Therapist-Supported Internet-Based Cognitive Behavior Therapy for Stress, Anxiety, and Depressive Symptoms Among Postpartum Women: A Systematic Review and Meta-Analysis

Ying Lau, Tha Pyai Htun, Suei Nee Wong, Wai San Wilson Tam, Piyanee Klainin-Yobas, Ying Lau, Tha Pyai Htun, Suei Nee Wong, Wai San Wilson Tam, Piyanee Klainin-Yobas

Abstract

Background: A growing number of meta-analyses have supported the application of therapist-supported Internet-based cognitive behavior therapy (iCBT) for psychological disorders across different populations, but relatively few meta-analyses have concentrated on postpartum women.

Objective: This meta-analysis evaluated the efficacy of therapist-supported iCBT in improving stress, anxiety, and depressive symptoms among postpartum women.

Methods: A total of 10 electronic databases were used to search for published and unpublished trials. Cochrane Collaboration tool for assessing risk of bias was utilized to measure methodological quality. Meta-analysis was performed using the RevMan software (Review Manager version 5.3 for Windows from the Nordic Cochrane Centre, the Cochrane Collaboration, 2014). Among the 789 studies identified, 8 randomized controlled trials were selected, involving 1523 participants across 6 countries.

Results: More than half (65%) of the eligible studies had a low risk of bias with no heterogeneity. Results revealed that therapist-supported iCBT significantly improved stress (d=0.84, n=5), anxiety (d=0.36, n=6), and depressive symptoms (d=0.63, n=8) of the intervention group compared with those of the control group at post-intervention.

Conclusions: This review revealed that therapist-supported iCBT significantly improves stress, anxiety, and depressive symptoms among postpartum women with small to large effects. Future effectiveness studies should establish the essential components, format, and approach of iCBT with optimal levels of human support to maximize a long-term effect.

Keywords: Internet; anxiety; cognitive behavior therapy; depression; meta-analysis; post-traumatic stress disorders; stress.

Conflict of interest statement

Conflicts of Interest: None declared.

©Ying Lau, Tha Pyai Htun, Suei Nee Wong, Wai San Wilson Tam, Piyanee Klainin-Yobas. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 28.04.2017.

Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta-analysis (PRISMA) diagram displaying procedure for trials selection.
Figure 2
Figure 2
Risk of bias summary. These are authors’ judgments of each methodological quality item for each included study. Plus signs (+) indicate high methodological quality (low risk of bias); minus signs (-) indicate low methodological quality (high risk of bias); question marks (?) indicate unclear methodological quality (reported information about what happened in the study was insufficient).
Figure 3
Figure 3
Forest plot of standardized mean difference (95% CI) in change of stress symptoms scores for Internet-based cognitive behavior therapy intervention and control group.
Figure 4
Figure 4
Forest plot of standardized mean difference (95% CI) in change of anxiety symptoms scores for Internet-based cognitive behavior therapy intervention and control group.
Figure 5
Figure 5
Forest plot of standardized mean difference (95% CI) in change of depressive symptoms scores for Internet-based cognitive behavior therapy intervention and control group.

