Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 3, 2021
Date Accepted: Dec 13, 2021
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Digitalized Cognitive Behavioral Interventions for Depression During Pregnancy: A Systematic Review
ABSTRACT
Background:
Studies have shown a high prevalence of depression during pregnancy and there is also evidence that cognitive behavior therapy (CBT) is one of the most effective psychosocial interventions. Emerging evidence from randomized controlled trials (RCTs) has shown that technology has been successfully harnessed to provide CBT interventions for other populations. However, very few studies have focused on their use during pregnancy.
Objective:
Our systematic review aimed to bring together the available research evidence on digitalized CBT interventions for depression during pregnancy. This approach has become increasingly important in many clinical areas, due to the COVID-19 pandemic, and our study aimed to expand the knowledge in this particular clinical area.
Methods:
A systematic review of the Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, PubMed, Embase, PsycINFO and Scopus databases was carried out from the earliest available evidence to 1 April 2021. Only peer-review RCT studies published in English were considered. The Preferred Reporting Items of Systematic Reviews and Meta-analyses guidelines were followed and the protocol was registered on the Prospective Register of Systematic Reviews. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials.
Results:
The review identified six studies from five countries, the USA, Australia, China, Norway and Sweden, published from 2015-2020. The sample sizes ranged from 25 to 1,342 participants. The interventions used various technological elements, including text, images, videos, games, interactive features and peer group discussions. They comprised two guided and four unguided approaches. Using digitalized CBT interventions for depression during pregnancy showed promising efficacy, with guided intervention showing higher effect sizes (Hedge’s g = 1.21) than the unguided interventions (Hedge’s g = 0.14 – 0.99). The acceptability of the digitalized CBT interventions was highly encouraging, based on user feedback. Attrition rates were low for the guided interventions (4.5 – 7.6%), but high for the unguided interventions (22.1 – 86.9%). All of the studies had a high overall risk of bias.
Conclusions:
Our search only identified a small number of digitalized CBT interventions for pregnant women, despite the potential of this approach. These showed promising evidence when it came to efficacy and positive outcomes for depression and user feedback was positive. Digitalized CBT interventions can provide prompt, effective evidence-based interventions for pregnant women. This review increases our understanding of the importance of digitalized interventions during pregnancy, including during the COVID-19 pandemic.
Citation
