Effect of telecounseling on depressive symptoms in primiparous women during the postpartum period: a systematic review and meta-analysis of randomized controlled trials.

Background: Telecounseling has emerged as a potential strategy to improve access to psychological support during the postpartum period. However, evidence regarding its effectiveness specifically among primiparous women remains limited. This systematic review evaluates the effect of telecounseling interventions on depressive symptoms among primiparous women during the postpartum period. Methods: PubMed, Scopus, and Web of Science were searched from inception to February 23, 2026. Eligible studies included randomized trials evaluating telecounseling interventions among primiparous postpartum women and reporting depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) as continuous outcomes. Random-effects meta-analyses were performed to pool post-intervention mean differences and mean change scores. Statistical heterogeneity was assessed using the I² statistic, and sources of heterogeneity were explored using meta-regression. Results: Fifteen randomized controlled trials involving 2,297 participants (telecounseling: n = 1,145; control: n = 1,152) were included. The mean age of participants across studies was 28.01 years. Telecounseling was associated with a statistically significant reduction in post-intervention EPDS scores compared with control (z = -6.26, p < 0.001), although substantial heterogeneity was observed (I² = 96.79%). Subgroup analyses demonstrated significant reductions in EPDS scores at 1 week, 1 month, 2 months, 3 months, and 6 weeks, while no significant differences were observed at later time points. Meta-regression indicated that longer follow-up duration was associated with less negative effect estimates, indicating attenuation of the effect favoring telecounseling over time (coefficient = 0.0642 per week, p = 0.003). Thirteen trials were included in the mean change analysis, which also demonstrated a greater reduction in EPDS scores with telecounseling compared with control (z = -4.86, p < 0.001), with substantial heterogeneity (I² = 90.14%). Follow-up duration remained significantly associated with effect size (coefficient = 0.0807 per week, p < 0.001). No significant associations were observed for maternal age, proportion of vaginal delivery, or risk of bias classification. Risk of bias assessment indicated low risk in eight studies and some concerns in seven studies. Conclusions: Telecounseling was associated with reductions in depressive symptom scores among primiparous postpartum women compared with routine care, although substantial heterogeneity was observed and treatment effects varied across follow-up durations. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420261333250.