Does timing matter—meta-analysis and systematic review of digital cognitive behavioral therapy in the perinatal period

Abstract

Abstract Depressive symptoms during and after pregnancy are a major concern in perinatal mental health, with implications for both mother and child. Digital cognitive behavioral therapy (CBT) is a scalable and accessible intervention. Yet, it remains unclear whether its effectiveness depends on the timing of delivery—a potentially important factor given that pregnancy and the postpartum period differ in both psychological demands and practical circumstances. To examine whether digital CBT interventions are more effective when delivered during pregnancy, after childbirth, or across both periods, we conducted a systematic review and meta-analysis of 16 randomized controlled trials involving 7577 participants. Across all studies, digital CBT was associated with a significant overall reduction in depressive symptoms compared with control conditions (pooled mean difference = –2.03, 95%CI [–2.73, –1.34]), although substantial heterogeneity was present. In meta-regression analyses, interventions delivered after childbirth appeared more effective than those delivered during pregnancy (b = –1.99, 95%CI [–3.90, –0.08], p = 0.04). However, this contrast became marginally non-significant ( p = 0.051) in sensitivity analyses excluding one high-risk-of-bias study, indicating that this finding should be interpreted with caution. Overall, these results suggest that digital CBT may be an effective approach for reducing perinatal depressive symptoms, with a possible advantage for postpartum delivery.