Effectiveness of Telehealth Care Interventions for Women's Mental Health During and After the COVID-19 Pandemic: Systematic Review and Meta-Analysis.

چکیده اصلی

BACKGROUND: The COVID-19 pandemic has increased telemental health interventions. However, evidence of effectiveness in improving women's mental health outcomes, acceptability, and user satisfaction remains fragmented. OBJECTIVE: This study examined the effectiveness of telehealth interventions in alleviating depression, anxiety, and stress in women during and after the pandemic and descriptively summarized the acceptability of and satisfaction with these interventions. METHODS: This systematic review and meta-analysis compared telemental health interventions with control conditions (waitlists or standard care) for women experiencing anxiety, depression, or stress. Databases (PubMed/MEDLINE, Embase, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials) were searched through March 19, 2026. Eligible studies evaluated interventions in women aged 18 to 64 years (≥80% female participants and female-specific outcomes) and included randomized controlled trials (RCTs), nonrandomized trials, and observational studies with ≥5 participants using outcome measures. Random-effects meta-analyses were conducted for depression, anxiety, and stress using RCT data. Risk of bias was assessed using Cochrane tools and certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS: Fifty-seven studies (N=13,457) from 24 countries, reported the effectiveness, acceptability, and satisfaction with telehealth interventions. Meta-analysis of 23 studies (n=3269) demonstrated significant benefits of telehealth interventions for depression, anxiety, and stress. Depression showed the greatest improvements, with a moderate reduction in symptoms (Hedges g=-0.56, 95% CI -0.86 to -0.26; P<.001), followed by anxiety (small to moderate reduction; Hedges g=-0.45, 95% CI -0.62 to -0.28; P<.001). Stress showed a smaller effect (Hedges g=-0.25, 95% CI -0.47 to -0.04; P=.02), indicating modest benefits. Heterogeneity was high, with 95% prediction intervals of -1.97 to 0.84, -1.11 to 0.21, and -0.98 to 0.40 for depression, anxiety, and stress, respectively. Subgroup analyses favored telehealth over waitlist and standard care for depression (waitlist: Hedges g=-0.60, 95% CI -0.86 to -0.33; standard care: Hedges g=-0.57, 95% CI -1.11 to -0.02; both P<.001) and anxiety (waitlist: Hedges g=-0.47, 95% CI -0.68 to -0.25; standard care: Hedges g=-0.52, 95% CI -0.80 to -0.25; both P<.001). Insufficient studies were available to evaluate stress in subgroup analyses. Treatment effects remained significant in female-only and predominantly female samples. Evidence certainty was downgraded due to heterogeneity, risk of bias, and methodological limitations. CONCLUSIONS: This is the first systematic review and meta-analysis focused on telemental health interventions for women. Telehealth was associated with moderate, small to moderate, and modest reductions in depression, anxiety, and stress, respectively, with benefits across female-only and predominantly female samples. Moderate to high heterogeneity in average effects (CIs), wide distributions of effects across settings (prediction intervals), and risk of bias resulted in moderate certainty of evidence. Overall, telehealth is a scalable approach for improving access to mental health care for women, although high-quality research is needed to strengthen the evidence base.

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