The effect of digital health interventions for postpartum depression or anxiety: a systematic review and meta-analysis of randomized controlled trials

LEWKOWITZ, Adam K.; WHELAN, Anna R.; AYALA, Nina K.; HARDI MLIS, Ms. Angela; STOLL, Ms. Carrie; BATTLE, Cynthia L.; TUULI, Methodius G.; RANNEY, Megan L.; MILLER, Emily S.

doi:10.1016/j.ajog.2023.06.028

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The effect of digital health interventions for postpartum depression or anxiety: a systematic review and meta-analysis of randomized controlled trials

1 2024
By LEWKOWITZ, Adam K. ; WHELAN, Anna R. ; AYALA, Nina K. ; ...
Source: Am J Obstet Gynecol. 230(1):12-43

Public Access Version Available on: January 01, 2025, 12:00 AM

Please check back on the date listed above.

English

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Details:

Alternative Title:

Am J Obstet Gynecol
Personal Author:

LEWKOWITZ, Adam K. ; WHELAN, Anna R. ; AYALA, Nina K. ; HARDI MLIS, Ms. Angela ; STOLL, Ms. Carrie ; ... More +

LEWKOWITZ, Adam K. ; WHELAN, Anna R. ; AYALA, Nina K. ; HARDI MLIS, Ms. Angela ; STOLL, Ms. Carrie ; BATTLE, Cynthia L. ; TUULI, Methodius G. ; RANNEY, Megan L. ; MILLER, Emily S. Less -
Description:

Objective:

To examine the effect of digital health interventions (DHIs) compared to treatment as usual (TAU) on preventing and treating postpartum depression (PPD) and postpartum anxiety (PPA).

Data Sources:

Searches in Ovid Medline, Embase, SCOPUS, Cochrane Database, and ClinicalTrials.gov for randomized controlled trials comparing DHIs to TAU for preventing or treating PPD and PPA. The primary outcome was the score on the first ascertainment of PPD or PPA symptoms after the intervention. Secondary outcomes included screening positive for PPD or PPA—as defined in the primary study—and loss to follow-up, defined as the proportion of participants who completed the final study assessment compared to the number who were initially randomized.

Methods of Study Selection:

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. For continuous outcomes, the Hedges method was used to obtain standardized mean differences (SMD) when the studies used different psychometric scales, and weighted mean differences (WMD) were calculated when studies used the same psychometric scales. For categorical outcomes, pooled relative risks (RR) were estimated.

Tabulation, Integration, and Results:

Of 921 studies originally identified, 31 randomized controlled trials—corresponding to 5,532 participants randomized to DHI and 5,492 participants randomized to TAU—were included. Compared to TAU, DHIs significantly reduced mean scores ascertaining PPD symptoms (29 studies: SMD −0.64 (95% Confidence Interval (CI): −0.88, −0.40), I2= 94.4%) and PPA symptoms (17 studies: SMD −0.49 (95% CI: −0.72, −0.25) ), I2= 84.6%). In the few studies that assessed screen-positive rates for PPD (n=4) or PPA (n=1), there was no significant differences between those randomized to DHI versus TAU. Overall, those randomized to DHI had 38% increased risk of not completing the final study assessment compared to those randomized to TAU (pooled RR 1.38 (95% CI 1.18, 1.62), but those randomized to app-based DHI had similar loss-to-follow-up rates as those randomized to TAU (RR 1.04 (95% Confidence Interval: 0.91, 1.19)).

Conclusion:

DHIs modestly, but significantly, reduced scores assessing PPD and PPA symptoms. More research is needed to identify DHIs that effectively prevent or treat PPD and PPA but encourage ongoing engagement throughout the study period.
Subjects:

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Anxiety Anxiety Disorders Depression Depression, Postpartum Digital Health Female Humans Randomized Controlled Trials As Topic
Keywords:

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Digital Health Intervention Internet Perinatal Mental Health Postpartum Anxiety Postpartum Depression Smartphone Application Text Message
Source:

Am J Obstet Gynecol. 230(1):12-43
Pubmed ID:

37330123
Pubmed Central ID:

PMC10721728
Document Type:

Journal Article
Funding:

K23 HD103961/HD/NICHD NIH HHSUnited States/ ; R01 HD081868/HD/NICHD NIH HHSUnited States/ ; R01 DA054698/DA/NIDA NIH HHSUnited States/ ; P20 GM139664/GM/NIGMS NIH HHSUnited States/ ; NU87PS004366/CC/CDC HHSUnited States/ ; ... More +

K23 HD103961/HD/NICHD NIH HHSUnited States/ ; R01 HD081868/HD/NICHD NIH HHSUnited States/ ; R01 DA054698/DA/NIDA NIH HHSUnited States/ ; P20 GM139664/GM/NIGMS NIH HHSUnited States/ ; NU87PS004366/CC/CDC HHSUnited States/ ; R01 HD104187/HD/NICHD NIH HHSUnited States/ ; R21 HD110912/HD/NICHD NIH HHSUnited States/ ; R34 DA055317/DA/NIDA NIH HHSUnited States/ ; P20 GM139767/GM/NIGMS NIH HHSUnited States/ ; R01 CE003267/CE/NCIPC CDC HHSUnited States/ ; R01 HD105499/HD/NICHD NIH HHSUnited States/ ; R01 HD093655/HD/NICHD NIH HHSUnited States/ Less -
Volume:

230
Issue:

1
Collection(s):

CDC Public Access
Main Document Checksum:

[+]

urn:sha-512:8d84aad082b89a7de82f915eca245838250d1d218c86d0c315d2bbd8b6731a4596724dfb11c289c2915ffe39db48ed8979eebd887870dca1a7b22469146c6ecd
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