The effectiveness of online psychotherapy interventions for the treatment of perinatal mental health disorders: A systematic review

Background: There is a wide spectrum of perinatal mental health (PMH) disorders including anxiety, depression, stress, compulsive disorders. Post-Traumatic Stress Disorder (PTSD), mania and postpartum psychosis. Up to twenty percent of women are found to be suffering from anxiety and or depression during pregnancy and the first three months postnatally. Maternal mental health can have an impact on the infant both antenatally and throughout the life course, with social, emotional and cognitive consequences. Therefore, there is a critical need for evidence-based interventions which address PMH disorders. At present, cognitive behavioural therapy (CBT) and Eye movement Desensitisation and Reprocessing Therapy (EMDR) are the most commonly used therapies. They remain the only approved psychotherapies for PTSD in the perinatal period by The National Institute for Health Care Excellence (NICE).
Objective: To assess the effectiveness of online psychotherapy (O-P-T) interventions for the treatment of perinatal mental health (PMH) disorders.
Methods: To address the research question “What is the effectiveness of online psychotherapy interventions for the treatment of perinatal mental health disorders?” the researchers developed eligibility criteria using the Cochrane PICOS framework. Five electronic databases were searched: PsycINFO, Medline, CINAHL Complete, Proquest Dissertations and Theses, Scopus along with Google Scholar and The Shapiro Library to identify papers which investigated O-P-T interventions published before July 2020. Interventions were included if study participants had a clinician assessed diagnosis of a PMH illness at screening, consisted of an experimental design and had clinician involvement as part of the intervention. The included studies were assessed for quality using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (QualSyst).
Findings: Searches yielded 2567 results from the selected databases. Five studies were included in the review (209 participants), three were postnatal depression (PND) interventions and two were antenatal depression (AD) interventions. All were cognitive behavioural therapy (CBT) based. Quality ratings of the included studies were found to be high based on QualSyst scores, however treatment fidelity was not reported. Pooled effect sizes found a small to medium effect favouring the intervention versus control on the reduction of depressive symptoms, according to their score on the selected depression measures, and in some cases remission (d = 0.48, 95% CI -0.07, 1.06). The results from the pooled effect sizes on available within-group data resulted in a large treatment effect for depression, anxiety and stress outcomes (d = 1.90; d = 0.81; d = 1.05). Attrition rates were comparable with other online psychotherapy studies for mental health.
Conclusions: This review provides evidence that O-P-T interventions for the treatment of PMH disorders are effective in improving clinical outcomes in the reduction of depression, anxiety and stress. Despite NICE recommendations for the treatment of PTSD in the perinatal period there remains a gap in the literature for online EMDR interventions. In addition, there is a lack of research for O-P-T interventions delivered via different modalities such as videoconferencing and a scarcity of research into O-P-T for other PMH disorders. This is the first synthesis of research into O-P-T for women who meet diagnostic criteria for PMH disorders as classified by the International Classification of Diseases 11th Revision (ICD-11) or Diagnostic and Statistical Manual of Mental Disorders (DSM–5).