A decolonized mental health framework for black women and birthing people.

Black perinatal mental health is an area that has received less focus in psychotherapy research in the United States. This area is especially important as recent attacks on Reproductive Justice impact not only birthing people's rights and freedoms but also their mental health and emotional well-being. Current psychotherapy interventions are rooted in evidence-based treatments (EBTs) that may not always align with the values and practices of frameworks like radical healing and liberation psychology that are meant to emphasize collective healing and empower individuals. To date, psychological research involving radical healing and liberation psychology approaches have not had a specific focus on birthing people. Psychotherapeutic interventions have also largely excluded the unique intersectional identities and healing of Black birthing people. In moving toward decolonizing psychotherapy, this conceptual paper will propose a multi-pronged framework for addressing racial stressors and other mental health concerns during the perinatal period. The proposed framework, The Three Cs of Decolonization, includes three components: Community, Creativity, and Connection to Self. These components of the framework are meant to address and highlight culturally relevant ways of healing for Black birthing people. Larger systemic changes are needed and necessary for the desired change across mental health, medical, and other integrated systems of care that have been impacted by racism and discrimination. The current framework is dedicated to healing and empowering Black birthing people with approaches and considerations that are consistent with Reproductive Justice.

I'm judging you! Influence of depression on moral judgments of COVID-19 infection control behaviors and policies.

Health officials recommended a number of COVID-19 infection control measures, such as social distancing and face covering. This study explores whether depression influences individuals' moral judgments regarding COVID-19 infection control behaviors and policies. In this study, participants (N = 340) were US residents, recruited via Amazon Mechanical Turk in March of 2020. Participants completed several questionnaires, such as demographics, including political affiliation, a depression screener, and a series of questions designed to capture individuals' moral judgments of infection control behaviors and policies. ANCOVA analyses indicated that, controlling for demographics, political affiliation, and the degree of news following, depression symptom level was consistently inversely related to the likelihood of judging infection control in moral terms. Depression symptom level was also inversely related to sensitivity to manipulation of moral judgments for personal behaviors, but not for policies. Individuals with higher levels of depression symptoms may be less willing to advocate for higher personal safety measures, which could lead to a higher likelihood of disease transmission. Outside of the pandemic, the lower propensity for moral judgment could translate into greater acceptance of morally questionable acts and behaviors from others.

Leading the charge toward a world without depression: perinatal depression can be prevented.

This manuscript is based on a keynote address presented at the 2020 Marcé Society's Conference celebrating the Society's 40th anniversary. The address described a 50-year perspective on prevention research, current evidence that perinatal depression can be prevented, and how digital tools could be used to disseminate perinatal depression prevention interventions throughout the world. We utilized the Mothers and Babies Course as a case study to illustrate these goals. The article reviews the gradual progress of depression prevention research, from the time when the state of the science was such that it was believed that the onset of major depressive episodes could not be prevented until the present day. In addition, the article recounts the three consensus reports on prevention of mental disorders published by the National Academies of Science, Engineering, and Medicine, culminating in the 2019 report, which calls on the field to implement known interventions for the prevention of depression and other mental disorders, and to scale up their administration to reduce the prevalence of these disorders in the general population. The paper presents the 2019 recommendations of the US Preventive Services Task Force, which instructs the health system to provide routine referrals to perinatal depression prevention interventions (e.g., the Mothers and Babies Course) to perinatal persons at risk for depression. We now have the knowledge to prevent approximately half of episodes of perinatal depression. It is time to implement this knowledge and begin to do research on how to prevent the remaining half.

A Systematic Review of Technology-Based Prevention and Treatment Interventions for Perinatal Depression and Anxiety in Latina and African American Women.

