, online mindfulness-based interventions showed significantly improved anxiety (g = 0.35, 95%CI 0.09, 0.62, I² = 92%) compared to controls. With regards to moderators, researchers reported higher attrition, they reported less beneficial effects on anxiety symptoms (β=-0.001, Q_model=4.59, p = .032). No other quality indicators moderated the effects of online mindfulness-based interventions on anxiety.

Online mindfulness-based interventions improved anxiety symptoms in adult population. Thus, it might be used as adjunctive or alternative complementary treatment for adults. However, our findings must be interpreted with caution due to the low and unclear power of the sample in primary studies; hence, high-quality studies are needed to confirm our findings.

Anxiety disorders are relatively common during pregnancy and the postnatal period. Despite their potential acceptability to users, psychological interventions research for this population is still in its infancy. The meta-analysis aimed to comprehensively evaluate the evidence of the effectiveness of psychological interventions for reducing perinatal anxiety.

The review followed PRISMA guidelines. A total of 26 studies published between 2004 and 2022 fulfilled inclusion criteria of which 22 were included in the meta-analysis.

Results indicated that psychological interventions were more effective than control conditions in reducing symptoms of perinatal anxiety (equivalent to a medium post treatment effect size). Effect sizes were robust for cognitive, behavioural and mindfulness-based interventions. Targeting anxiety also appeared to impact on depression symptoms. There was substantial evidence of methodological heterogeneity.

This review demonstrates that psychological interventions are effective in reducing symptoms of both anxiety and comorbid anxiety and depression in both the antenatal and postnatal periods. Further research on longer-term effects, infant outcomes, treatment approach and modality are required.

Pregnancy and the postpartum period are times when women are at increased risk for depression and mental problems. This may also negatively affect the foetus. Thus, there is a need for interventions with low-threshold access and care. Telemedicine interventions are a promising approach to address these issues. This systematic literature review examined the efficacy of telemedicine interventions for pregnant women and/or new mothers to address mental health-related outcomes. The primary objective was to analyse whether telemedicine interventions can reduce mental health problems in pregnant women and new mothers. The secondary aim was to clarify the impact of type of interventions, their frequency and their targets.

Inclusion criteria: randomized controlled trials, with participants being pregnant women and/or new mothers (with infants up to twelve months), involving telemedicine interventions of any kind (e.g. websites, apps, chats, telephone), and addressing any mental health-related outcomes like depression, postnatal depression, anxiety, stress and others. Search terms were pregnant women, new mothers, telemedicine, RCT (randomised controlled trials), mental stress as well as numerous synonyms including medical subject headings. The literature search was conducted within the databases PubMed, Cochrane Library, Web of Science and PsycINFO. Screening, inclusion of records and data extraction were performed by two researchers according to the PRISMA guidelines, using the online tool CADIMA.

Forty four articles were included. A majority (62%) reported significantly improved mental health-related outcomes for participants receiving telemedicine interventions compared to control. In particular (internet-delivered) Cognitive Behavioural Therapy was successful for depression and stress, and peer support improved outcomes for postnatal depression and anxiety. Interventions with preventive approaches and interventions aimed at symptom reduction were largely successful. For the most part there was no significant improvement in the symptoms of anxiety.

Telemedicine interventions evaluated within RCTs were mostly successful. However, they need to be designed to specifically target a certain mental health issue because there is no one-size-fits-all approach. Further research should focus on which specific interventions are appropriate for which mental health outcomes in terms of intervention delivery modes, content, target approaches, etc. Further investigation is needed, in particular with regard to anxiety.

Pregnancy distress among childbearing women is common and can negatively affect both mother and infant. Mindfulness-based interventions (MBIs) may have a positive effect on pregnancy distress but randomized controlled trials with sufficient power are lacking. The current study examined the effectiveness of an online self-guided MBI in pregnant women with pregnancy distress.

Pregnant women with elevated pregnancy distress levels at 12 weeks of pregnancy, measured with the Edinburgh Depression Scale (EDS) and Tilburg Pregnancy Distress Scale negative affect (TPDS-NA), were randomized into an intervention group (online MBI, N = 109) or control group (care as usual, N = 110). The primary outcome was the change in pregnancy distress post-intervention and at eight-weeks-follow-up. Secondary outcomes were mindfulness skills (Three Facet Mindfulness Questionnaire-Short Form), rumination (Rumination-Reflection Questionnaire), and self-compassion (Self-Compassion Scale-Short Form) at post-intervention and follow-up in the intervention group.

Significant improvements were found in pregnancy distress scores, but no significant differences between intervention and control group appeared. The MBI group showed improvements in mindfulness skills, rumination, and self-compassion.

Low adherence to the intervention and assessment of secondary outcome measures in the intervention group only.

An intervention trial with one of the largest samples (N = 219) provided no evidence of a significant effect of an online self-guided MBI in distressed pregnant women. An online MBI may be associated with an improvement in mindfulness skills, rumination, and self-compassion. Future research should address the effectiveness of MBI's with different formats (online and group-based combined) and examine a possible delayed effect.

