There has been increasing interest in the use of digital interventions and apps to provide mental health support and treatment. While digital interventions have the potential to increase access to care in a cost-effective and scalable way, many interventions, particularly smartphone apps, have not been adequately studied. A recent review looks at the effectiveness of digital cognitive behavioral therapy (CBT) interventions for the treatment of depression during pregnancy.
The authors identified a total of seven randomized controlled trials (RCTs) from 5 countries (United States, China, Australia, Norway, and Sweden) published between 2015 and 2021. The sample sizes ranged from 25 to 1342 participants. The interventions used various technological elements, including texts, videos, games, interactive features, and peer group discussions.
Six interventions were delivered via a website, and only one was delivered via a smartphone app. The shortest intervention, from Australia, lasted for 4 weeks and included three brief unguided internet-based CBT sessions, while the largest Norwegian intervention, Mamma Mia, lasted 11.5 months, and provided sessions during pregnancy and after delivery. Two of the interventions provided therapeutic guidance. For example, in the Swedish intervention, CBT-trained therapists provided feedback through the digital platform.
Overall digital CBT interventions for depression during pregnancy showed efficacy, although the effect sizes varied. Programs offering guided intervention appeared to show higher effect sizes (Hedges g=1.21) than the unguided interventions (Hedges g=0.14-0.99). In addition, attrition rates were lower for the guided interventions (4.5%) but higher for the unguided interventions (22.1%-46.5%). While these results are encouraging, the authors note a high overall risk of bias was present for 6 of the 7 studies.Therefore, the findings on efficacy should be interpreted with caution, and more high-quality studies are needed.
One of the more efficacious interventions was the iCBT Internet Psychiatry Clinic (Forsell et al, 2017). The platform provides a form of guided self-help treatment consisting of reading material (about 75,000 words), assessments, homework, and worksheets delivered via a secure online platform (accessible using a computer or mobile device). The modules covered behavioral activation, cognitive restructuring, relationships, anxiety and worry, sleep problems, and relapse prevention. In addition, patients also had a CBT-trained therapist who provided regular feedback, encouragement and support in written messages during the treatment. At the present time, this particular type of ICBT is only available to those living in Sweden.
Despite these limitations, this review suggests that CBT can be used to target depression during pregnancy and can be delivered using a digital platform. There was promising evidence of efficacy and positive outcomes for depression. The interventions which provided therapeutic guidance appeared to have a greater effect on depressive symptoms and were associated with lower rates of attrition.
Ruta Nonacs, MD PhD
Forsell E, Bendix M, Holländare F, Szymanska von Schultz B, Nasiell J, Blomdahl-Wetterholm M, Eriksson C, Kvarned S, Lindau van der Linden J, Söderberg E, Jokinen J, Wide K, Kaldo V. Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial. J Affect Disord. 2017 Jun 13;221:56-64.
Wan Mohd Yunus WMA, Matinolli HM, Waris O, Upadhyaya S, Vuori M, Korpilahti-Leino T, Ristkari T, Koffert T, Sourander A. Digitalized Cognitive Behavioral Interventions for Depressive Symptoms During Pregnancy: Systematic Review. J Med Internet Res. 2022 Feb 23;24(2):e33337.
Wan Mohd Yunus WMA, Matinolli HM, Waris O, Upadhyaya S, Vuori M, Korpilahti-Leino T, Ristkari T, Koffert T, Sourander A. Digitalized Cognitive Behavioral Interventions for Depressive Symptoms During Pregnancy: Systematic Review. J Med Internet Res. 2022 Feb 23;24(2):e33337.
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