References

    1. Beck J. Cognitive Behavior Therapy: Basics and Beyond. 2nd edition. New York, NY: The Guilford Press; 2011.
    1. Beck AT, Haigh EA. Advances in cognitive theory and therapy: the generic cognitive model. Annu Rev Clin Psychol. 2014;10:1–24. doi: 10.1146/annurev-clinpsy-032813-153734.
    1. Hope DA, Burns JA, Hayes SA, Herbert JD, Warner MD. Automatic thoughts and cognitive restructuring in cognitive behavioral group therapy for social anxiety disorder. Cogn Ther Res. 2007 Jun 2;34(1):1–12. doi: 10.1007/s10608-007-9147-9.
    1. Addis M, Martell C. Overcoming Depression One Step at a Time: The New Behavioral Activation Approach to Getting Your Life Back. New York: New Harbinger Press; 2004.
    1. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res. 2012 Oct 1;36(5):427–40. doi: 10.1007/s10608-012-9476-1.
    1. Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA. 2010 May 19;303(19):1961–9. doi: 10.1001/jama.2010.605.
    1. Rooksby M, Elouafkaoui P, Humphris G, Clarkson J, Freeman R. Internet-assisted delivery of cognitive behavioural therapy (CBT) for childhood anxiety: systematic review and meta-analysis. J Anxiety Disord. 2015 Jan;29:83–92. doi: 10.1016/j.janxdis.2014.11.006.
    1. Andersson G. Internet-delivered psychological treatments. Annu Rev Clin Psychol. 2016;12:157–79. doi: 10.1146/annurev-clinpsy-021815-093006.
    1. ITU. ITU world telecommunication /ICT indicators databases: statistical highlights .
    1. Olthuis JV, Watt MC, Bailey K, Hayden JA, Stewart SH. Therapist-supported internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev. 2015;(3):CD011565. doi: 10.1002/14651858.CD011565.
    1. Enander J, Andersson E, Mataix-Cols D, Lichtenstein L, Alström K, Andersson G, Ljótsson B, Rück C. Therapist guided internet based cognitive behavioural therapy for body dysmorphic disorder: single blind randomised controlled trial. BMJ. 2016;352:i241.
    1. Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E. Guided internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry. 2014 Oct;13(3):288–95. doi: 10.1002/wps.20151. doi: 10.1002/wps.20151.
    1. Kuester A, Niemeyer H, Knaevelsrud C. Internet-based interventions for posttraumatic stress: a meta-analysis of randomized controlled trials. Clin Psychol Rev. 2016 Feb;43:1–16. doi: 10.1016/j.cpr.2015.11.004.
    1. Kelders SM, Bohlmeijer ET, Pots WT, van Gemert-Pijnen JE. Comparing human and automated support for depression: fractional factorial randomized controlled trial. Behav Res Ther. 2015 Sep;72:72–80. doi: 10.1016/j.brat.2015.06.014.
    1. Hedman E, Andersson E, Ljótsson B, Axelsson E, Lekander M. Cost effectiveness of internet-based cognitive behaviour therapy and behavioural stress management for severe health anxiety. BMJ Open. 2016;6(4):e009327. doi: 10.1136/bmjopen-2015-009327.
    1. Musiat P, Tarrier N. Collateral outcomes in e-mental health: a systematic review of the evidence for added benefits of computerized cognitive behavior therapy interventions for mental health. Psychol Med. 2014 Nov;44(15):3137–50. doi: 10.1017/S0033291714000245.
    1. Agius A, Xuereb RB, Carrick-Sen D, Sultana R, Rankin J. The co-existence of depression, anxiety and post-traumatic stress symptoms in the perinatal period: a systematic review. Midwifery. 2016 May;36:70–9. doi: 10.1016/j.midw.2016.02.013.
    1. Clout D, Brown R. Marital relationship and attachment predictors of postpartum stress, anxiety, and depression symptoms. J Soc Clin Psychol. 2016 Apr;35(4):322–41. doi: 10.1521/jscp.2016.35.4.322.
    1. Grekin R, O'Hara MW. Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis. Clin Psychol Rev. 2014 Jul;34(5):389–401. doi: 10.1016/j.cpr.2014.05.003.
    1. Osma J, Barrera AZ, Ramphos E. Are pregnant and postpartum women interested in health-related apps? implications for the prevention of perinatal depression. Cyberpsychol Behav Soc Netw. 2016 Jun;19(6):412–5. doi: 10.1089/cyber.2015.0549.
