Background

Postpartum depression and anxiety are experienced by some parents as they welcome their new child into their family. They can be experienced by any parent, including birth or adoptive mothers and fathers (Foli et al., 2016). It is crucial to further understand postpartum depression and anxiety because they can cause significant short- and long-term effects on the parents and child (Wilkinson & Mulcahy, 2010). Well-evidenced short-term effects include sleep disturbance (Sreejith et al., 2021), poorer parent-infant attachment, and marriage dissatisfaction (Wilkinson & Mulcahy, 2010). Well-evidenced long-term effects include poorer cognitive development for the infant (Murray et al., 2010), the breakdown of close relationships (Wilkinson & Mulcahy, 2010), and challenges in parental responsiveness to infant cues such as facial expressions (Stein et al., 2010).

There is a large body of research on postpartum depression and anxiety interventions. Current research provides much support for multiple interventions aimed at reducing symptoms. These include Cognitive Behavioural Therapy (Huang et al., 2018) and Interpersonal Psychotherapy (Weissman et al., 2007). These interventions tend to be administered in person or over video conferencing, phone calls or text with the direct and immediate involvement of a therapist. The need for client and therapist interaction to be in person or in real time has created barriers for many parents who need help. These barriers include not having the transport to get to a session, not having a babysitter or feeling uncomfortable leaving their new child to go to the sessions or take a phone call, and the stigma attached to seeking help (Stewart & Vigod, 2016). On a larger scale, we are currently living in a pandemic which involves lockdowns and increased anxiety for many people to leave their house (Okruszek et al., 2020). These are just some of the psychological, practical, and physical barriers to receiving in person or in real time therapy that parents face. These barriers are potentially reducing the number of parents receiving treatment, who would benefit from getting professional help for their postpartum depression and anxiety (Stewart & Vigod, 2016).

To overcome these barriers, new forms of interventions are being created. There are now a range of self-help websites, smartphone applications and chatbots that aim to educate parents with postpartum depression and anxiety symptoms and teach them skills to navigate through the postpartum period (O'Mahen et al., 2015). Some have been empirically tested, and there is evidence that these methods can be successful in reducing symptoms (Milgrom et al., 2016) and tend to be well accepted by participants (O'Mahen et al., 2013).

In this project, we will conduct a systematic review to answer the question ‘what evidence-based distal interventions exist for postpartum depression and anxiety in birth and adoptive parents?’. In this paper, distal will be defined as interventions that are conducted without the direct and immediate input of a therapist or support person. Distal interventions include podcasts, phone applications, and self-help online programs. They will be technology-based, meaning they are accessed or downloaded online. This increases accessibility and reduces costs. The effectiveness of each intervention to reduce symptoms of postpartum depression and anxiety, as well as the acceptability of the intervention, will be assessed.