Department of Nursing, KK Women and Children's Hospital, Singapore.
Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Psychosom Res. 2022 Jun;157:110790. doi: 10.1016/j.jpsychores.2022.110790. Epub 2022 Mar 22.
The current review aims to (1) investigate the effectiveness of Internet-based psychological intervention in reducing depressive, anxiety, and stress symptoms and fear of childbirth among pregnant women at post-intervention and follow-up; (2) compare the effects of the intervention using different psychological principles; and (3) explore potential covariates on the intervention effect.
A literature search of seven databases was carried out to identify published and unpublished randomized controlled trials (RCTs) in English without any time limitation up to February 2021. Meta-analysis and meta-regression were conducted using Comprehensive Meta-analysis software. This review protocol was registered on PROSPERO (CRD42021235565).
Sixteen RCTs involving 3894 pregnant women were included from more than 23 countries. Internet-delivered psychological interventions were found to significantly (p < 0.05) reduce depressive (g = -0.16 to -0.32) and anxiety (g = -0.22 to -0.33) symptoms with small effect sizes at post-intervention and follow-up during 6 to 8 weeks postpartum compared with those in the comparator group. However, there was insufficient evidence for fear of childbirth and stress symptoms. Our subgroup analyses found that psychological interventions adopting component of cognitive behavioral therapy (g = -0.29) or mindfulness therapy (g = -0.62) showed beneficial effects to improve depressive symptoms among pregnant women. Univariate random-effect regression analyses showed that the attrition rate was a significant covariate (Z = -2.33, p = 0.02) on depressive symptoms. The certainty of main outcomes was graded from low to very low in accordance with the GRADE criteria.
Our reviews suggested that Internet-delivered psychological intervention may complement usual antenatal care in the improvement of depressive and anxiety symptoms. Future trials involving a large-scale sample are needed to improve the methodological quality.
本次综述旨在：(1) 调查基于互联网的心理干预在降低产后即刻和随访时孕妇的抑郁、焦虑和压力症状及对分娩的恐惧方面的有效性；(2) 比较采用不同心理原理的干预效果；(3) 探讨干预效果的潜在协变量。
对七个数据库进行文献检索，检索截至 2021 年 2 月、发表及未发表的英文随机对照试验（RCT），无时间限制。使用 Comprehensive Meta-analysis 软件进行荟萃分析和荟萃回归。本综述方案在 PROSPERO（CRD42021235565）上注册。
纳入了来自 23 个以上国家的 16 项 RCT，共 3894 名孕妇。与对照组相比，产后 6 至 8 周，互联网心理干预可显著（p<0.05）降低产后即刻和随访时的抑郁（g=-0.16 至-0.32）和焦虑症状（g=-0.22 至-0.33），效果较小。但对分娩恐惧和压力症状的证据不足。亚组分析发现，采用认知行为疗法（g=-0.29）或正念疗法（g=-0.62）组成部分的心理干预对改善孕妇的抑郁症状有有益效果。单变量随机效应回归分析显示，失访率（Z=-2.33，p=0.02）是抑郁症状的一个显著协变量。根据 GRADE 标准，主要结局的确定性从低到极低分级。
本综述表明，互联网心理干预可能对改善抑郁和焦虑症状起到补充作用，常规的产前护理。需要更大规模样本的未来试验来提高方法学质量。