INTRODUCTION: Latina and African American women have elevated risk for perinatal depression and anxiety but have low rates of treatment engagement. Amid significant improvements in narrowing the digital divide, the number of technology-based mental health interventions has increased. A technology-based mode of delivery is important to consider because it can increase patient engagement and should inform program development. This review aimed to assess the mode of technology used for preventing and/or treating perinatal depression and anxiety in Latina and African American women, examine symptom management, and describe participant satisfaction. METHODS: We used PubMed, CINAHL, PsycINFO, PsycARTICLES, EBSCO, and Social Services Abstracts to identify studies that used technology (e.g., smartphones) to prevent and/or treat depression and/or anxiety in Latina and/or African American perinatal women. To be eligible for inclusion, studies must have had at least 50% Latina and/or African American samples. The review was conducted between November 2018 and October 2019, with no set publication start date. RESULTS: Of 152 studies reviewed, six met the inclusion criteria. Four studies included African American women; two studies had samples that were mostly composed of Latina women. Three studies used telephone/smartphone (e.g., text messaging) and three implemented internet-based interventions. All studies addressed depression; one focused on anxiety. The findings demonstrated participant satisfaction and promise for symptom management. DISCUSSION: Despite the limited number of studies that used technology to engage Latina and African American perinatal women, the results suggest that these women were willing to participate in digital interventions to address perinatal depression and anxiety.

A proof-of-concept pilot randomized comparative trial of brief Internet-based compassionate mind training and cognitive-behavioral therapy for perinatal and intending to become pregnant women.

OBJECTIVE: Depression is a prevalent and costly mental health problem that affects women as well as their larger communities, with substantial impacts on mother and infant during childbearing years. Face-to-face care has not adequately addressed this global concern due to difficulties in scaling these resources. Internet interventions, which can provide psychological tools to those lacking adequate access, show promise in filling this void. METHOD: We conducted a 2-condition proof-of-concept pilot randomized trial comparing brief Internet-based cognitive behavioural therapy (CBT) and brief Internet-based compassionate mind training (CMT) for women who are currently pregnant, became pregnant within the last year, and intend to become pregnant in the future. RESULTS: We found that, although CMT and CBT demonstrated near equivalence in improving affect, self-reassurance, self-criticism, and self-compassion, CMT showed superiority to CBT in reducing depression and anxiety symptoms. CONCLUSION: These findings provide a compelling initial argument for the use of CMT as an avenue for addressing problems associated with negative affect. Implications, limitations, and future directions along this line of research will also be discussed.

Depression help-seeking attitudes and behaviors among an Internet-based sample of Spanish-speaking perinatal women.

OBJECTIVE: To examine attitudes and beliefs related to help-seeking for depression among an international sample of pregnant women, a majority of whom were Spanish-speakers residing in Latin America. METHODS: More than 6 000 (n = 6 672) pregnant women met eligibility criteria and consented to participate between 15 January 2009-12 August 2011. Of these, 1 760 with a Latino/Hispanic background completed a baseline survey as part of a larger study. Group comparisons analyzed attitudes and behaviors related to seeking help for depression, while a logistic regression was conducted to identify demographic characteristics related to help-seeking support. RESULTS: Of the participants, three-fourths reported experiencing depression during or after their current or past pregnancies. The majority of participants did not seek help, and generally reported ambivalence about their depressive symptoms and uncertainty as to the helpfulness of others. However, 44.8% did seek help, mostly by speaking to family or partners and reported feeling fear, shame, and embarrassment about their symptoms. A current major depressive episode and an income less than or equal to US$ 10 000 were significant predictors of help-seeking behaviors. CONCLUSIONS: Data from this study suggest that when feeling sad or depressed, perinatal Latinas tend to seek emotional support first from family and friends and may underutilize mental health services when needed. The Internet is an effective means for reaching perinatal women, especially those in areas of the world where there may be barriers to accessing psychological resources.

Keywords to recruit Spanish- and English-speaking participants: evidence from an online postpartum depression randomized controlled trial.

