Investigating the Effectiveness of Technology-Based Distal Interventions for Postpartum Depression and Anxiety: Systematic Review and Meta-Analysis
Authors: Brocklehurst Sarah P , Morse Alyssa R , Cruwys Tegan , Batterham Philip J , Leach Liana , Robertson Alysia M , Sahib Aseel , Burke Colette T , Nguyen Jessica , Calear Alison L 
Published: November 2024

Background
Postpartum anxiety and depression are common in new parents. While effective interventions exist, they are often delivered in person, which can be a barrier for some parents seeking help. One approach to overcoming these barriers is the delivery of evidence-based self-help interventions via websites, smartphone apps, and other digital media.

Objective
This study aims to evaluate the effectiveness of technology-based distal interventions in reducing or preventing symptoms of postpartum depression or anxiety in male and female birth and adoptive parents, explore the effectiveness of technology-based distal interventions in increasing social ties, and determine the level of adherence to and satisfaction with technology-based distal interventions.

Methods
A systematic review and series of meta-analyses were conducted. Three electronic bibliographic databases (PsycINFO, PubMed, and Cochrane Library) were searched for randomized controlled trials evaluating technology-based distal interventions for postpartum depression or anxiety in birth and adoptive parents. Searches were updated on August 1, 2023, before conducting the final meta-analyses. Data on trial characteristics, effectiveness, adherence, satisfaction, and quality were extracted. Screening and data extraction were conducted by 2 reviewers. Risk of bias was assessed using the Joanna Briggs Institute quality rating scale for randomized controlled trials. Studies were initially synthesized qualitatively. Where possible, studies were also quantitatively synthesized through 5 meta-analyses.

Results
Overall, 18 articles met the inclusion criteria for the systematic review, with 14 (78%) providing sufficient data for a meta-analysis. A small significant between-group effect on depression favored the intervention conditions at the postintervention (Cohen d=–0.28, 95% CI –0.41 to –0.15; P<.001) and follow-up (Cohen d=–0.27, 95% CI –0.52 to –0.02; P=.03) time points. A small significant effect on anxiety also favored the intervention conditions at the postintervention time point (Cohen d=–0.29, 95% CI –0.48 to –0.10; P=.002), with a medium effect at follow-up (Cohen d=–0.47, 95% CI –0.88 to –0.05; P=.03). The effect on social ties was not significant at the postintervention time point (Cohen d=0.04, 95% CI –0.12 to 0.21; P=.61). Effective interventions tended to be web-based cognitive behavioral therapy programs with reminders. Adherence varied considerably between studies, whereas satisfaction tended to be high for most studies.

Conclusions
Technology-based distal interventions are effective in reducing symptoms of postpartum depression and anxiety in birth mothers. Key limitations of the reviewed evidence include heterogeneity in outcome measures, studies being underpowered to detect modest effects, and the exclusion of key populations from the evidence base. More research needs to be conducted with birth fathers and adoptive parents to better ascertain the effectiveness of interventions in these populations, as well as to further assess the effect of technology-based distal interventions on social ties.

Trial Registration
PROSPERO CRD42021290525; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=290525