    1. O'Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol. 2013;9:379–407. doi: 10.1146/annurev-clinpsy-050212-185612.
    1. Sanger C, Iles JE, Andrew CS, Ramchandani PG. Associations between postnatal maternal depression and psychological outcomes in adolescent offspring: a systematic review. Arch Womens Ment Health. 2015 Apr;18(2):147–62. doi: 10.1007/s00737-014-0463-2.
    1. Grace SL, Evindar A, Stewart DE. The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Arch Womens Ment Health. 2003 Nov;6(4):263–74. doi: 10.1007/s00737-003-0024-6.
    1. de Camps MD, Philipp D, Israel A, Vigod S. Maternal-infant mental health: postpartum group intervention. Arch Womens Ment Health. 2016 Apr;19(2):243–51. doi: 10.1007/s00737-015-0551-y.
    1. Sockol LE. A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. J Affect Disord. 2015 May 15;177:7–21. doi: 10.1016/j.jad.2015.01.052.
    1. Maloni JA, Przeworski A, Damato EG. Web recruitment and internet use and preferences reported by women with postpartum depression after pregnancy complications. Arch Psychiatr Nurs. 2013 Apr;27(2):90–5. doi: 10.1016/j.apnu.2012.12.001.
    1. Fonseca A, Gorayeb R, Canavarro M. Women's use of online resources and acceptance of e-mental health tools during the perinatal period. Int J Med Inform. 2016 Oct;94:228–36. doi: 10.1016/j.ijmedinf.2016.07.016.
    1. Milgrom J, Danaher BG, Gemmill AW, Holt C, Holt CJ, Seeley JR, Tyler MS, Ross J, Ericksen J. Internet cognitive behavioral therapy for women with postnatal depression: a randomized controlled trial of MumMoodBooster. J Med Internet Res. 2016;18(3):e54. doi: 10.2196/jmir.4993.
    1. Nieminen K, Berg I, Frankenstein K, Viita L, Larsson K, Persson U, Spånberger L, Wretman A, Silfvernagel K, Andersson G, Wijma K. Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth-a randomized controlled trial. Cogn Behav Ther. 2016 Jun;45(4):287–306. doi: 10.1080/16506073.2016.1169626.
    1. O'Mahen HA, Richards DA, Woodford J, Wilkinson E, McGinley J, Taylor RS, Warren FC. Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression. Psychol Med. 2014 Jun;44(8):1675–89. doi: 10.1017/S0033291713002092.
    1. Pugh NE, Hadjistavropoulos HD, Dirkse D. A randomised controlled trial of therapist-assisted, internet-delivered cognitive behavior therapy for women with maternal depression. PLoS One. 2016;11(3):e0149186. doi: 10.1371/journal.pone.0149186.
    1. O'Mahen HA, Woodford J, McGinley J, Warren FC, Richards DA, Lynch TR, Taylor RS. Internet-based behavioral activation--treatment for postnatal depression (Netmums): a randomized controlled trial. J Affect Disord. 2013 Sep 25;150(3):814–22. doi: 10.1016/j.jad.2013.03.005.
    1. Sheeber LB, Seeley JR, Feil EG, Davis B, Sorensen E, Kosty DB, Lewinsohn PM. Development and pilot evaluation of an internet-facilitated cognitive-behavioral intervention for maternal depression. J Consult Clin Psychol. 2012 Oct;80(5):739–49. doi: 10.1037/a0028820.
    1. Carolan-Olah M, Barry M. Antenatal stress: an Irish case study. Midwifery. 2014 Mar;30(3):310–6. doi: 10.1016/j.midw.2013.03.014.
    1. Amstadter AB, Broman-Fulks J, Zinzow H, Ruggiero KJ, Cercone J. Internet-based interventions for traumatic stress-related mental health problems: a review and suggestion for future research. Clin Psychol Rev. 2009 Jul;29(5):410–20. doi: 10.1016/j.cpr.2009.04.001.
    1. Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther. 2009;38(4):196–205. doi: 10.1080/16506070903318960.
    1. Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012 Jun;32(4):329–42. doi: 10.1016/j.cpr.2012.02.004.
    1. Ashford MT, Olander EK, Ayers S. Computer- or web-based interventions for perinatal mental health: a systematic review. J Affect Disord. 2016 Jun;197:134–46. doi: 10.1016/j.jad.2016.02.057.