BACKGROUND: One of the advantages of Internet-based research is the ability to efficiently recruit large, diverse samples of international participants. Currently, there is a dearth of information on the behind-the-scenes process to setting up successful online recruitment tools. OBJECTIVE: The objective of the study was to examine the comparative impact of Spanish- and English-language keywords for a Google AdWords campaign to recruit pregnant women to an Internet intervention and to describe the characteristics of those who enrolled in the trial. METHODS: Spanish- and English-language Google AdWords campaigns were created to advertise and recruit pregnant women to a Web-based randomized controlled trial for the prevention of postpartum depression, the Mothers and Babies/Mamás y Bebés Internet Project. Search engine users who clicked on the ads in response to keyword queries (eg, pregnancy, depression and pregnancy) were directed to the fully automated study website. Data on the performance of keywords associated with each Google ad reflect Web user queries from February 2009 to June 2012. Demographic information, self-reported depression symptom scores, major depressive episode status, and Internet use data were collected from enrolled participants before randomization in the intervention study. RESULTS: The Google ads received high exposure (12,983,196 impressions) and interest (176,295 clicks) from a global sample of Web users; 6745 pregnant women consented to participate and 2575 completed enrollment in the intervention study. Keywords that were descriptive of pregnancy and distress or pregnancy and health resulted in higher consent and enrollment rates (i.e., high-performing ads). In both languages, broad keywords (eg, pregnancy) had the highest exposure, more consented participants, and greatest cost per consent (up to US $25.77 per consent). The online ads recruited a predominantly Spanish-speaking sample from Latin America of Mestizo racial identity. The English-speaking sample was also diverse with most participants residing in regions of Asia and Africa. Spanish-speaking participants were significantly more likely to be of Latino ethnic background, not married, completed fewer years of formal education, and were more likely to have accessed the Internet for depression information (P<.001). CONCLUSIONS: The Internet is an effective method for reaching an international sample of pregnant women interested in online interventions to manage changes in their mood during the perinatal period. To increase efficiency, Internet advertisements need to be monitored and tailored to reflect the target population's conceptualization of health issues being studied. TRIAL REGISTRATION: ClinicalTrials.gov NCT00816725; http://clinicaltrials.gov/show/NCT00816725 (Archived by WebCite at http://www.webcitation.org/6LumonjZP).

Mothers and Babies Virtual Group (MBVG) for perinatal Latina women: study protocol for a hybrid type-1 effectiveness-implementation randomized controlled trial.

BACKGROUND: Immigrant Latinas (who are foreign-born but now reside in the USA) are at greater risk for developing postpartum depression than the general perinatal population, but many face barriers to treatment. To address these barriers, we adapted the Mothers and Babies Course-an evidence-based intervention for postpartum depression prevention-to a virtual group format. Additional adaptations are inclusion of tailored supplemental child health content and nutrition benefit assistance. We are partnering with Early Learning Centers (ELC) across the state of Maryland to deliver and test the adapted intervention. METHODS: The design is a Hybrid Type I Effectiveness-Implementation Trial. A total of 300 participants will be individually randomized to immediate (N = 150) versus delayed (N = 150) receipt of the intervention, Mothers and Babies Virtual Group (MB-VG). The intervention will be delivered by trained Early Learning Center staff. The primary outcomes are depressive symptoms (measured via the Center for Epidemiologic Studies-Depression Scale), parenting self-efficacy (measured via the Parental Cognition and Conduct Towards the Infant Scale (PACOTIS) Parenting Self-Efficacy subscale), and parenting responsiveness (measured via the Maternal Infant Responsiveness Instrument) at 1-week, 3-month, and 6-month post-intervention. Depressive episodes (Structured Clinical Interview for DSM-V- Disorders Research Version) at 3-month and 6-month post-intervention will also be assessed. Secondary outcomes include social support, mood management, anxiety symptoms, perceived stress, food insecurity, and mental health stigma at 1-week, 3-month, and 6-month post-intervention. Exploratory child outcomes are dysregulation and school readiness at 6-month post-intervention. Intervention fidelity, feasibility, acceptability, and appropriateness will also be assessed guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. DISCUSSION: This study will be one of the first to test the efficacy of a group-based virtual perinatal depression intervention with Latina immigrants, for whom stark disparities exist in access to health services. The hybrid effectiveness-implementation design will allow rigorous examination of barriers and facilitators to delivery of the intervention package (including supplemental components) which will provide important information on factors influencing intervention effectiveness and the scalability of intervention components in Early Learning Centers and other child-serving settings. REGISTRATION: ClinicalTrials.gov NCT05873569.

Mothers and Babies Online Course: Participant Characteristics and Behaviors in a Web-Based Prevention of Postpartum Depression Intervention.

