Table 1.
Characteristics of selected 25 randomised controlled trials
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Ref.
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Country/setting
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Design
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Population (nature)
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Age (mean ± SD)
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Intervention (name)
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Comparator
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Sample size
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Outcome (Measures)
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Attrition rate (%)
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ITT/MDM
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Protocol/registry
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Grant
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| Barrera et al[61], 2015 | 23 countries/Community | 2-arm RCT | Antenatal (mixed trimesters) | 30.2 ± 5.6 | Mood management internet intervention (Curso Internet de Mamás y Bebés) | Placebo (Information only) | I: 57; C: 54 | Depression symptoms (CES-D) | 66.1% | No/No | No/No | Yes |
| Duffecy et al[62], 2019 | United States/Community | 2-arm RCT | Antenatal (20–28 wk) | 30.5 ± 4.1 | Share (group) condition (Sunnyside) | Placebo (individual) condition | I: 18; C: 7 | Depression symptoms (PHQ-8 and HDRS) | 28% | No/No | No/Yes | Yes |
| Felder et al[63], 2020 | United States/Community | 2-arm RCT | Antenatal (≤ 28 wk, insomnia by SCI, EPDS ≥ 15) | 33.6 ± 3.7 | Digital cognitive behavioural therapy for insomnia (Sleepio) | Treatment as usual | I: 105; C: 103 | Depression symptoms (EPDS), Anxiety symptoms (GAD-7) | 11.1 % | Yes/No | No/Yes | Yes |
| Fonseca et al[64], 2019 | Portugal /Community | 2-arm RCT | Postnatal women (PDPI-R ≥ 5.5 or EPDS > 9 | 32.6 ± NR | Web-based intervention (Be a Mom) | Waitlist | I: 98; C: 96 | Depression symptoms (EPDS) | 24.2 % | Yes/Yes | No/Yes | Yes |
| Forsell et al[65], 2017 | Sweden/Community | 2-arm RCT | Antenatal (10-28 wk, major depression by SCID; MADRS-S: 15-35) | 31.0 ± NR | Internet-delivered cognitive behaviour therapy (ICBT) | Treatment as usual | I: 22; C: 20 | Depression symptoms (EPDS and MADRS-S), Anxiety symptoms (GAD-7) | 7.1 % | Yes/Yes | No/Yes | Yes |
| Heller et al[66], 2020 | Netherlands /Community | 2-arm RCT | Antenatal (< 30 wk with CES-D ≥ 16, HADS-A ≥ 8) | 32.0 ± NR | Internet- based problem-solving treatment (MamaKits Online) | Treatment as usual | I: 79; C: 80 | Depression symptoms (EPDS and CES-D), Anxiety symptoms (HADS-A) | 17.6% | Yes/Yes | Yes/Yes | Yes |
| Jannati et al[67], 2020 | Iran/Community | 3-arm RCT | Postnatal (≤ 6 mo, EPDS ≥ 13 and MINI) | 27.7 ± 4.2 | App-based cognitive behavioural therapy (Happy Mom) | Treatment as usual | I: 39; C: 39 | Depression symptoms (EPDS) | 3.9% | No/No | No/Yes | Yes |
| Jiao et al[68], 2019 | Singapore/Hospital | 3-arm RCT | Postnatal (first time mother < 6 wk) | 30.7 ± NR | Web-based psychoeducational intervention (NR) | Treatment as usual | I: 68; C: 68 | Depression symptoms (EPDS) | 6.9% | Yes/Yes | Yes/Yes | Yes |
