The following is a summary of “Effect of digital health interventions on postpartum depression or anxiety: a systematic review and meta-analysis of randomized controlled trials,” published in the January 2024 issue of Obstetrics and Gynecology by Lewkowitz, et al.
For a study, researchers sought to assess the impact of digital health interventions compared to standard treatment on the prevention and treatment of postpartum depression and postpartum anxiety.
A comprehensive search was conducted across multiple databases, including Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Full-text randomized controlled trials were included in the systematic review. These trials compared digital health interventions with standard treatment for the prevention or treatment of postpartum depression and postpartum anxiety. Two authors independently screened all abstracts for eligibility and reviewed potentially eligible full-text articles. A third author resolved discrepancies as needed. The primary outcome was the score on the initial assessment of postpartum depression or anxiety symptoms after the intervention. Secondary outcomes included screening positive for postpartum depression or anxiety and loss of follow-up. The Hedges method was used for standardized mean differences, and weighted mean differences were calculated for continuous outcomes. Pooled relative risks were estimated for categorical outcomes.
Out of 921 initially identified studies, 31 randomized controlled trials were included, encompassing 5,532 participants randomized to digital health intervention and 5,492 participants to treatment as usual. Digital health interventions significantly decreased mean scores assessing postpartum depression symptoms (29 studies: standardized mean difference, -0.64 [95% CI, -0.88 to -0.40]; I2=94.4%) and postpartum anxiety symptoms (17 studies: standardized mean difference, -0.49 [95% CI, -0.72 to -0.25]; I2=84.6%) compared to treatment as usual. However, in the few studies assessing screen-positive rates for postpartum depression (n=4) or postpartum anxiety (n=1), no significant differences were observed between digital health intervention and treatment as usual. Overall, individuals randomized to digital health intervention had a 38% higher risk of not completing the final study assessment than those receiving treatment as usual (pooled relative risk, 1.38 [95% CI, 1.18–1.62]). However, those randomized to app-based digital health intervention showed similar rates of loss to follow-up as those receiving treatment as usual (relative risk, 1.04 [95% Cl, 0.91–1.19]).
Digital health interventions demonstrated a modest yet significant reduction in scores assessing postpartum depression and postpartum anxiety symptoms. However, further research was warranted to identify digital health interventions that effectively prevent or treat these conditions while promoting sustained engagement throughout the study duration.
Reference: ajog.org/article/S0002-9378(23)00420-9/abstract