Despite the availability of evidence-based postpartum depression (PPD) prevention and treatment interventions, perinatal persons continue to suffer. eHealth and mHealth tools to address mental health issues have grown exponentially, especially given the ubiquity of technology and the increased demand for telemental health resources. The Mothers and Babies Online Course (eMB), an 8-lesson prevention of PPD intervention, was digitally adapted to expand the reach of evidence-based interventions to perinatal persons with limited access to maternal mental health resources. This report describes the characteristics, behaviors, and feedback provided by users of the updated eMB website. Two hundred eight predominantly English-speaking U.S. residents enrolled in the eMB. Thirty-seven percent were either pregnant (n = 38) or postpartum (n = 39) women interested in learning skills to manage changes in their mood during and after pregnancy; 63% were health providers (n = 131) interested in learning how to support their patient communities. Seventy-six percent (n = 159) viewed at least one of the eight eMB lessons, with 50.9% exclusively viewing Lesson 1. Few (4.4%) viewed all eight lessons. The lessons were rated favorably on usefulness and understanding. Perinatal women engaged with interactive content at higher rates than health providers. Examining user behaviors and feedback is an essential developmental step before empirically testing the efficacy of digital tools. Future iterations of the eMB will incorporate these preliminary findings to provide perinatal persons with accessible web-based interventions that will hopefully reduce the incidence and negative consequences of postpartum depression.

Integrating SMS Text Messages Into a Preventive Intervention for Postpartum Depression Delivered via In-Home Visitation Programs: Feasibility and Acceptability Study.

BACKGROUND: The Mothers and Babies (MB) Course is recognized by the US Preventive Services Task Force as an evidence-based preventive intervention for postpartum depression (PPD) that should be recommended to pregnant women at risk for PPD. OBJECTIVE: This report examines the feasibility and acceptability of enhancing the MB 1-on-1 intervention by adding 36 SMS text messages that target 3 areas: reinforcement of skills, between-session homework reminders, and responding to self-monitoring texts (ie, MB Plus Text Messaging [MB-TXT]). METHODS: In partnership with 9 home visiting programs, 28 ethnically and racially diverse pregnant women (mean 25.6, SD 9.0 weeks) received MB-TXT. Feasibility was defined by home visitors' adherence to logging into the HealthySMS platform to enter session data and trigger SMS text messages within 7 days of the in-person session. The acceptability of MB-TXT was measured by participants' usefulness and understanding ratings of the SMS text messages and responses to the self-monitoring SMS text messages. RESULTS: On average, home visitors followed the study protocol and entered session-specific data between 5.50 and 61.17 days following the MB 1-on-1 sessions. A high proportion of participants responded to self-monitoring texts (25/28, 89%) and rated the text message content as very useful and understandable. CONCLUSIONS: This report contributes to a growing body of research focusing on digital adaptations of the MB course. SMS is a low-cost, accessible digital tool that can be integrated into existing interventions. With appropriate resources to support staff, it can be implemented in community-based organizations and health care systems that serve women at risk for PPD. TRIAL REGISTRATION: ClinicalTrials.gov NCT03420755; https://clinicaltrials.gov/ct2/show/NCT03420755.

The Factor Reliability and Convergent Validity of the Patient Health Questionnaire-4 Among an International Sample of Pregnant Women.

Background: Pregnant women are at an increased risk for anxiety and depression, but a majority of women go untreated due to a high rate of undetected symptoms. The 4-item Patient Health Questionnaire (PHQ-4) is an ultrabrief screening instrument for anxiety and depression with sound psychometric properties demonstrated in the general population and primary care, but not among pregnant women. The aim of this study was to provide initial evidence of the validity and reliability of the PHQ-4 among pregnant women. Materials and Methods: Data from an international sample of 1148 pregnant women who participated in an online cross-sectional survey were examined using a confirmatory factor analysis (CFA) and multigroup analysis approaches. Average chronological and gestational ages were 27.7 years old (standard deviation [SD] = 6.5) and 16.8 weeks (SD = 10.6), respectively. Participants were from diverse cultural backgrounds and English and Spanish speaking (n = 587 and n = 561, respectively). Results: CFA reflected two distinct factors, which accounted for 59% of the proportion of variance in the two anxiety items and 50% in the two depression items. Coefficient H values of 0.74 for anxiety and 0.70 for depression suggested good factor reliability. Conclusions: This is the first study demonstrating initial evidence supporting the validity and reliability of the PHQ-4 in pregnant women. Should this study be replicated, a clinical interview, which is the gold standard procedure, should be included. Regardless, the PHQ-4 may be a useful ultrabrief resource for maternal mental health clinicians and health care providers who need to identify potential cases of anxiety and depression in pregnant women using efficient and evidence-based tools.

