title: Web-based interventions for prevention and treatment of perinatal mood disorders: a systematic review.
abstract: BACKGROUND
  Perinatal depression is strikingly common with a prevalence of 10-15%. The adverse effects of perinatal depression on maternal and child health are profound with considerable costs. Despite this, few women seek medical attention. E-health, providing healthcare via the Internet is an accessible and effective solution for the treatment of depression in the general population. We aimed to conduct a systematic review of web-based interventions for the prevention and treatment of mood disorders in the perinatal period, defined as the start of pregnancy to 1 year post-partum.
  
  
  METHODS
  Six databases were searched until 26(th) March 2015. Two researchers independently screened articles for eligibility. Of the 547 screened articles, four met the inclusion criteria. These included three randomised-controlled trials and one feasibility trial, with total data from 1274 participants. MOOSE and PRISMA guidelines were adhered to for the conduct and reporting of the systematic review.
  
  
  RESULTS
  All studies were conducted in the post-partum period. All reported an improvement in maternal mood following intervention. A significant improvement in depressive symptoms was measured using validated rating scales, such as the Edinburgh Postnatal Depression Scale (EPDS), either at post-treatment or follow-up which ranged from 3 to 12 months post study completion. For the two RCTs utilising the EPDS, the EPDS score reductions were (mean ± SEM) 8.52 ± 0.22 (Range 19.46 to10.94) and 9.19 ± 0.63 (Range, 20.24 to 11.05) for treatment groups and 5.16 ± 0.25 (Range 19.44 to 14.28) and 6.81 ± 0.71 (Range 21.07 to 14.26) for comparator groups. However attrition within studies ranged from 13 to 61%. One study was rated as 'good' quality.
  
  
  CONCLUSIONS
  Preliminary data suggests web-based therapies for perinatal depression delivered in the post-partum period may play a role in improving maternalmood but more studies are needed, particularly with interventions delivered antenatally. Further research is needed to address the limitations of the existing evidence base.
authors.affiliation: Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland. s1103824@sms.ed.ac.uk.
authors.forename: Eleanor W
authors.initials: EW
authors.lastname: Lee
authors.affiliation: Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland. fiona.denison@ed.ac.uk.
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Denison
authors.affiliation: Obstetrics and Gynaecology, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, Scotland. horkahyee@gmail.com.
authors.forename: Kahyee
authors.initials: K
authors.lastname: Hor
authors.affiliation: Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland. R.Reynolds@ed.ac.uk.|Endocrinology Unit, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland. R.Reynolds@ed.ac.uk.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Reynolds
mesh_terms: D000328:Adult; D019052:Depression, Postpartum / Q000517:prevention & control / Q000628:therapy; D003866:Depressive Disorder / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D017216:Telemedicine / Q000379:methods*; D055815:Young Adult