Background
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Primary research question: Can telemedicine interventions reduce mental health problems in pregnant women and new mothers?
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Secondary research questions:1.Which kinds of telemedicine interventions (applications, modalities, targets) were developed and conducted for the specified patient group?2.For which kinds of mental problems, mental disorders, mental diseases or mental diagnoses in pregnant women and new mothers were the telemedicine interventions developed and evaluated?3.Which delivery modes were successful (e.g., intervention provided via phone calls, apps, web portals)? Were there differences between interventions using only a technical device and interventions with (additional) personal support? Were there differences in success with regard to the pre- or postpartum delivery timeframe?4.How was the participants’ acceptance of the intervention?5.Were implementation barriers reported and if so, what kind?6.Which kinds of mental health-related outcomes were addressed with telemedicine interventions?
Main text
Methods
Eligibility criteria
Databases and search
Concept | Search terms |
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Telemedicine | telemedicine, telemedical, tele care, Mobile Health, telehealth, telepsychiatry, eHealth, mhealth, phone call, text messages, smartphone, tablet, apps, web apps, web portal, internet |
mental stress | mentally stressed, mental health, mental disorder, mental disease, mentally ill, psychological, psychological impairment, psychologically affected, psychologically stressed, psychological disorder, psychological distress, psychiatric disorder, psychiatric disease, depression, anxiety, panic disorder |
pregnant women | pregnancy, pregnant, prenatal, prepartal, antenatal, prepartum, peripartum, gestation, gravidic, childbearing |
new mothers | young mothers, new mums/moms, young mums/moms, peripartum, postnatal, postpartal, postpartum, puerperium |
Screening, extraction and critical appraisal
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set up of the review (including to define the research question)
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protocol development (including inclusion and exclusion criteria)
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duplicate checking
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article screening/article selection (for a team of reviewers)
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and critical appraisal/risk of bias assessments.
Evaluation
Results
Step 1: General results
Step 2: Mental health-related outcomes addressed
Mental health-related outcomes | Articles with significantly improved scores compared to control | Articles without a significant difference in effect between groups | Articles with significantly higher (i.e. worse) scores compared to control | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
N | [Literature References] | N | [Literature References] | N | [Literature References] | ||||||
RoB: low | RoB: con-cerns | RoB: high | RoB: n.i | RoB: low | RoB: con-cerns | RoB: high | RoB: low | ||||
Postnatal depression | 14 | [36] | 13 | 1 | [72] | ||||||
Anxiety | 8 | [39] | 16 a, b | ||||||||
Depression | 11 | [36] | 10 a, b | ||||||||
Stress | 5 | [39] | 7 | [60] | |||||||
Mindfulness AND/OR self-compassion | 4 | [57] | [65] | 1 | [76] | ||||||
Wellbeing | 4 | [65] | [56] | ||||||||
Emotion regulation AND/OR psychological flexibility | 2 | [73] | [57] | ||||||||
Quality of life | 2 | [52] | [39] | 5 | [36], | ||||||
Positive mental health | 1 | [61] | 1 | [51] | |||||||
Post-traumatic stress disorder | 1 | [62] | |||||||||
Total | 52 | 53 | 1 |
Step 3: Characteristics of telemedicine interventions
Articles (n (%)) with at least one outcome with significant improvement [Literature References] | ||
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Timeframe for inclusion in the study | ||
Pregnancy (n = 24) | 13 (54.1) | |
Postpartum period (n = 20) | 15 (75.0) | |
Timeframe for intervention | ||
Pregnancy (n = 14) | 9 (64.3) | |
Postpartum period (n = 20) | 15 (75.0) | |
Both pregnancy and postpartum (n = 10) | 4 (40.0) |
Prevention/Treatment | Articles (n (%)) with at least one outcome with significant improvement [Literature References] | |
---|---|---|
Prevention (n = 27) | 17 (63%) | |
Treatment (n = 17) | 12 (71%) |
Kind of intervention | Articles (n (%)) with at least one outcome with significant improvement [Literature References] | |
---|---|---|
Self-help tool (n = 32) | 20 (66%) | |
Support (n = 7) | 5 (71%) | |
Support and monitoring (n = 1) | 1 (100%) | [45] |
Treatment (n = 3) | 2 (67%) |
Intervention target | Articles (n (%)) with at least one outcome with significant improvement [Literature References] | |
---|---|---|
Managing and coping with stress (n = 3) | 1 (33%) | [60] |
Preventing stress/mental health impairment (n = 11) | 10 (91%) | |
Strengthening mental health (n = 6) | 5 (83%) | |
Symptom reduction (n = 17) | 11 (65%) | |
Main intervention target not in the field of mental health (n = 7) | 1 (14%) | [67] |
Intervention contents | Articles (n (%)) with at least one outcome with significant improvement [Literature References] | |
---|---|---|
iCBT (n = 14) | 11 (79%) | |
Education lessons (n = 10) | 5 (50%) | |
Mindfulness (n = 5) | 5 (100%) | |
Peer support (n = 3) | 2 (67%) | |