ClinicalTrials.gov: NCT03917745, registered on 4 March 2019.

About one in four mothers will experience depression and anxiety during pregnancy and within their first year following childbirth. The meta-analysis aggregated the findings of randomized controlled trials (RCTs) evaluating the immediate post-intervention and maintenance effects of MBI on perinatal depression and anxiety.

A systematic search was conducted in PubMed, PsycINFO, Medline, Scopus, and Web of Science for English-language journal articles from the first available date until Oct 27th, 2022.

Twenty-five published RCTs were identified and reviewed, with a total of 2495 perinatal women. MBI was superior to controls for clinical and subthreshold perinatal depression and anxiety. The benefit for depression reduction was stable over time and sustained to the postpartum period, but the maintenance effect on perinatal anxiety was less conclusive. Moreover, MBI's post-intervention effects on depression and anxiety were moderated by perinatal women's symptom severity. The post intervention effects were significantly greater among women in Low- and Middle-Income countries, where perinatal mental health care is less available and accessible. Greater improvement in mindfulness was also associated with a significantly larger post-intervention effect on perinatal depression.

This meta-analysis suggests that MBIs may complement and extend the available range of effective interventions for clinical and subthreshold perinatal depression and anxiety.

Depression and anxiety contribute to an estimated 74.6 million years of life with disability, and 80% of this burden occurs in low- and middle-income countries (LMICs), where there is a large gap in care.

We aimed to systematically synthesize available evidence and quantify the effectiveness of digital mental health interventions in reducing depression and anxiety in LMICs.

In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases from the inception date to February 2022. We included randomized controlled trials conducted in LMICs that compared groups that received digital health interventions with controls (active control, treatment as usual, or no intervention) on depression or anxiety symptoms. Two reviewers independently extracted summary data reported in the papers and performed study quality assessments. The outcomes were postintervention measures of depression or anxiety symptoms (Hedges g). We calculated the pooled effect size weighted by inverse variance.

Among 11,196 retrieved records, we included 80 studies in the meta-analysis (12,070 participants n=6052, 50.14% in the intervention group and n=6018, 49.85% in the control group) and 96 studies in the systematic review. The pooled effect sizes were -0.61 (95% CI -0.78 to -0.44; n=67 comparisons) for depression and -0.73 (95% CI -0.93 to -0.53; n=65 comparisons) for anxiety, indicating that digital health intervention groups had lower postintervention depression and anxiety symptoms compared with controls. Although heterogeneity was considerable (I²=0.94 for depression and 0.95 for anxiety), we found notable sources of variability between the studies, including intervention content, depression or anxiety symptom severity, control type, and age. Grading of Recommendations, Assessments, Development, and Evaluation showed that the evidence quality was overall high.

Digital mental health tools are moderately to highly effective in reducing depression and anxiety symptoms in LMICs. Thus, they could be effective options to close the gap in depression and anxiety care in LMICs, where the usual mental health care is minimal.

PROSPERO CRD42021289709; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=289709.

Mindfulness-based interventions (MBIs) delivered via the Internet become increasingly popular for improving maternal mental health, but the effectiveness of internet-delivered MBIs (iMBIs) is still unclear.

PubMed, PsycINFO, Embase, Scopus, CINAHL, and Cochrane Central Register of Controlled Trials were searched. We included studies that were randomized controlled trials (RCTs), quasi-experimental study design, and pre-post test design and contained information on the population of interest (women during pregnancy or within one year after delivery), intervention contents (mindfulness components), and intervention delivery formats (internet-based). ROBINS-I and RoB 2 were used to rate the risk of bias in non-RCTs and RCTs, respectively.

Eleven studies composed of six RCTs and five non-RCTs were included. The overall risk of bias was high. IMBIs are effective in improving maternal depression and mindfulness and self-compassion. However, limited by the small number of studies included in the review, effect sizes of iMBIs cannot be estimated. Characteristics of iMBIs (delivery formats, duration, et al.) and studies (study design, measures et al.) were described.

iMBIs are still in the initial stage. Studies with rigorous study design and larger sample size, and determining the optimal delivery formats and duration and intensity of interventions are necessary.

To address the lack of mental health practitioners in developing countries, the current study explored the feasibility of a newly developed self-guided digital intervention program TEA (training for emotional adaptation) in alleviating depressive and anxiety symptoms, as one of a few studies which adapted from theoretical models with effective intervention techniques.

The first part of this study involved 11 professional mental health practitioners giving feedback on the feasibility of the TEA; while the second part involved a mixed-method single-arm study with 32 participants recruited online, who went through the seven intervention sessions within 14 days. The questionnaires were collected before, after, 14 days after, and 30 days after intervention. Additionally, 10 participants were invited to semi-structured interviews regarding their suggestions.

Practitioners thought that the TEA showed high professionalism (8.91/10) and is suitable for treating emotional symptoms (8.09/10). The generalized estimating equation model showed that the TEA significantly reduced participants' depressive and anxiety symptoms, while the effects of the intervention remained 30 days post intervention (Cohen's d > 1). Thematic analysis revealed three main themes about future improvement, including content improvement, interaction improvement, and bug-fixing.

