Treating Perinatal Mood Disorders: Web-Based Interventions Effective?

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This review highlights a need for more high-quality studies, especially those in which interventions are examined during the antenatal period.
This review highlights a need for more high-quality studies, especially those in which interventions are examined during the antenatal period.

Preliminary data suggest that web-based, perinatal depression therapy after childbirth may help improve maternal mood. These findings were published in BMC Pregnancy and Childbirth.

Rebecca M Reynolds, PhD, from the University of Edinburgh, United Kingdom, and colleagues conducted a systematic review of web-based interventions meant to prevent and treat perinatal mood disorders. Two independent researchers searched 6 databases until March 26, 2015, and of 547 screened articles, 4 met the criteria for inclusion in the study. Of those 4 articles, 3 were randomized controlled trials and 1 was a feasibility trial.

The meta-analysis of Observational Studies in Epidemiology guidelines were followed to conduct this systematic review, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to report it.

All 4 of the studies examined web-based interventions after childbirth, and all 4 reported an improvement in maternal mood after the intervention.

"A significant improvement in depressive symptoms was measured using validated rating scales, such as the Edinburgh Postnatal Depression Scale (EPDS), either at post-treatment or follow-up which ranged from 3 to 12 months post study completion," the researchers noted.

For the 2 trials measuring depressive symptoms with the EPDS, score reductions were (mean ± SEM) 8.52±0.22 (range, 19.46-10.94) and 9.19±0.63 (range, 20.24-11.05) for treatment groups, and 5.16±0.25 (range, 19.44-14.28) and 6.81±0.71 (range, 21.07-14.26) for control groups.

However, the quality of the studies varied: attrition within the 4 studies ranged from 13% to 61%, and 1 study was rated as "good" quality.

A Gap in the Research

"Although CCBT has been endorsed by [the National Institute for Health and Care Excellence] for management of depressive symptoms in the general population, this systematic review demonstrates that there has been much less work in this field in relation to the perinatal period," the researchers wrote. "We identified only 4 studies meeting the inclusion criteria for the review, 3 of which were [randomized controlled trials]."

The findings of this review highlight a gap in research: None of the studies reported an intervention delivered in the antenatal period.

Summary and Clinical Applicability

"Though there were small numbers of studies with heterogeneity of study design, participant characteristics, duration, timing and nature of the intervention, and intermediate quality of studies, the overall findings suggest web-based interventions implemented in the post-partum period improve maternal mood outcomes," the researchers concluded.

However, this review also highlights a need for more high-quality studies, especially those in which interventions are examined during the antenatal period.

Limitations

● Only a small number of studies were identified for inclusion in this review, and none of them studied interventions in the antenatal period.

● The researchers were unable to quantitate outcomes because of heterogeneity in the study designs and lack of consistency in outcome measures.

● Generalizability is limited: 2 of the studies selected only women participants, and 1 of the studies examined both women and their partners.

● Results may have been confounded with treatment effects because some of the studies included women with preexisting depression or those who were receiving antidepressant therapy.

The studies included in this systematic review lacked information on the acceptability of the interventions.

Reference

Lee EW, Denison FC, Hor K, Reynolds RM. Web-based interventions for prevention and treatment of perinatal mood disorders: a systematic review [published online February 29, 2016]. BMC Pregnancy Childbirth. doi: 10.1186/s12884-016-0831-1

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