eHealth Interventions for Treatment and Prevention of Depression, Anxiety and Insomnia during Pregnancy: A Systematic Review and Meta-Analysis (Preprint)

BACKGROUND Pregnancy is associated with an increased risk for depression, anxiety and insomnia. eHealth interventions provide a promising and accessible treatment alternative to face-to-face intervention. OBJECTIVE The objective of this systematic review and meta-analysis was to determine the effectiveness of eHealth interventions to prevent and/or treat depression, anxiety and insomnia during pregnancy. Secondary aims were to identify demographic and intervention moderators of effectiveness. METHODS Five databases (PsycINFO, Medline, CINAHL, Embase, Cochrane) were searched from inception to May 2021. Terms related to eHealth, pregnancy, randomized controlled trials, depression, anxiety, and insomnia were included. RCTs were included if they reported (a) an eHealth intervention for (b) the prevention or treatment of depression, anxiety or insomnia (c) in pregnant women. Study screening, data extractions and quality assessment were conducted independently by two reviewers. Random effects meta-analyses of pooled effect sizes were conducted to determine the effect of eHealth interventions on prenatal mental health. Meta-regression analyses were conducted to identify potential moderators. RESULTS In total, 17 studies were included in the current review that assessed changes in depression (11), anxiety (n=10), and insomnia (n=3). Several studies included both depression and anxiety symptoms as outcomes (n=7). The results indicated that during pregnancy, eHealth interventions showed small effect sizes for preventing and treating symptoms of anxiety and depression and a moderate effect size for treating symptoms of insomnia. With the exception of intervention type for the outcome of depressive symptoms, where Mindfulness interventions outperformed other intervention types, no significant moderators were detected. CONCLUSIONS eHealth interventions are an accessible and promising resource for treating symptoms of anxiety, depression and insomnia during pregnancy. However, more research is necessary to identify ways to increase the efficacy of eHealth interventions for this population. CLINICALTRIAL The study was registered with PROSPERO through the University of York Center for Reviews and Dissemination (Registration No. CRD42020205186).