To address the current needs for digital mental health intervention programs to account for the insufficient availability of mental health services in China, the current study provides preliminary evidence of the effectiveness of TEA, with the potential to address the urgent need for remote mental health services.

The study was registered at the Chinese Clinical Trial Register (ChiCTR), with number [ChiCTR2200065944].

Studies on guided internet-delivered treatment have demonstrated promising results for patients with depressive disorder.

The aim of this study was to provide an overview of this research area and identify potential gaps in the research.

In this scoping review, web-based databases were used to identify research papers published between 2010 and 2022 where guided internet-delivered treatment was administered to participants with depressive disorders, a standardized rating scale of depressive symptoms was used as the primary outcome measure, and the treatment was compared with a control condition.

A total of 111 studies were included, and an overview of the studies was provided. Several gaps in the research were identified regarding the design of the studies, treatments delivered, participant representation, and treatment completion.

This review provides a comprehensive overview of the research area, and several research gaps were identified. The use of other designs and active control conditions is recommended. Future studies should provide access to treatment manuals, and more replications should be conducted. Researchers should aim to include underrepresented populations and provide reports of comorbidities. Definitions of adequate dosage, reports of completion rates, and reasons for treatment dropout are recommended for future studies.

This study systematically evaluates the effect of mindfulness meditation on depression during pregnancy. We provide evidence-based suggestions for preventing and reducing depression during pregnancy by exploring the most effective intervention mode, cycle, and frequency of mindfulness meditation.

Records were retrieved from PubMed, Web of Science, EBSCO, and Science Direct. A total of 1,612 randomized controlled trial studies on the effect of mindfulness meditation on pregnancy depression were collected. 10 studies with 658 subjects meeting the inclusion criteria were extracted and analyzed by Revman 5.3 to evaluate study qualities. Stata 12.0 was used for the meta-analysis.

Mindfulness meditation had a positive effect on depression during pregnancy [standardized difference of the mean (SMD) = -0.786, 95% confidence interval (-1.289, -0.283), P < 0.001]. Subgroup analysis showed that mindfulness-based cognitive therapy (MBCT) had the best intervention effect on depression during pregnancy (SMD = 2.795), the best intervention duration was below 4 weeks (SMD = 1.756), applied from the first to the third stage of pregnancy (SMD = 1.024), the frequency guided by experts was less than six times a week (SMD = 2.055) of <60 min each time (SMD = 1.068), and completing homework by themselves every day for 30 mins (SMD = 1.822) was most significant for the improvement of depression during pregnancy. We found high heterogeneity across studies [q = 97.003, DF = 10, I2 = 88.0% (P < 0.001), I2 > 75%]. This may be caused by variance in measurement tools, among which Beck Depression Inventory-II was a significant source of heterogeneity.

Mindfulness meditation can improve the prevention, remission, and reduction of depression during pregnancy and can be used as an auxiliary measure for the clinical treatment of pregnancy depression.

Postpartum depression and anxiety (PPDA) is experienced by up to 20% of families in the first year. The condition impacts not only parents but also their developing child. While mindfulness-based interventions (MBI) have shown to be beneficial for this population, many parents do not have access to treatment or find it challenging to commit or complete the treatment. The COVID-19 pandemic has heightened some of the challenges that parents face. The ability to find time for needed self-care and health interventions is also affected by limited childcare support. The opportunity to attend a group online may significantly improve the accessibility to group MBI but may also bring challenges. This study aims to examine the feasibility and acceptability of online MBI groups for parents in families affected with PPDA.

In this feasibility study, participants will include mothers diagnosed with PPDA and their partners. Two online MBI groups will run simultaneously for 8 weeks: one for mothers with PPDA and another one for their partners. The primary outcome will be feasibility of conducting the online groups, assessed from the facilitators' perspective, participants' perspective and attrition throughout the study. The participants' perspectives on feasibility will be assessed by questions including how difficult it was for them to make it to the sessions, specific obstacles encountered and their scheduling preferences. The facilitators' perspective will be assessed by frequency of technical difficulties encountered, of disruptions in the online sessions and of episodes where parents leave the screen (eg, to calm their child). Secondary outcomes will include mental health, couple relationship, satisfaction and acceptability which will also be evaluated through participant questionnaires.

The study has received ethics approval from the University of British Columbia Children's and Women's Research Ethics Board. Study results will be disseminated through peer-reviewed journals and conferences.

NCT04617132.

Perinatal depression can result in short- and long-term adverse effects for women and their children if untreated. Psychological interventions, the preferred treatment for most women with perinatal depression, can also be provided online.

This study aimed to provide a comprehensive and systematic review of Internet-based psychological interventions and to evaluate their effectiveness in the treatment of perinatal depression.

Systematic review and meta-analysis.

