The Effect of Virtual Psychological Interventions on Anxiety and Depression in the Perinatal Period: A Systematic Review of Internet-Delivered Smartphone Apps and Chatbot-Based Programs

Background: Anxiety and depression during the perinatal period can negatively impact maternal and infant well-being. Identifying effective approaches to promote perinatal mental health is important. Although previous reviews have examined digital psychological interventions, evidence across different virtual modalities, particularly chatbot-based interventions, remains limited. We aimed to systematically synthesize evidence on the effectiveness of virtual psychological interventions for anxiety and depression during the perinatal period. Methods: Published studies in Persian and English were searched from inception to February 2026 in Embase, Cochrane Library, Web of Science, Google Scholar, PubMed, Scopus, SID, and Magiran. The review was reported in accordance with PRISMA guidelines. We included randomized controlled trials (RCTs) assessing virtual psychological interventions for anxiety and/or depression during the perinatal period. Risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 1), and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Of 3,976 records identified, 23 RCTs involving 4,133 women were included. Studies were categorized as internet/web-based (11 studies), telephone-based (3 studies), and mobile app- and chatbot-based (9 studies). Twelve studies assessed depression in 2,456 women, and 11 studies assessed depression and anxiety in 1,677 participants. Overall, the included studies generally reported reductions in depression and/or anxiety symptoms following virtual psychological interventions compared with usual care. Conclusions: Virtual psychological interventions may reduce perinatal depression and anxiety symptoms. However, the certainty of evidence was low, with substantial clinical and methodological heterogeneity. Further well-designed RCTs are needed. Registration: This study was registered on PROSPERO (ID: CRD420261279726).