Acceptance and commitment therapy (ACT) (n = 1) | 1 (100%) | [73] |
Internet-based behavioural activation (iBA) (n = 1) | 1 (100%) | [63] |
Prenatal care (n = 1) | 1 (100%) | [45] |
Relaxation exercises/mood tracking (n = 1) | 1 (100%) | [56] |
Treatment sessions via telephone by certified nurse-midwives (n = 1) | 1 (100%) | [51] |
Intervention delivery mode | Articles (n (%)) with at least one outcome with significant improvement [Literature References] | |
---|---|---|
App (n = 7) | 3 (57%) | |
Emails (n = 1) | 0 | |
Internet intervention: website (n = 26) | 18 (69%) | |
Telephone (n = 6) | 4 (67%) | |
Telephone and app (n = 1) | 1 (100%) | [67] |
Telephone and/or online community (n = 1) | 1 (100%) | [45] |
Telephone, emails or other messengers (n = 1) | 1 (100%) | [77] |
Videoconference (n = 1) | 0 |
Personal contacts – yes/no | Articles (n (%)) with at least one outcome with significant improvement [Literature References] | |
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Yes (n = 29) | 16 (55%) | |
No (n = 15) | 12 (80%) |
Kind of personal contact | Articles (n (%)) with at least one outcome with significant improvement [Literature References] | |
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Bilateral contacts (n = 20) | 12 (60%) | |
Forum (n = 3) | 2 (67%) | |
Contact and forum (n = 4) | 2 (50%) | |
Forum with idiographic answers to queries (n = 1) | 1 (100%) | [63] |
Step 4: Results for the most common mental health-related outcomes
Depression
Depression (n = 19 articles in total) | Articles (n (%)) with at least one outcome with significant improvement [Literature References] | |
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Kind of intervention | ||
Self-help tool (n = 13) | 7 (54%) | |
Support (n = 4) | 3 (75%) | |
Treatment (n = 1) | 1 (100%) | [51] |
Intervention target | ||
Preventing stress/mental health impairment (n = 4) | 3 (75%) | |
Symptom reduction (n = 12) | 8 (67%) | |
Intervention contents | ||
iCBT (n = 8) | 6 (75%) | |
Education lessons (n = 4) | 2 (50%) | |
Mindfulness (n = 2) | 1 (50%) | [69] |
Peer support (n = 2) | 1 (50%) | [77] |
Treatment sessions via telephone by certified nurse-midwives (n = 1) | 1 (100%) | [51] |
Delivery mode | ||
App (n = 3) | 1 (33%) | [36] |
Internet intervention: website (n = 11) | 7 (64%) | |
Telephone (n = 3) | 2 (67%) | |
Telephone, emails or other messengers (n = 1) | 1 (100%) | [77] |
Personal contacts | ||
Yes (n = 13) | 10 (77%) | |
No (n = 6) | 1 (17%) | [39] |
Postnatal depression
Postnatal depression (n = 28 articles in total) | Articles (n (%)) with at least one outcome with significant improvement [Literature References] | |
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Kind of intervention | ||
Self-help tool (n = 20) | 11 (55%) | |
Support (n = 4) | 2 (50%) | |
Treatment (n = 3) | 1 (33%) | [66] |
Intervention target | ||
Managing and coping with stress (n = 2) | 1 (50%) | [60] |
Preventing stress/mental health impairment (n = 9) | 6 (67%) | |
Strengthening mental health (n = 1) | 1 (100%) | [75] |
Symptom reduction (n = 10) | 5 (50%) | |
Main intervention target not in the field of mental health (n = 6) | 1 (17%) | [67] |
Intervention contents | ||
iCBT (n = 9) | 5 (56%) | |
Education lessons (n = 8) | 4 (50%) | |
Internet-based behavioural activation (iBA) (n = 1) | 1 (100%) | [63] |
Mindfulness (n = 2) | 2 (100%) | |
Peer support (n = 2) | 2 (100%) | |
Delivery mode | ||
App (n = 3) | 1 (33%) | [36] |
Internet intervention: website (n = 17) | 9 (53%) | |
Telephone (n = 5) | 2 (40%) | |
Telephone and app (n = 1) | 1 (100%) | [67] |
Telephone, emails or other messengers (n = 1) | 1 (100%) | [77] |
Personal contacts | ||
Yes (n = 20) | 9 (45%) | |
No (n = 8) | 5 (63%) |
Anxiety
Anxiety (n = 22 articles in total) | Articles (n (%)) with at least one outcome with significant improvement [Literature References] | |
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Kind of intervention | ||
Self-help tool (n = 18) | 5 (28%) | |
Support (n = 3) | 3 (100%) | |
Intervention target | ||
Preventing stress/mental health impairment (n = 5) | 3 (60%) | |
Symptom reduction (n = 11) | 4 (36%) | |
Main intervention target was not in the field of mental health (n = 2) | 1 (50%) | [67] |
Intervention contents | ||
iCBT (n = 8) | 4 (50%) | |
Education lessons (n = 5) | 1 (20%) | [67] |
Mindfulness (n = 3) | 1 (33%) | [69] |
Peer support (n = 2) | 2 (100%) | |
Delivery mode | ||
Internet intervention: website (n = 15) | 5 (33%) | |
Telephone (n = 1) | 1 (100%) | [46] |
Telephone and app (n = 1) | 1 (100%) | [67] |
Telephone, emails or other messengers (n = 1) | 1 (100%) | [77] |
Personal contacts | ||
Yes (n = 13) | 6 (43%) | |
No (n = 8) | 2 (25%) |
Stress
Stress (n = 12 articles in total) | Articles (n (%)) with at least one outcome with significant improvement [Literature References] | |
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Kind of intervention | ||
Self-help tool (n = 10) | 4 (40%) | |
Support and monitoring (n = 1) | 1 (100%) | [45] |
Intervention target | ||
Preventing stress/mental health impairment (n = 2) | 1 (50%) | [45] |
Symptom reduction (n = 7) | 4 (57%) | |
Intervention contents | ||
iCBT (n = 3) | 3 (100%) | |
Education lessons (n = 3) | 1 (33%) | [71] |
Prenatal care (n = 1) | 1 (100%) | [45] |
Delivery mode | ||
Internet intervention: website (n = 8) | 4 (50%) | |
Telephone and/or online community (n = 1) | 1 (100%) | [45] |
Personal contacts | ||
Yes (n = 9) | 3 (33%) | |
No (n = 3) | 2 (67%) |