A systematic literature search was conducted of six databases, including CINAHL, PubMed, Embase, Web of Science, the Cochrane Library and PsycINFO. Depression and anxiety, which were the primary and secondary results of this search, were presented as standardised mean differences (SMD) and 95% confidence intervals (CIs). This review was conducted according to the PRISMA checklist.

Thirteen studies involving 2158 perinatal women were included. Content, method, duration and frequency of Internet-based psychological interventions were varied. Participants indicated a high rate of satisfaction with these interventions; participants' dropout rates ranged from 2.6% to 60.8%. Meta-analysis demonstrated that Internet-based psychological interventions improved perinatal depression (SMD = -0.72, CI = [-1.02, -0.42], p < .01) and anxiety symptoms (SMD = -0.52, CI = [-0.73, -0.30], p < .01), with heterogeneity of 86% and 59%, respectively.

Internet-based psychological interventions are considered as convenient and effective alternative treatment for perinatal depression and anxiety. In the future, additional studies are needed to investigate the long-term effects of these interventions on the mental health of perinatal women and the effects on the growth and development of infants while controlling for the dropout rate.

Internet-based psychological interventions are innovative approaches to improving perinatal depressive symptoms that can leverage mental health resources and improve accessibility while promoting multidisciplinary integration. The approach, content, frequency and duration of intervention should be considered comprehensively to achieve the objectives of the intervention while maintaining compliance of women with perinatal depression.

The current review aims to (1) investigate the effectiveness of Internet-based psychological intervention in reducing depressive, anxiety, and stress symptoms and fear of childbirth among pregnant women at post-intervention and follow-up; (2) compare the effects of the intervention using different psychological principles; and (3) explore potential covariates on the intervention effect.

A literature search of seven databases was carried out to identify published and unpublished randomized controlled trials (RCTs) in English without any time limitation up to February 2021. Meta-analysis and meta-regression were conducted using Comprehensive Meta-analysis software. This review protocol was registered on PROSPERO (CRD42021235565).

Sixteen RCTs involving 3894 pregnant women were included from more than 23 countries. Internet-delivered psychological interventions were found to significantly (p < 0.05) reduce depressive (g = -0.16 to -0.32) and anxiety (g = -0.22 to -0.33) symptoms with small effect sizes at post-intervention and follow-up during 6 to 8 weeks postpartum compared with those in the comparator group. However, there was insufficient evidence for fear of childbirth and stress symptoms. Our subgroup analyses found that psychological interventions adopting component of cognitive behavioral therapy (g = -0.29) or mindfulness therapy (g = -0.62) showed beneficial effects to improve depressive symptoms among pregnant women. Univariate random-effect regression analyses showed that the attrition rate was a significant covariate (Z = -2.33, p = 0.02) on depressive symptoms. The certainty of main outcomes was graded from low to very low in accordance with the GRADE criteria.

Our reviews suggested that Internet-delivered psychological intervention may complement usual antenatal care in the improvement of depressive and anxiety symptoms. Future trials involving a large-scale sample are needed to improve the methodological quality.

The effectiveness of mindfulness-based interventions (MBIs) on the mental health of perinatal women with or without current mental health issues remains unclear.

Four electronic databases were searched from inception to October 1, 2021. Data synthesis, sensitivity analysis, subgroup analysis, and quality assessment were performed on the included studies. I² and Q tests were applied to evaluate heterogeneity across studies. The risk of publication bias was assessed and visualized using a funnel plot.

A total of 21 RCTs with 1765 perinatal women were enrolled in the meta-analysis. We found MBIs were effective in reducing depression, anxiety, and stress, as well as increasing mindfulness in perinatal women with current mental health issues. However, MBIs were not prior to controls in reducing depression and stress, and increasing mindfulness in perinatal women without current mental health issues. The effectiveness of MBIs on reducing anxiety in perinatal women without current mental health issues was unclear.

Considerable heterogeneity was found in the pooled analyses of the RCTs in depression and anxiety in perinatal women with mental health issues and stress in perinatal women without mental health issues.

MBIs could serve as a useful addition to existing support for perinatal women with current mental health issues. However, further studies were needed to explore and prove the effectiveness of MBIs on the mental health of perinatal women without current mental health.

Antepartum depressive symptoms (ADS) are highly prevalent and may affect the mother and child. Cognitive-behavioural therapy and interpersonal therapy are effective psychological interventions for depression. However, low adherence and high attrition rates in studies of prevention and treatment of antepartum depression suggest that these approaches might not be entirely suitable for women with mild/moderate ADS. Considering the protective association between resilience and ADS, women with ADS might benefit more from interventions focusing on promotion of mental well-being and resilience.

We aimed to provide an overview of studies evaluating the effectiveness of antepartum resilience-enhancing interventions targeting the improvement of ante- and postpartum depressive symptoms. We also investigated whether these interventions improve resilience and resilience factors in the peripartum period.

We conducted a systematic review, using PRISMA guidelines. Studies were eligible for inclusion when they utilised a randomised controlled trial or quasi-experimental design, studied pregnant women with ADS, and implemented psychological interventions that (a) aimed to reduce maternal ADS and/or prevent peripartum major depression, and (b) addressed one or more psychological resilience factors.

