Effectiveness of eHealth Interventions to Reduce Perinatal Anxiety: A Systematic Review and Meta-Analysis

Objective: eHealth interventions have been shown to be effective in improving anxiety among the general population. Despite the effectiveness of eHealth interventions for perinatal depression, a recent review reported mixed results for perinatal anxiety. The review, however, was not focused on anxiety, and studies with various designs were included. The aim of this systematic review is to summarize the evidence specific to anxiety and to conduct a meta-analysis to examine the effectiveness of eHealth interventions in reducing perinatal anxiety.

Data Sources: MEDLINE, CINAHL, EMBASE, and PsycINFO were searched beginning with the date that the databases were available through March 2018 using keywords such as perinatal period, web-based interventions, and anxiety.

Study Selection: Randomized controlled trials that were conducted during the perinatal period, examined the effectiveness of an eHealth mental health intervention, measured anxiety symptoms or disorders as a primary or secondary outcome, provided data on anxiety levels both pre-intervention and post-intervention, had a comparison group, and were published in English were included. A total of 770 articles were retrieved, and the full texts of 64 articles were reviewed. Five studies met the inclusion criteria, 4 of which fulfilled the quality criteria and were included in the meta-analysis.

Data Extraction: Data were extracted using a data extraction form developed for this study. The Cochrane Collaboration’s Review Manager software was used to conduct the meta-analysis.

Results: The test for heterogeneity (I2 = 0%; P = .80) suggested a homogeneous sample. The meta-analysis for the total effect size showed that at post-intervention, the eHealth group had significantly lower anxiety scores than the control group, with a standardized mean difference of −0.41 (95% CI, −0.71 to −0.11; P = .007).

Conclusions: eHealth interventions are promising in improving perinatal anxiety. The content of these interventions should account for common comorbid mental health conditions during the perinatal period and provide opportunities to tailor further treatment if necessary.