Internet-based interventions for postpartum depression: A systematic review and meta-analysis.
Ting-Yu Mu, Yu-Hong Li, Ri-Xiang Xu and 3 others
PMID 33373101WHAT IT FOUND
Internet-based programmes for postpartum depression lowered PPD prevalence compared with control in pooled results.
Nurses and midwives can consider them as an option, but high dropout and varied studies limit certainty.
Key findings
01The pooled analysis of 7 studies and 856 analysed participants favoured internet-based interventions for reducing PPD prevalence, with relative risk 0.642 (95% CI 0.508 to 0.813).
02Heterogeneity was marked (I² = 59.9%, p < .001), and attrition was wide: intervention groups 4.5% to 86.9% and control groups 0% to 87.1%.
03Subgroup RRs varied by follow-up: 0.727 for over 12 weeks, 0.488 for under 12 weeks, and 0.257 for exactly 12 weeks.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only seven RCTs were analysed, and 2,277 reported participants fell to 856 analysed after attrition. Heterogeneity was marked (I² = 59.9%), so the studies were not interchangeable. Attrition was very wide: 4.5% to 86.9% in intervention groups and 0% to 87.1% in control groups. Blinding was not possible for internet treatment, and outcomes relied on self-report, raising performance and detection bias. Publication bias could not be assessed properly because only a few studies were included. Interventions varied by type, therapist support, sessions and follow-up, so the effect of any single component cannot be separated. Most studies were conducted in developed countries (Australia, Sweden, United States, Canada, United Kingdom), limiting generalisability to least developed countries. The authors noted that effects appeared to weaken as follow-up increased, based on subgroup analyses.
Declared interests
The authors declared no competing interests. The supplied text does not state a funding source.
The easy way to misread this
Do not read the pooled benefit as proof that any internet-based programme works for every mother. The seven trials used different interventions, follow-up periods, therapist support and session numbers, and attrition was high, so the contribution of any single component cannot be separated.