Five of the six included cognitive-behavioural therapy interventions and all four mindfulness-based interventions were effective in reducing peripartum depressive symptoms and/or the incidence of depression. However, the methodological quality of most of the included studies was low to moderate. Only three studies assessed change in resilience factors.

Resilience-enhancing interventions might be beneficial for mental well-being of pregnant women with ADS, although more rigorously designed intervention studies are needed.

Postpartum depression (PPD) is a public health problem that has significant adverse effects on mothers, couple's relationships, newborn neurodevelopment, and child emotional and cognitive development. This study reviewed the effectiveness of telemedicine interventions in postparturient women with postpartum depression.

To evaluate the effectiveness of telemedicine intervention in women with postpartum depression.

Cochrane Library, PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO were searched for relevant articles published between 2003 and March 2021. We also manually reviewed the reference lists of the retrieved articles. The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias for individual studies was evaluated according to the Cochrane Handbook. RevMan 5.4 software was used to carry out the meta-analysis.

The meta-analysis included 20 randomized controlled trials with a total of 3252 patients. The results demonstrated that telemedicine was an effective intervention for treating PPD and anxiety and for improving functional impairment in women during their postpartum period.

This meta-analysis provided evidence that telemedicine was an effective intervention for treating PPD in women. Telemedicine also has significant effects on anxiety and improved functional impairment in women during their postpartum period. Our findings may provide accurate evidence-based guidance for postpartum women's mental health management. In the future, more high-quality studies are required for verifying these results.

Pregnancy is associated with an increased risk for depression, anxiety, and insomnia. eHealth interventions provide a promising and accessible treatment alternative to face-to-face interventions.

The objective of this systematic review and meta-analysis is to determine the effectiveness of eHealth interventions in preventing and treating depression, anxiety, and insomnia during pregnancy. Secondary aims are to identify demographic and intervention moderators of effectiveness.

A total of 5 databases (PsycINFO, Medline, CINAHL, Embase, and Cochrane) were searched from inception to May 2021. Terms related to eHealth, pregnancy, randomized controlled trials (RCTs), depression, anxiety, and insomnia were included. RCTs and pilot RCTs were included if they reported an eHealth intervention for the prevention or treatment of depression, anxiety, or insomnia in pregnant women. Study screening, data extractions, and quality assessment were conducted independently by 2 reviewers from an 8-member research team (KAS, PRS, Hangsel Sanguino, Roshni Sohail, Jasleen Kaur, Songyang (Mark) Jin, Makayla Freeman, and Beatrice Valmana). Random-effects meta-analyses of pooled effect sizes were conducted to determine the effect of eHealth interventions on prenatal mental health. Meta-regression analyses were conducted to identify potential moderators.

In total, 17 studies were included in this review that assessed changes in depression (11/17, 65%), anxiety (10/17, 59%), and insomnia (3/17, 18%). Several studies included both depression and anxiety symptoms as outcomes (7/17, 41%). The results indicated that during pregnancy, eHealth interventions showed small effect sizes for preventing and treating symptoms of anxiety and depression and a moderate effect size for treating symptoms of insomnia. With the exception of intervention type for the outcome of depressive symptoms, where mindfulness interventions outperformed other intervention types, no significant moderators were detected.

eHealth interventions are an accessible and promising resource for treating symptoms of anxiety, depression, and insomnia during pregnancy. However, more research is necessary to identify ways to increase the efficacy of eHealth interventions for this population.

PROSPERO (International Prospective Register of Systematic Reviews) CRD42020205954; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205954.

Symptoms of anxiety are common in pregnancy, with severe symptoms associated with negative outcomes for women and babies. Low-level psychological therapy is recommended for women with mild to moderate anxiety, with the aim of preventing an escalation of symptoms and providing coping strategies. Remotely delivered interventions have been suggested to improve access to treatment and support and provide a cost-effective, flexible, and timely solution.

This study identifies and evaluates remotely delivered, digital, or web-based interventions to support women with symptoms of anxiety during pregnancy.

This mixed methods systematic review followed a convergent segregated approach to synthesize qualitative and quantitative data. The ACM Digital Library, Allied and Complementary Medicine Database, Applied Social Sciences Index and Abstracts, Centre for Reviews and Dissemination database, the Cochrane Central Register of Controlled Trials, the Cochrane Library, CINAHL, Embase, Health Technology Assessment Library, IEEE Xplore, Joanna Briggs Institute, Maternity and Infant Care, MEDLINE, PsycINFO, and the Social Science Citation Index were searched in October 2020. Quantitative or qualitative primary research that included pregnant women and evaluated remotely delivered interventions reporting measures of anxiety, fear, stress, distress, women's views, and opinions were included.

