Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Apr 19, 2021; 11(4): 133-152
Published online Apr 19, 2021. doi: 10.5498/wjp.v11.i4.133
Effectiveness of digital psychotherapeutic intervention among perinatal women: A systematic review and meta-analysis of randomized controlled trials
Ying Lau, Jing-Ying Cheng, Sai-Ho Wong, Kai-Yoong Yen, Ling-Jie Cheng
Ying Lau, Jing-Ying Cheng, Sai-Ho Wong, Kai-Yoong Yen, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Ling-Jie Cheng, Nursing Research Unit, Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore 768828, Singapore
Author contributions: Lau Y conceived and guided the study; Cheng JY, Wong SH and Yen KY carried out the literature searches; Cheng JY and Yen KY extracted the data; Cheng JY and Yen KY assessed the study quality; Lau Y, Wong SH, and Cheng LJ performed the statistical analysis; Lau Y wrote the manuscript; Lau Y, Cheng JY, Wong SH, Yen KY and Cheng LJ revised the manuscript.
Supported by Ministry of Education Academic Research Fund (AcRF) Tier 1, No. NUHSRO/2017/054/T1.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ying Lau, BSc, MSN, PhD, RN, Associate Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, Level 2, 10 Medical Drive, Singapore 117597, Singapore.
Received: December 30, 2020
Peer-review started: December 30, 2020
First decision: January 11, 2021
Revised: January 11, 2021
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: April 19, 2021

The perinatal period is a challenging time of substantial emotional, physiological, social, and relational changes. Depression, anxiety, and stress symptoms are common, and co-exist in the perinatal period. Digital technology continues to grow at an unprecedented pace with wide application, including psychotherapeutic intervention. A growing number of meta-analyses supported the application of digital psychotherapeutic intervention across different populations, but relatively few meta- and meta-regression analyses have concentrated on perinatal women.


To evaluate the effectiveness of digital psychotherapeutic intervention on improving psychological outcomes among perinatal women and identify its essential features.


Randomized controlled trials (RCTs) were obtained from eight databases, including Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, Scopus, PsycINFO, PubMed, Web of Science, and ProQuest Dissertation and Theses from inception up until November 24, 2020. Comprehensive Meta-analysis 3.0 software was used to conduct meta- and meta-regression analyses. The Cochrane risk-of-bias tool and the Grading of the Recommendation, Assessment, Development, and Evaluation system were adopted to assess the individual and overall qualities of the evidence, respectively.


A total of 25 RCTs that included 3239 women were identified. Meta-analyses revealed that intervention significantly improved depression (Hedges’s g = 0.49), anxiety (g = 0.25), and stress (g = 0.47) symptoms compared to the control. Subgroup analyses demonstrated that a website platform with ≥ eight therapist-guided sessions using the theoretical principle of cognitive behavioral therapy was more effective than other treatments in improving depression symptoms in postnatal women. Meta-regression analyses observed that the age of perinatal women and the type of psychotherapy also had statistically significant effects on depression symptoms. Egger’s regression asymmetry tests suggested that no publication biases occurred, but the overall quality of the evidence was very low.


This review suggests that digital psychotherapeutic intervention may be a potential solution to reduce psychological problems in perinatal women. Further high-quality RCTs with large sample sizes are needed.

Keywords: Digital psychotherapeutic intervention, Perinatal women, Meta-analysis, Meta-regression

Core Tip: This systematic review identified and analyzed the findings of 25 randomized controlled trials, and the results indicated that digital psychotherapeutic intervention could significantly reduce depression, anxiety, and stress symptoms among perinatal women. The essential features of this intervention were a website platform with ≥ eight therapist-guided sessions using the cognitive behavioral therapy theoretical principle. This intervention was also effective in reducing depression symptoms when treating young postnatal women. The overall evidence grade of outcomes was very low according to the Grading of Recommendations, Assessment, Development, and Evaluation criteria. Thus, future trials need to include a high-quality design and a large sample size.