| Kalmbach et al[69], 2020 | United States/Community | 2-arm RCT | Antenatal (27.76 ± 0.87 wk with insomnia using ISI ≥ 10 and EPDS ≥ 19) | 29.0 ± 4.2 | Digital cognitive behavioural therapy for insomnia (Sleepio) | Placebo (Digital sleep education) | I: 46; C: 45 | Depression symptoms (EPDS) | 1.1% | Yes/Yes | No/Yes | Yes |
| Kersting et al[71], 2011 | Germany/Community | 2-arm RCT | Postnatal (loss of child with 5-43 wk) | 34.3 ± 5.3 | Internet-based cognitive behavioural treatment programme (NR) | Waitlist | I: 45; C: 33 | Depression symptoms (GSI-D), Anxiety symptoms (GSI-A) Stress symptoms (IES) | 22.9% | Yes/Yes | No/No | Yes |
| Kersting et al[70], 2013 | Germany/Community | 2-arm RCT | Postnatal (loss of child with 2-40 wk) | 34.2 ± 5.2 | Internet-based cognitive behavioural treatment programme (NR) | Waitlist | I: 115; C: 113 | Depression symptoms (GSI-D) Anxiety symptoms (GSI-A) Stress symptoms (IES-R) | 12.7% | Yes/No | No/No | Yes |
| King et al[85], 2009 | United States/Community | 2-arm RCT | Postnatal (≤ 12 mo) | 32.5 ± NR | Internet-based stress management program (LivingSmart) | Face- to-Face control group | I: 28; C: 29 | Depression symptoms (BDI-II), Anxiety symptoms (STAI) Stress symptoms (PSS) | 33.1% | No/No | No/No | Yes |
| Klein et al[72], 2012 | Scotland/Community | 2-arm RCT | Postnatal (Miscarriage with < 24 wk) | 33.0 ± 6.3 | Web-based intervention (Miscarriage matters) | Treatment as usual | I: 33; C: 34 | Depression symptoms (HADS-D), Anxiety symptoms (HADS-A) | 35.8% | Yes/Yes | No/No | Yes |
| Loughnan et al[73], 2019 | Australia/Community | 2-arm RCT | Antenatal (13-30 wk, GAD-7 > 9 and/or PHQ-9 > 9) | 31.6 ± 4.0 | Internet-delivered cognitive behavioural therapy program (MUMentum Pregnancy) | Treatment as usual | I: 43; C: 44 | Depression symptoms (EPDS), Anxiety symptoms (GAD-7) Stress symptoms (K-10) | 11.5% | Yes/Yes | Yes/Yes | Yes |
| Matvienko-Sikar et al[74], 2017 | Sweden/Community | 3-arm RCTs | Antenatal (10-22) wk | 33.8 ± 3.0 | Novel positive psychological intervention (BodyScan and Reflection) | Treatment as usual | I: 32; C: 14 | Depression symptoms (EPDS) Stress symptoms (PDQ) | 6.5% | No/No | No/No | No |
| Milgrom et al[75], 2016 | Australia/Community | 2-arm RCT | Postnatal (< 12 mo, EPDS 11-23) | 31.6 ± NR | Internet cognitive behavioural therapy (MumMoodBooster) | Treatment as usual | I: 21; C: 22 | Depression symptoms (BDI-II), Anxiety symptoms (DASS-21-A), Stress symptoms (DASS-21-S) | 6.9% | Yes/Yes | No/Yes | Yes |
| Missler et al[76], 2020 | Netherlands/Community | 2-arm RCT | Antenatal (26-34 wk) | 32.5 ± NR | Psycho-educational Intervention (NR) | Waitlist | I: 68; C: 69 | Depression symptoms (EPDS), Anxiety symptoms (HADS-A), Stress symptoms (PSI) | 11.7% | Yes/Yes | Yes/Yes | Yes |
| Molenaar et al[77], 2020 | Netherlands/Community | 2-arm RCT | Antenatal (12-16 wk, depression history) | 32.2 ± 4.9 | Discontinuation of anti-depressants with Preventive Cognitive Therapy (STOP) | Treatment as usual | I: 24; C: 20 | Depression symptoms (EPDS and HDRS), Anxiety symptoms(STAI) | 13.6% | No/No | Yes/Yes | Yes |
| Nieminen et al[78], 2016 | Sweden/Community | 2-arm RCT | Postnatal (≥ 3 mo, TES ≥ 30) | 34.6 ± 4.8 | Internet-based trauma-focused cognitive behaviour therapy (TF-ICBT) | Waitlist | I: 28; C: 28 | Depression symptoms (BDI-II and PHQ-9), Anxiety symptoms (BAI), Stress symptoms (IER-R) | 9.8% | Yes/Yes | No/No | Yes |