Overall, 3 qualitative studies and 14 quantitative studies were included. Populations included a general antenatal population and pregnant women having anxiety and depression, fear of childbirth, insomnia, and preterm labor. Interventions included cognitive behavioral therapy, problem solving, mindfulness, and educational designs. Most interventions were delivered via web-based platforms, and 62% (8/13) included direct contact from trained therapists or coaches. A meta-analysis of the quantitative data found internet-based cognitive behavioral therapy and facilitated interventions showed a beneficial effect in relation to the reduction of anxiety scores (standardized mean difference -0.49, 95% CI -0.75 to -0.22; standardized mean difference -0.48, 95% CI -0.75 to -0.22). Due to limitations in the amount of available data and study quality, the findings should be interpreted with caution. Synthesized findings found some evidence to suggest that interventions are more effective when women maintain regular participation which may be enhanced by providing regular contact with therapists or peer support, appropriate targeting of interventions involving components of relaxation and cognitive-based skills, and providing sufficient sessions to develop new skills without being too time consuming.

There is limited evidence to suggest that women who are pregnant may benefit from remotely delivered interventions. Components of interventions that may improve the effectiveness and acceptability of remotely delivered interventions included providing web-based contact with a therapist, health care professional, or peer community. Women may be more motivated to complete interventions that are perceived as relevant or tailored to their needs. Remote interventions may also provide women with greater anonymity to help them feel more confident in disclosing their symptoms.

In today's society, people are experiencing the rapid development of digitalisation. Expecting parents may have difficulties evaluating the information online; they are not always sure which sources of information are trustworthy, and this exacerbates their feelings of anxiety. More research is needed to broaden the knowledge about how their use of digital sources may influence their health.

The focus of this study was to explore expecting parents' use of digital sources and how this influences their health during pregnancy.

A systematic review covered the thematic analysis of 39 articles.

The analysis resulted in the following theme: The digitalised society involves both opportunities and challenges, and expecting parents express a need for a variety of digital sources to improve their health, and sub-themes: Digital sources could promote parents' health and well-being in a digitalised society; Consuming digital health information facilitates understanding, different feelings and social connections; and A variety of digital sources may facilitate parental identification and adaption to parenthood.

Different digital sources in our digitalised society mean access to information and opportunities to extend social connections for expecting parents. This can promote their ability to understand and adapt to parenthood, as well as to improve their health and well-being and make the parental transition. However, professional support during face-to-face consultations cannot always be exchanged to digital sources. It is important to base digital sources devoted to expecting parents and digitalisation overall on multi-sectorial collaborations and coordination between different organisations and the digital sources they provide.

Background: Parents use digital sources (such as the internet or online forums and applications) during pregnancy and after childbirth to receive informative support. Research shows that there is further need for innovation development in digital parental support despite informative support available in digital form. Purpose: To explore parents' perceptions of future digital parental support concerning pregnancy and the first 18 months of parenthood. Method: A phenomenographic interview study with an inductive approach including 15 semi-structured interviews was conducted. Results: The analysis process resulted in three descriptive categories: Opportunities for virtual and in-person meetings, Individualized digital parental support, and Professional knowledge and trustworthiness concerning future digital parental support. Conclusion: The results broaden the knowledge about how future digital parental support can be designed to facilitate the functional, interactive, and critical digital health literacy of new and would-be parents. To succeed, healthcare organizations should allow healthcare professionals to assume an active role in developing digital parental support, both as health educators (i.e., providing parents with knowledge) and facilitators (i.e., facilitating parents' use of digital parental support). However, parents perceived that future digital parental support should complement standard care instead of replacing in-person meetings with healthcare professionals.

Given their growing popularity, mindfulness practices including meditation are actively being studied in clinical trials to assess their efficacy at improving health outcomes during pregnancy and the postpartum period. We conducted a literature review to compile these studies and assessed their findings. There is sufficient evidence to support the practice of mindfulness practices in pregnancy to reduce anxiety, depression, and stress during pregnancy, which may continue to have beneficial effects through the postpartum period. There is limited evidence on the benefits of mindfulness and meditation for other aspects of pregnancy. However, due to the low-risk nature of these techniques, all women should be encouraged to engage in mindfulness practices during pregnancy.

Pregnant adolescent women increasingly seek support during pregnancy and the puerperium through digital platforms instead of the traditional support system of family, friends, and the community. However, it is uncertain whether digital, web-based tools are reliable and effective in providing information to the user on a variety of topics such as fetal development, pregnancy outcomes, delivery, and breastfeeding to improve maternal and infant outcomes.

We aimed to identify web-based tools designed to promote knowledge, attitudes, and skills of pregnant adolescents or adolescent mothers and determine the efficacy of such web-based tools compared with conventional resources in promoting good pregnancy and infant outcomes.

A systematic search was conducted using Medline, Scopus, CINAHL, and PsycINFO for articles published from January 2004 to November 2020 to identify randomized trials and observational studies that evaluated digital, web-based platforms to deliver resources to pregnant adolescents. All articles written in the author's languages were included. Two authors independently reviewed abstracts and full-text articles for inclusion and assessed study quality. Risk of bias in each study was assessed using appropriate tools recommended by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) and the Joanna Briggs Institute. We adopted a qualitative synthesis and presented the results in a narrative format due to the heterogenous nature of the studies.

