Postpartum anxiety (PPA) and depression symptoms are significantly reduced by digital health interventions (DHIs), according to a recent study published in the American Journal of Obstetrics & Gynecology.
Takeaways
- A recent study in the American Journal of Obstetrics & Gynecology found that digital health interventions (DHIs) significantly reduce symptoms of postpartum anxiety (PPA) and postpartum depression (PPD).
- Approximately 20% of women experience PPA and 15% experience PPD after childbirth. However, less than 20% of these women can access traditional interventions like psychoeducation, psychotherapy, and interpersonal therapy.
- With 95% of individuals aged 18 to 49 years in the United States owning smartphones, DHIs are more accessible than in-person interventions, highlighting their potential to bridge the treatment gap.
- A systematic review and meta-analysis evaluated 31 randomized trials comparing DHIs to treatment as usual (TAU). The DHI group showed a significant reduction in PPD and PPA symptoms compared to the TAU group, with standardized mean differences indicating effectiveness.
- While DHIs have shown promise, further high-quality trials are recommended, especially to explore the potential of DHIs in delivering psychotherapy for PPD and PPA.
Postpartum depression (PPD) is reported in approximately 15% of women after childbirth and PPA in approximately 20%. Interventions to reduce PPD and PPA symptoms include psychoeducation, psychotherapy, and interpersonal therapy. However, under 20% of women with PPD and PPA are able to access these interventions.
DHIs are interventions delivered to a patient through the internet, a text message, or a smartphone application. Smartphones are owned by 95% of individuals aged 18 to 49 years in the United States, making DHIs more accessible than in-person interventions. However, data on the efficacy of DHIs against PPA and PPD is lacking.
Investigators conducted a systematic review and meta-analysis to evaluate the efficacy of DHIs vs treatment as usual (TAU) against PPA and PPD. Published literature was evaluated for records about PPA, PPD, or postpartum distress management using digital or mobile health interventions.
Databases evaluated included Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Titles and abstracts were screened by 2 independent authors, with a third author consulted during disagreements. This process was repeated for evaluating full-text articles for inclusion.
Exclusion criteria included being published in English and being a review article, case report or series, or abstract. Randomized trials comparing any perinatal DHI with TAU were included in the final analysis, with the first postpartum ascertainment score after intervention measured as the primary outcome.
There were 31 studies included in the final analysis, all of which were randomized trials published as full-text manuscripts. Higher quality was reported in 20 studies and lower quality in 11. The route of delivery for DHI was an online or internet-based intervention in 19 studies, a smartphone application in 11, and a text message-based intervention in 1.
Across the 31 studies, a DHI was delivered to 5532 participants and TAU to 5492. Most studies conducted recruitment in person during a prenatal care clinic visit or birth hospitalization. Most studies screened for PPA or PPD from 4 to 12 weeks postpartum, though the range extended from under 1 week to 32 weeks postpartum.
A significant reduction in PPD symptoms and PPA symptoms was reported from DHIs compared to TAU, with standardized mean differences of -0.64 and -0.49 respectively. The interstudy heterogeneity for PPD and PPA was 94.4% and 83.4% respectively.
The Edinburgh Postnatal Depression Scale (EPDS) was used to measure PPD and the Generalized Anxiety Disorder-7 (GAD-7) to measure PPA as secondary outcomes. DHI significantly decreased EPDS and GAD-7 scores, with weighted mean differences of -0.64 and -0.52 respectively.
For overall PPD and PPA outcomes, interventions providing psychotherapy had a more significant impact compared to those providing psychoeducation. Online-based studies had increased odds of not completing the final study assessment.
These results indicated efficacy from DHIs in reducing PPD and PPA symptoms. Investigators recommended further high-quality trials to examine the potential of DHIs delivering psychotherapy.
Reference
Lewkowitz AK, Whelan AR, Ayala NK, et al.The effect of digital health interventions on postpartum depression or anxiety: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol. 2023;230(1):12-43. doi:10.1016/j.ajog.2023.06.028
