Published online Apr 19, 2021. doi: 10.5498/wjp.v11.i4.133
Peer-review started: December 30, 2020
First decision: January 11, 2021
Revised: January 11, 2021
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: April 19, 2021
Perinatal women are at increased susceptibility of psychological problems, including depression, anxiety, and stress. Perinatal psychological problems are associated with considerable adverse effects on women, offspring, family, and healthcare services.
Previous reviews were limited to few selected trials, a mixture of different research designs, few databases, and only narrative synthesis. None of the previous reviews investigated the preferred features of digital psychotherapeutic intervention and the influence of covariates on study effect size.
This review aimed to synthesize the best evidence to (1) assess the effectiveness of digital psychotherapeutic intervention in reducing depression, anxiety, and stress symptoms; and (2) evaluate the preferred design features of the intervention.
A comprehensive three-step search strategy was conducted in congruence with the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions from eight databases. Comprehensive Meta-analysis 3.0 software was used to conduct meta- and meta-regression analyses. The individual and overall quality of the evidence were evaluated using the Cochrane risk-of-bias tool and the Grading of Recommenda
A total of 25 randomized controlled trials that included 3239 perinatal women were identified. Meta-analyses revealed that digital psychotherapeutic intervention significantly improved the depression (g = 0.49), anxiety (g = 0.25), and stress (g = 0.47) symptoms of perinatal women compared to the control. Subgroup analyses demonstrated that a website platform with ≥ eight therapist-guided sessions using the cognitive behavioral therapy theoretical principle was more effective than other treatments in postnatal women. Meta-regression analyses observed that the age of perinatal women and the type of psychotherapy had statistically significant effects on depression symptoms. Egger’s regression asymmetry tests found no publication biases, but the overall quality of evidence was very low.
This systematic review provides evidence for the effectiveness of digital psychothera
Given that the poor quality of the existing evidence reduced certainty in implementing digital psychotherapeutic intervention at this phase, further high-quality randomized controlled trials with large sample sizes are required to evaluate the sustainability of the intervention.