Seven articles met the inclusion criteria and were analyzed. The majority of the studies were graded to be of low to moderate risk for bias. The research methodologies represented were varied, ranging from randomized (n=1) and nonrandomized controlled trials (n=1) and prospective cohort studies (n=1) to mixed methods studies (n=1) and longitudinal surveys (n=3). Four studies included active web-based interventions, and 3 described exposure to web-based tools, including the use of social media and/or other internet content. Web-based tools positively influenced treatment-seeking intentions (intervention 17.1%, control 11.5%, P=.003) and actual treatment-seeking behavior for depression among postpartum adolescents (intervention 14.1%, control 6.5%, P<.001). In contrast, readily available information on the internet may leave adolescents with increased anxiety. The critical difference lies in information curated by health care professionals specifically to address targeted concerns versus self-acquired data sourced from various websites.

Despite almost universal web use, few studies have used this platform for health promotion and disease prevention. Social media interventions or web-based tools have the potential to positively influence both maternal and infant outcomes in adolescent pregnancy, but there is a need for more well-conducted studies to demonstrate the effectiveness of these support programs. The vastness of the information available on the web limits the ability of health care professionals to monitor or control sources of information sought by patients. Thus, it is important to create professionally curated platforms to prevent or limit exposure to potentially misleading or harmful information on the internet while imparting useful knowledge to the user.

PROSPERO International Prospective Register of Systematic Reviews CRD42020195854; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=195854.

There is a need to regularly update the evidence base on the effectiveness of online mindfulness-based interventions (MBIs), especially considering how fast this field is growing and developing.

This study presents an updated meta-analysis of randomized controlled trials assessing the effects of online MBIs on mental health and the potential moderators of these effects.

We conducted a systematic literature search in PsycINFO, PubMed, and Web of Science up to December 4, 2020, and included 97 trials, totaling 125 comparisons. Pre-to-post and pre-to-follow-up between-group effect sizes (Hedges g) were calculated for depression, anxiety, stress, well-being, and mindfulness using a random effects model.

The findings revealed statistically significant moderate pre-to-post effects on depression (g=0.34, 95% CI 0.18-0.50; P<.001), stress (g=0.44, 95% CI 0.32-0.55; P<.001), and mindfulness (g=0.40, 95% CI 0.30-0.50; P<.001) and small effects on anxiety (g=0.26, 95% CI 0.18-0.33; P<.001). For well-being, a significant small effect was found only when omitting outliers (g=0.22, 95% CI 0.15-0.29; P<.001) or low-quality studies (g=0.26, 95% CI 0.12-0.41; P<.001). Significant but small follow-up effects were found for depression (g=0.25, 95% CI 0.12-0.38) and anxiety (g=0.23, 95% CI 0.13-0.32). Subgroup analyses revealed that online MBIs resulted in higher effect sizes for stress when offered with guidance. In terms of stress and mindfulness, studies that used inactive control conditions yielded larger effects. For anxiety, populations with psychological symptoms had higher effect sizes. Adherence rates for the interventions ranged from 35% to 92%, but most studies lacked clear definitions or cut-offs.

Our findings not only demonstrate that online MBIs are booming but also corroborate previous findings that online MBIs are beneficial for improving mental health outcomes in a broad range of populations. To advance the field of online MBIs, future trials should pay specific attention to methodological quality, adherence, and long-term follow-up measurements.

Social networking platforms offer a wide reach for public health interventions allowing communication with broad audiences using tools that are generally free and straightforward to use and may be combined with other components, such as public health policies. We define interactive social media as activities, practices, or behaviours among communities of people who have gathered online to interactively share information, knowledge, and opinions.

We aimed to assess the effectiveness of interactive social media interventions, in which adults are able to communicate directly with each other, on changing health behaviours, body functions, psychological health, well-being, and adverse effects. Our secondary objective was to assess the effects of these interventions on the health of populations who experience health inequity as defined by PROGRESS-Plus. We assessed whether there is evidence about PROGRESS-Plus populations being included in studies and whether results are analysed across any of these characteristics.

We searched CENTRAL, CINAHL, Embase, MEDLINE (including trial registries) and PsycINFO. We used Google, Web of Science, and relevant web sites to identify additional studies and searched reference lists of included studies. We searched for published and unpublished studies from 2001 until June 1, 2020. We did not limit results by language.

We included randomised controlled trials (RCTs), controlled before-and-after (CBAs) and interrupted time series studies (ITSs). We included studies in which the intervention website, app, or social media platform described a goal of changing a health behaviour, or included a behaviour change technique. The social media intervention had to be delivered to adults via a commonly-used social media platform or one that mimicked a commonly-used platform. We included studies comparing an interactive social media intervention alone or as a component of a multi-component intervention with either a non-interactive social media control or an active but less-interactive social media comparator (e.g. a moderated versus an unmoderated discussion group). Our main outcomes were health behaviours (e.g. physical activity), body function outcomes (e.g. blood glucose), psychological health outcomes (e.g. depression), well-being, and adverse events. Our secondary outcomes were process outcomes important for behaviour change and included knowledge, attitudes, intention and motivation, perceived susceptibility, self-efficacy, and social support.

