Digitalized Cognitive Behavioral Interventions for Depressive Symptoms During Pregnancy: Systematic Review
Open accessPublished version of a preprint
Abstract
Background: Studies have shown a high prevalence of depression during pregnancy, and there is also evidence that cognitive behavioral 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. 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. Objective: Our systematic review aimed to bring together the available research-based evidence on digitalized CBT interventions for depression symptoms during pregnancy. Methods: A systematic review of the Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, Embase, PsycINFO, Scopus, ClinicalTrials.gov, and EBSCO Open Dissertations databases was carried out from the earliest available evidence to October 27, 2021. Only RCT studies published in English were considered. The PRISMA (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 7 studies from 5 countries (the United States, China, Australia, Norway, and Sweden) published from 2015 to 2021. The sample sizes ranged from 25 to 1342 participants. The interventions used various technological elements, including text, images, videos, games, interactive features, and peer group discussions. They comprised 2 guided and 5 unguided approaches. Using digitalized CBT interventions for depression during pregnancy showed promising efficacy, with guided intervention showing higher effect sizes (Hedges g=1.21) than the unguided interventions (Hedges 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 intervention (4.5%) but high for the unguided interventions (22.1%-46.5%). A high overall risk of bias was present for 6 of the 7 studies. 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 symptoms, and user feedback was positive. However, the overall risk of bias suggests that the efficacy of the interventions needs to be interpreted with caution. Future studies need to consider how to mitigate these sources of biases. 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. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020216159; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216159
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Yunus et al found efficacy of digitalized interventions for depression in pregnant women and included studies from before the pandemic.
“Yunus et al [41] found efficacy of digitalized interventions for depression in pregnant women and included studies from before the pandemic.”
From Effectiveness of Online and Remote Interventions for Mental Health in Children, Adolescents, and Young Adults After the Onset of the COVID-19 Pandemic: Systematic Review and Meta-Analysis (2024) · cites this paper as [41]
The Abstract Results report that the review included studies published from 2015 to 2021, so it included pre-pandemic studies. The Discussion’s Principal Findings describe promising evidence for digitalized CBT in pregnant women, but say the limited evidence and high risk of bias prevented firm conclusions about efficacy; “found efficacy” overstates that finding. (LLM, conf=0.86)
Experimental — accuracy not yet measuredA review found digitalized CBT interventions reduce depressive symptoms in pregnant women.
“For adults, a review found digitalized CBT interventions to reduce depressive symptoms in pregnant women [41].”
From Effectiveness of Online and Remote Interventions for Mental Health in Children, Adolescents, and Young Adults After the Onset of the COVID-19 Pandemic: Systematic Review and Meta-Analysis (2024) · cites this paper as [41]
The Discussion’s Principal Findings report promising evidence of improved depressive symptoms in pregnant women receiving digitalized CBT. But the review says the limited evidence and high risk of bias in six of seven studies prevented firm conclusions about efficacy; the claim presents symptom reduction more definitively than the source does. (LLM, conf=0.86)
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- Authors
- Wan Mohd Yunus, W. M. A., Matinolli, H.-M., Waris, O., Upadhyaya, S., Vuori, M., Korpilahti-Leino, T., Ristkari, T., Koffert, T., & Sourander, A.
- Affiliations
- University of Turku (FI)
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2022-02-23
- Volume
- 24
- Issue
- 2
- Pages
- e33337
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC8908191
- OpenAlex
- W4200498959
- Cited by
- 26
- References
- 86
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 3 · 2023: 4 · 2022: 1
- FWCI
- 0.31
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- antenatal depression, cognitive behavioral therapy, digital interventions, mobile health, attrition, acceptability, COVID-19 pandemic, maternal mental health, peer discussion, video-based intervention, interactive features, user feedback, risk of bias, effect size, attrition rates, pregnancy outcomes, child outcomes
- MeSH terms
- COVID-19, SARS-CoV-2, Cognition, Depression, Female, Humans, Pregnancy, Cognitive Behavioral Therapy
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