JMIR Publications

ABSTRACT

Background:

Since the onset of the COVID-19 pandemic, there has been an uptick in the use of tele-mental health interventions. However, evidence on the effectiveness and acceptability of these interventions for women has been scarce.

Objective:

This study aims to examine the acceptability and reported satisfaction with the effectiveness of telehealth care in women experiencing depression and anxiety.

Methods:

This systematic review and meta-analysis investigated studies comparing tele-mental health interventions and standard care for anxiety and depression in women. Electronic databases of published literature (e.g., PubMed/MEDLINE, EMBASE, Web of Science, PsycINFO, Cochrane Central Register of Clinical Trials) were searched between December 1st, 2019, and August 26th, 2025. Studies were included if they tested fully online telehealth interventions for depression or anxiety in women aged 18–64 years (≥80% female or reporting female-specific outcomes). Eligible designs included RCTs, non-randomized trials, and observational studies with ≥5 participants that used validated questionnaires to assess changes in depression, anxiety, and/or stress. A meta-analysis was performed for depression, anxiety, and stress outcomes using data from RCT studies with female participants. The studies' risk of Bias was evaluated using the Cochrane RoB2 and ROBINS-I tools, and the evidence quality was assessed using the GRADE criteria.

Results:

Fifty studies from across over 20 countries were included in this systematic review. Most studies reported high levels of effectiveness and satisfaction. Meta-analysis of 12 eligible studies (n=1248 participants) revealed significant benefits for anxiety (Hedge’s g = -0.48, 95% CI: -0.69 to -0.27, p<.001), stress (Hedge’s g -0.41, 95% CI: -0.79 to -0.03, p=.03), and depression (Hedge’s g = -0.67, 95% CI: -1.30 to -0.04, p=.04). Subgroup analyses showed significantly higher benefits for telehealth interventions compared to waitlist conditions (Hedge’s g = -0.69, 95% CI: -1.34 to -0.04, p=.04), but not standard care (e.g., face-to-face interventions) (Hedge’s g = -0.66, 95% CI: -1.64 to 0.32, p=0.19) for depression. However, telehealth interventions showed significant reductions in anxiety scores when compared to both waitlist and standard of care comparators (Hedge’s g = -0.59, 95%CI: -0.85 to -0.34, p<.001, and Hedge’s g = -0.41, 95%CI: -0.72 to -0.10, p=.01, respectively).

Conclusions:

Telehealth for mental health care is widely acceptable to women across diverse settings and shows efficacy when compared to both waitlist and standard care for anxiety and stress, and when compared to waitlist for depression. Thus, telehealth could be a valuable tool to improve access when traditional care settings are unavailable, to ensure greater access to mental health care for women in need. PROSPERO registration: CRD42022360516