We used a pre-tested data extraction form and collected data independently, in duplicate. Because we aimed to assess broad outcomes, we extracted only one outcome per main and secondary outcome categories prioritised by those that were the primary outcome as reported by the study authors, used in a sample size calculation, and patient-important.

We included 88 studies (871,378 participants), of which 84 were RCTs, three were CBAs and one was an ITS. The majority of the studies were conducted in the USA (54%). In total, 86% were conducted in high-income countries and the remaining 14% in upper middle-income countries. The most commonly used social media platform was Facebook (39%) with few studies utilising other platforms such as WeChat, Twitter, WhatsApp, and Google Hangouts. Many studies (48%) used web-based communities or apps that mimic functions of these well-known social media platforms. We compared studies assessing interactive social media interventions with non-interactive social media interventions, which included paper-based or in-person interventions or no intervention. We only reported the RCT results in our 'Summary of findings' table. We found a range of effects on health behaviours, such as breastfeeding, condom use, diet quality, medication adherence, medical screening and testing, physical activity, tobacco use, and vaccination. For example, these interventions may increase physical activity and medical screening tests but there was little to no effect for other health behaviours, such as improved diet or reduced tobacco use (20,139 participants in 54 RCTs). For body function outcomes, interactive social media interventions may result in small but important positive effects, such as a small but important positive effect on weight loss and a small but important reduction in resting heart rate (4521 participants in 30 RCTs). Interactive social media may improve overall well-being (standardised mean difference (SMD) 0.46, 95% confidence interval (CI) 0.14 to 0.79, moderate effect, low-certainty evidence) demonstrated by an increase of 3.77 points on a general well-being scale (from 1.15 to 6.48 points higher) where scores range from 14 to 70 (3792 participants in 16 studies). We found no difference in effect on psychological outcomes (depression and distress) representing a difference of 0.1 points on a standard scale in which scores range from 0 to 63 points (SMD -0.01, 95% CI -0.14 to 0.12, low-certainty evidence, 2070 participants in 12 RCTs). We also compared studies assessing interactive social media interventions with those with an active but less interactive social media control (11 studies). Four RCTs (1523 participants) that reported on physical activity found an improvement demonstrated by an increase of 28 minutes of moderate-to-vigorous physical activity per week (from 10 to 47 minutes more, SMD 0.35, 95% CI 0.12 to 0.59, small effect, very low-certainty evidence). Two studies found little to no difference in well-being for those in the intervention and control groups (SMD 0.02, 95% CI -0.08 to 0.13, small effect, low-certainty evidence), demonstrated by a mean change of 0.4 points on a scale with a range of 0 to 100. Adverse events related to the social media component of the interventions, such as privacy issues, were not reported in any of our included studies. We were unable to conduct planned subgroup analyses related to health equity as only four studies reported relevant data.

This review combined data for a variety of outcomes and found that social media interventions that aim to increase physical activity may be effective and social media interventions may improve well-being. While we assessed many other outcomes, there were too few studies to compare or, where there were studies, the evidence was uncertain. None of our included studies reported adverse effects related to the social media component of the intervention. Future studies should assess adverse events related to the interactive social media component and should report on population characteristics to increase our understanding of the potential effect of these interventions on reducing health inequities.

COVID-19 can lead to increased psychological symptoms such as post-traumatic stress disorder (PTSD), depression, and anxiety among patients with COVID-19. Based on the previous mindfulness-based interventions proved to be effective, this protocol reports a design of a randomized controlled trial aiming to explore the efficacy and possible mechanism of a mindful living with challenge (MLWC) intervention developed for COVID-19 survivors in alleviating their psychological problems caused by both the disease and the pandemic.

In April 2021, more than 1600 eligible participants from Hubei Province of China will be assigned 1:1 to an online MLWC intervention group or a waitlist control group. All participants will be asked to complete online questionnaires at baseline, post-program, and 3-month follow-up. The differences of mental health status (e.g. PTSD) and physical symptoms including fatigue and sleeplessness between the COVID-19 survivors who receiving the online MLWC intervention and the control group will be assessed. In addition, the possible mediators and moderators of the link between the MLWC intervention and target outcomes will be evaluated by related verified scales, such as the Five Facets Mindfulness Questionnaire. Data will be analyzed based on an intention-to-treat approach, and SPSS software will be used to perform statistical analysis.

The efficacy and potential mechanism of MLWC intervention in improving the quality of life and psychological status of COVID-19 survivors in China are expected to be reported. Findings from this study will shed light on a novel and feasible model in improving the psychological well-being of people during such public health emergencies. Trial registration Chinese Clinical Trial Registry (ChiCTR), ChiCTR2000037524; Registered on August 29, 2020, http://www.chictr.org.cn/showproj.aspx?proj=60034 .