| O'Mahen et al[80], 2013 | United Kingdom/Community | 2-arm RCT | Postnatal (< 12 mo, EPDS > 12) | 32.3 ± NR | Internet-based behavioral activation (Netmums) | Treatment as usual | I: 462;C: 448 | Depression symptoms (EPDS) | 61% | Yes/No | No/No | Yes |
| O'Mahen et al[79], 2014 | United Kingdom/Community | 2-arm RCT | Postnatal (< 12 mo, EPDS > 12) | 32.3 ± NR | Internet behavioral activation treatment (NetmumsHWD) | Treatment as usual | I: 41; C: 42 | Depression symptoms (EPDS), Anxiety symptoms (GAD-7) | 13.2% | Yes/Yes | No/No | Yes |
| Pugh et al[81], 2016 | Canada/Community | 2-arm RCT | Postnatal (< 12 mo, EPDS ≥ 10) | ≥ 18 ± NR | Therapist assisted, Internet-delivered cognitive behavior therapy (TA-ICBT) | Waitlist | I: 25; C: 25 | Depression symptoms (DASS-21-D), Anxiety symptoms (DASS-21-A), Stress symptoms (DASS-21-S) | 18% | Yes/Yes | No/Yes | Yes |
| Scherer et al[82], 2016 | Switzerland/Community | 2-arm RCT | Postnatal (preterm labour with 18-32 wk) | 32.7 ± 3.0 | Internet-based cognitive behavioral stress management (IB-CBSM) | Placebo (Limited support) | I: 51; C: 42 | Anxiety symptoms (STAI-S), Stress symptoms (PSS) | 37.6% | No/No | No/Yes | Yes |
| Urech et al[83], 2018 | Switzerland/Community | 2-arm RCT | Postnatal (preterm labour with 18-32 wk) | 32.6 ± 3.7 | Internet-based cognitive behavioral stress management (IB-CBSM) | Placebo (Generic information) | I: 50; C: 43 | Depression symptoms (EPDS), Anxiety symptoms(STAI-S and PRA), Stress symptoms (PSS) | 44.1% | No/Yes | No/No | Yes |
| Yang et al[84], 2019 | China/Hospital | 2-arm RCT | Antenatal (24-30 wk, GAD-7 > 4 or PHQ-9 > 4) | 30.9 ± NR | Online mindfulness intervention (NR) | Placebo (Wechat) | I: 62; C: 61 | Depression symptoms (PHQ-9), Anxiety symptoms (GAD-7) | 13.8% | Yes/Yes | No/No | Yes |
BAI: Beck anxiety inventory; BDI-II: Beck depression inventory-II; C: Control; CES-D: Center for epidemiological studies depression; CES-D: Centre for epidemiologic studies-depression scale; DASS-21-A: Depression, anxiety and stress scales-21- anxiety subscale; DASS-21-D: Depression, anxiety and stress scales-21- depression subscale; DASS-21-S: Depression, anxiety and stress scales-21- stress subscale; EPDS: Edinburgh postnatal depression scale; GAD-7: Generalized anxiety disorder scale; GSI-A: Global severity index-anxiety subscale; GSI-D: Global severity index-depression subscale; HADS-A: Hospital anxiety and depression scale-anxiety subscale; HADS-A: Hospital anxiety and depression scale-anxiety subscale; HADS-D: Hospital anxiety and depression scale-depression subscale; HDRS: Hamilton depression rating scale; I: Intervention; IES: Impact of event scale; IES-R: Impact of event scale-revised; ISI: Insomnia severity index; ITT: Intention-to-treat analysis; K-10: Kessler psychological distress 10-item scale; MADRS-S: Montgomery-Asberg depression rating scale self-report version; MDM: Missing data management; MINI: International neuropsychiatric interview; NR: Not reported; PDPI-R: Postpartum depression predictors inventory-revised; PDQ: Prenatal distress scale; PHQ-8: Patient health questionnaire-8; PRA: The pregnancy related anxiety test; PSI: Parenting stress index; PSS: Perceived stress scale; RCT: Randomised controlled trial; SCI: Sleep condition indicator; SCI-I: Structural clinical interview for DSM Axis I disorders; STAI: State trait anxiety inventory; STAI-S: Spielberger state trait anxiety inventory; TES: Traumatic event scale.