Who comes to a self-help depression prevention website? Characteristics of Spanish- and English-speaking visitors.

OBJECTIVE: To describe demographic and clinical characteristics of Spanish- and English-speaking visitors to a "Healthy Mood" website. METHODS: An online study intended to prevent depression by teaching users mood management skills recruited participants globally using primarily Google Ads. Those who consented responded to the Patient Health Questionnaire (PHQ-9) and the MDE Screener (Muñoz, 1998) upon entry into the study. RESULTS: 1423 participants consented, 437 English speakers and 986 Spanish speakers. Of the 1271 participants with sufficient depression symptom data, 65% screened positive for a current major depressive episode, 30% were at high risk for onset of a major depressive episode, and 5% were in the low-risk category. CONCLUSION: Websites intended to be preventive appear to attract primarily individuals who are currently experiencing enough symptoms to screen positive for a major depressive episode. Only 30% of participants were appropriate for a depression prevention intervention. Therefore, such sites must be ready to encourage those with current depression to obtain professional help as well as ensure that the online self-help interventions are appropriate for participants who could benefit from both preventive and treatment interventions.

Development and usability of a Spanish/English smoking cessation website: lessons learned.

BACKGROUND: Smoking cessation Internet interventions have been shown to be comparable in effectiveness to the nicotine patch. The aim of this study was to develop a Spanish/English smoking cessation web app using input from low-income smokers, and to evaluate modifications to the online intervention in terms of its ability to engage smokers. METHODS: Three versions of a smoking cessation web app were developed and tested. Measures of engagement, such as completion of study registration, utilization of cigarette, mood, and craving trackers, and completion of follow-up assessments, were collected to determine whether changes in the website resulted in increased engagement. RESULTS: The third version of the website, which featured improved look-and-feel and fewer barriers to engagement, markedly increased tracker engagement from the first two versions. However, follow-up rates remained low across all three versions. CONCLUSIONS: The increase in engagement was attributed to the following modifications: A more inviting landing page with key intervention elements available immediately; an easily accessible dashboard with users' data; and tracking tools that were more user friendly. We conclude that in addition to adequate and functional elements, design principles are key factors in increasing engagement in online interventions.

Prevention of major depression.

Before the 1980s, no randomized controlled trials had been carried out to test whether major depressive episodes could be prevented. In the past 30 years, several trials have reported success in reducing the incidence (the number of new cases) of major depressive episodes. These studies suggest that major depression can be prevented. Given the large burden of disease caused by major depression, it is time for substantial systematic efforts to replicate these studies, carry out multisite trials, and widely disseminate prevention interventions found to be effective. The present review examines the conceptual and practical differences between treatment and prevention trials and the importance of identifying groups at high short-term risk for major depressive episodes to make prevention trials feasible. We also list the randomized controlled prevention trials that have been carried out to date and discuss the need for prevention interventions that go beyond the limits of traditional face-to-face interventions.

A preliminary study on the acceptability of a brief SMS program for perinatal women.

This study examined the acceptability of the BabyText program, a Spanish and English textmessaging program adapted from a prevention of postpartum depression group intervention. Ten ethnically and racially diverse pregnant and postpartum women (mean age = 31.3, standard deviation = 5.25) recruited from a metropolitan, urban area of the United States received the BabyText program over a 69-day period (between October 2015 and April 2016). Each tip was assessed for the helpfulness of the content, and all women were invited to provide qualitative feedback about the program. Eighteen of the tips received a positive endorsement of helpfulness from 75 to 100 percent of the women, 12 tips received a positive endorsement of helpfulness from 50 percent of the women, and one tip was rated negatively by those who responded. Qualitative feedback described the need to personalize the tips to reflect the characteristics of women such as planned/unplanned pregnancy status, available economic resources, and current psychological distress. Women in this study favored tips that described stress management skills and emphasized caring for the self (vs only the baby). Data from this study are preliminary but add to the growing sentiment that digital tools should continue to be developed and tested, and personalization of intervention content is important to users.