    1. Lee EW, Denison FC, Hor K, Reynolds RM. Web-based interventions for prevention and treatment of perinatal mood disorders: a systematic review. BMC Pregnancy Childbirth. 2016;16:38. doi: 10.1186/s12884-016-0831-1.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009 Oct;62(10):1006–12. doi: 10.1016/j.jclinepi.2009.06.005.
    1. Neville CE, McKinley MC, Holmes VA, Spence D, Woodside JV. The effectiveness of weight management interventions in breastfeeding women--a systematic review and critical evaluation. Birth. 2014 Sep;41(3):223–36. doi: 10.1111/birt.12111.
    1. Higgins JP, Green S. Cochrane. [2017-03-01]. Cochrane handbook for systematic reviews of interventions, Version 5.1.0
    1. Meades R, Ayers S. Anxiety measures validated in perinatal populations: a systematic review. J Affect Disord. 2011 Sep;133(1-2):1–15. doi: 10.1016/j.jad.2010.10.009.
    1. Borenstein M, Hedges LV, Rothstein H. Introduction to Meta-Analysis. Oxford: Wiley; 2009.
    1. Sormani MP. Subgroup analysis in MS trials. Mult Scler. 2017 Jan;23(1):34–5. doi: 10.1177/1352458515625808.
    1. Kersting A, Dölemeyer R, Steinig J, Walter F, Kroker K, Baust K, Wagner B. Brief internet-based intervention reduces posttraumatic stress and prolonged grief in parents after the loss of a child during pregnancy: a randomized controlled trial. Psychother Psychosom. 2013;82(6):372–81. doi: 10.1159/000348713.
    1. Kersting A, Kroker K, Schlicht S, Baust K, Wagner B. Efficacy of cognitive behavioral internet-based therapy in parents after the loss of a child during pregnancy: pilot data from a randomized controlled trial. Arch Womens Ment Health. 2011 Dec;14(6):465–77. doi: 10.1007/s00737-011-0240-4.
    1. Asselmann E, Wittchen H, Erler L, Martini J. Peripartum changes in social support among women with and without anxiety and depressive disorders prior to pregnancy: a prospective-longitudinal study. Arch Womens Ment Health. 2016 Dec;19(6):943–52. doi: 10.1007/s00737-016-0608-6.
    1. Asselmann E, Wittchen H, Petzoldt J, Martini J. Peripartum changes in partnership quality among women with and without anxiety and depressive disorders prior to pregnancy: a prospective-longitudinal study. Arch Womens Ment Health. 2016 Apr;19(2):281–90. doi: 10.1007/s00737-015-0556-6.
    1. Weiss DS. The impact of event scale-revised. In: Wilson JP, Tang CS, editors. Cross-Cultural Assessment of Psychological Trauma and PTSD. Boston, MA: Springer US; 2007. pp. 219–38.
    1. Martini J, Petzoldt J, Einsle F, Beesdo-Baum K, Höfler M, Wittchen H. Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: a prospective-longitudinal study. J Affect Disord. 2015 Apr 1;175:385–95. doi: 10.1016/j.jad.2015.01.012.
    1. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092–7. doi: 10.1001/archinte.166.10.1092.
    1. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988 Dec;56(6):893–7.
    1. Winkel S, Einsle F, Pieper L, Höfler M, Wittchen H, Martini J. Associations of anxiety disorders, depressive disorders and body weight with hypertension during pregnancy. Arch Womens Ment Health. 2015 Jun;18(3):473–83. doi: 10.1007/s00737-014-0474-z.
    1. Sutter-Dallay AL, Giaconne-Marcesche V, Glatigny-Dallay E, Verdoux H. Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort. Eur Psychiatry. 2004 Dec;19(8):459–63. doi: 10.1016/j.eurpsy.2004.09.025.
    1. Alvarado R, Perucca E, Neves E, Rojas M, Monardes J, Olea E, Vera A. Depressive disorders during pregnancy and associated factors. Rev Chil Obstet Ginecol. 1993;58(2):135–41.
    1. Furukawa TA, Noma H, Caldwell DM, Honyashiki M, Shinohara K, Imai H, Chen P, Hunot V, Churchill R. Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis. Acta Psychiatr Scand. 2014 Sep;130(3):181–92. doi: 10.1111/acps.12275.

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