International Spanish/English Internet smoking cessation trial yields 20% abstinence rates at 1 year.

INTRODUCTION: There are 1.1 billion smokers worldwide. Traditional smoking cessation methods, such as nicotine replacement therapy and smoking cessation groups, yield between 14% and 27% abstinence rates at 6 months. Evidence-based Internet interventions with comparable abstinence rates could be a powerful global tool to reduce tobacco-related morbidity and mortality. METHODS: We report a randomized control trial in which 500 Spanish-speaking and 500 English-speaking adult Internet users, smoking at least 5 cigarettes/day and intending to quit in the next month, were recruited online from 68 countries. Consenting participants who completed baseline measures, logged cigarettes smoked on 3 days within a week, and set a quit date were randomized to four conditions. Each condition added new elements: Condition 1 was the "Guía Para Dejar de Fumar," a static National Cancer Institute evidence-based stop smoking guide; Condition 2 consisted of Condition 1 plus E-mail reminders to return to the site; Condition 3 consisted of Condition 2 plus mood management lessons; and Condition 4 consisted of Condition 3 plus a "virtual group" (an asynchronous bulletin board). Main outcome measures were 7-day point prevalence abstinence at 1, 3, 6, and 12 months after initial quit date. RESULTS: There were no significant differences among the four conditions. The overall 12-month 7-day abstinence rates were 20.2% for Spanish speakers and 21.0% for English speakers when those with missing data were assumed to be smoking. DISCUSSION: Internet smoking cessation interventions with such abstinence rates provided globally in additional languages could contribute substantially to tobacco control efforts.

Responding to women's needs and preferences in an online program to prevent postpartum depression.

PURPOSE: Global access to adequate resources to address postpartum depression (PPD) are limited and, at times, not reflective of the needs of pregnant women and new mothers. Gathering information about the preferences and needs of women when designing and implementing Internet-based programs is warranted, especially given the diversity of experiences related to childbirth. Thus, the aim of this study was to obtain user feedback on the content, structural, and cultural factors associated with a fully automated online PPD prevention intervention that, like similar programs, suffered from poor adherence and engagement. METHODS: Following the completion of the Mothers and Babies Internet Course (eMB), an online prevention of PPD trial, a convenience sampling method was used to invite consenting participants to return to the site. Participants provided anonymous feedback on how to improve and adapt the eMB based on screenshots and video content from the Internet intervention. Demographic information and engagement in the online trial were examined as factors influencing participant responses. RESULTS: One hundred nineteen English and Spanish speaking women from 27 countries and territories provided feedback about the eMB. Content-based feedback included requesting additional detail in explanations and simplifying recommended exercises. Structure-based feedback included requests for more visual representations of the materials. In general, participants did not explicitly suggest culturally specific feedback that differed by geographic region, but instead reported similar themes related to motherhood and childrearing. An unexpected finding that only emerged among English-speaking participants was the need for the eMB to address perfectionism and introspection as factors that impact motherhood. Relative to those who did not access the eMB in the parent study, women who did thought the intervention content was acceptable (i.e., no suggested changes) and provided feedback that referenced maternal stress and pregnancy experiences. Age, education, pregnancy status and number of children were not significant factors associated with participants' use of the eMB. CONCLUSIONS: Findings from this study offer preliminary information about the needs and preferences of an international sample of childrearing women who access automated Internet interventions to manage mood changes during the perinatal period.

Perinatal depression among a global sample of Spanish-speaking women: A sequential-process latent growth-curve analysis.

BACKGROUND: Despite high rates of perinatal depression among women from diverse backgrounds, the understanding of the trajectory of depressive symptoms is limited. The aim of this study was to investigate the trajectories of depressive symptoms from pregnancy to postpartum among an international sample of pregnant women. METHODS: Hispanic/Latina (79.2%), Spanish-speaking (81%) pregnant women (N = 1796; Mean age = 28.32, SD = 5.51) representing 78 unique countries/territories participated in this study. A sequential-process latent growth-curve model was estimated to examine general trajectories of depression as well as risk and protective factors that may impact depression levels throughout both the prenatal and postpartum periods. RESULTS: Overall, depression levels decreased significantly across the entire perinatal period, but this decrease slowed over time within both the prenatal and postpartum periods. Spanish-speaking women, those who were partnered, and those with no history of depression reported lower levels of depression during early pregnancy, but this buffer effect reduced over time. Depression levels at delivery best predicted postpartum depression trajectories (i.e., women with higher levels of depression at delivery were at greater risk for depression postpartum). LIMITATIONS: Given the emphasis on language and not country or culture of origin this study was limited in its ability to examine the impact of specific cultural norms and expectations on perinatal depression. CONCLUSIONS: Given these findings, it is imperative that providers pay attention to, and assess for, depressive symptoms and identified buffers for depression, especially when working with women from diverse communities.

Facebook for recruiting Spanish- and English-speaking smokers.

BACKGROUND: Recruitment for research is usually expensive and time consuming. Facebook (FB) recruitment has become widely utilized in recent years. The main aim of this study was to assess FB as a recruitment tool in a study for Spanish- and English-speaking smokers. Additionally, the study set out to compare performance of ads by language (Spanish vs. English), location (U.S. vs. San Francisco) and content (self-efficacy ad vs. fear appeal ad). METHODS: Participants of a one-condition smoking cessation webapp study were recruited utilizing FB ads and posts through two phases: a recruitment-focused phase and an experimental phase comparing language, location and content. RESULTS: During the recruitment phase 581 participants in total (U.S. = 540, San Francisco = 41) provided consent. Of the U.S. participants 275 were Spanish-speakers and 265 English-speakers. The cost-per-consent was $25.81 for Spanish-speakers, and $15.49 for English-speakers. During the experimental phase U.S. users performed better (i.e. more clicks, engagement and social reach) than San Francisco users, Spanish-speakers engaged more than English-speakers, and the self-efficacy ad performed better than the fear appeal ad. CONCLUSIONS: This study showed that although there were differences in cost-per-consent for Spanish- and English-speakers, recruitment of Spanish-speakers through Facebook is feasible. Furthermore, comparing performance of ads by location, language, and ad content may contribute to developing more efficient campaigns.

Comparing Amazon Mechanical Turk with unpaid internet resources in online clinical trials.

Internet interventions face significant challenges in recruitment and attrition rates are typically high and problematic. Finding innovative yet scientifically valid avenues for attaining and retaining participants is therefore of considerable importance. The main goal of this study was to compare recruitment process and participants characteristics between two similar randomized control trials of mood management interventions. One of the trials (Bunge et al., 2016) was conducted with participants recruited from Amazon's Mechanical Turk (AMT), and the other trial recruited via Unpaid Internet Resources (UIR). METHODS: The AMT sample (Bunge et al., 2016) consisted of 765 adults, and the UIR sample (recruited specifically for this study) consisted of 329 adult US residents. Participants' levels of depression, anxiety, confidence, motivation, and perceived usefulness of the intervention were assessed. The AMT sample was financially compensated whereas the UIR was not. RESULTS: AMT yielded higher recruitment rates per month (p < .05). At baseline, the AMT sample reported significantly lower depression and anxiety scores (p < .001 and p < .005, respectively) and significantly higher mood, motivation, and confidence (all p < .001) compared to the UIR sample. AMT participants spent significantly less time on the site (p < .05) and were more likely to complete follow-ups than the UIR sample (p < .05). Both samples reported a significant increase in their level of confidence and motivation from pre- to post-intervention. AMT participants showed a significant increase in perceived usefulness of the intervention (p < .0001), whereas the UIR sample did not (p = .1642). CONCLUSIONS: By using AMT, researchers can recruit very rapidly and obtain higher retention rates; however, these participants may not be representative of the general online population interested in clinical interventions. Considering that AMT and UIR participants differed in most baseline variables, data from clinical studies resulting from AMT samples should be interpreted with caution.