MomMoodBooster web-based intervention for postpartum depression: feasibility trial results.

BACKGROUND: Postpartum depression (PPD)-the most common complication of childbirth-is a significant and prevalent public health problem that severely disrupts family interactions and can result in serious lasting consequences to the health of women and the healthy development of infants. These consequences increase in severity when left untreated; most women with PPD do not obtain help due to a range of logistical and attitudinal barriers. OBJECTIVE: This pilot study was designed to test the feasibility, acceptability, and potential efficacy of an innovative and interactive guided Web-based intervention for postpartum depression, MomMoodBooster (MMB). METHODS: A sample of 53 women who satisfied eligibility criteria (<9 months postpartum, ≥18 years of age, home Internet access and use of personal email, Edinburgh Postnatal Depression Survey score of 12-20 or Patient Health Questionnaire score from 10-19) were invited to use the MMB program. Assessments occurred at screening/pretest, posttest (3 months following enrollment), and at 6 months follow-up. RESULTS: All six sessions of the program were completed by 87% (46/53) of participants. Participants were engaged with the program: visit days (mean 15.2, SD 8.7), number of visits (mean 20.1, SD 12.2), total duration of visits in hours (mean 5.1, SD 1.3), and number of sessions viewed out of six (mean 5.6, SD 1.3) all support high usage. Posttest data were collected from 89% of participants (47/53) and 6-month follow-up data were collected from 87% of participants (46/53). At pretest, 55% (29/53) of participants met PHQ-9 criteria for minor or major depression. At posttest, 90% (26/29) no longer met criteria. CONCLUSIONS: These findings support the expanded use and additional testing of the MMB program, including its implementation in a range of clinical and public health settings.

Web-Based Intervention for Postpartum Depression: Formative Research and Design of the MomMoodBooster Program.

BACKGROUND: Postpartum depression is a significant public health problem affecting approximately 13% of women. There is strong evidence supporting Cognitive Behavioral Therapy (CBT) for successful psychosocial treatment. This treatment model combines cognitive and behavioral strategies to address pessimism, attributions for failure, low self-esteem, low engagement in pleasant activities, social withdrawal, anxiety, and low social support. Encouraging results have been reported for using Web-based CBT interventions for mental health domains, including the treatment of panic disorder, post-traumatic stress disorder, and complicated grief and depression. To date, however, Web-based interventions have not been used and evaluated specifically for the treatment of postpartum depression. OBJECTIVE: We describe the formative work that contributed to the development of our Web-based intervention for helping to ameliorate symptoms of postpartum depression, and the design and key components of the program. METHODS: A total of 17 focus group participants and 22 usability testers, who shared key characteristics with the participants of our planned feasibility study, took part. The proposed structure and ingredients of the program and mock-ups of selected webpages were presented to focus group participants. At various points, participants were asked a series of thought questions designed to elicit opinions and set the occasion for group discussion. At the end of the session, participants were asked to describe their overall reaction to the proposed features of the program emphasizing candid opinions about what they did not like and features they thought were missing and should be added. Usability testers were asked to interact with a series of seven different Web-based interactions planned for the program while receiving minimal direction. Each tester was asked to describe her thoughts using a think-aloud technique. They were then asked to consider all that they had learned about the program and complete the System Usability Scale that we adapted slightly to be appropriate for evaluating the proposed website. Transcripts from the focus groups and usability tests were reviewed by research team members for overarching themes with particular emphasis on suggested changes. A list emerged, and iterative and incremental adjustments were made as a result. RESULTS: The qualitative and quantitative data gathered in the focus groups and usability sessions reported here suggest that the new mothers involved had largely positive reactions to the major features of the program and that those program features performed well in terms of usability. CONCLUSIONS: An overview of the eventual design, architecture, and key program ingredients of the MomMoodBooster program is provided including innovative features supplementing 6 core CBT sessions, which include a partner's website, a library, and individual feedback by a personal coach.

Treating postnatal depressive symptoms in primary care: a randomised controlled trial of GP management, with and without adjunctive counselling.

BACKGROUND: Postnatal depression (PND) is under-diagnosed and most women do not access effective help. We aimed to evaluate comparative management of (PND) following screening with the Edinburgh Postnatal Depression Scale, using three best-practice care pathways by comparing management by general practitioners (GPs) alone compared to adjunctive counselling, based on cognitive behavioural therapy (CBT), delivered by postnatal nurses or psychologists. METHODS: This was a parallel, three-group randomised controlled trial conducted in a primary care setting (general practices and maternal & child health centres) and a psychology clinic. A total of 3,531 postnatal women were screened for symptoms of depression; 333 scored above cut-off on the screening tool and 169 were referred to the study. Sixty-eight of these women were randomised between the three treatment groups. RESULTS: Mean scores on the Beck Depression Inventory (BDI-II) at entry were in the moderate-to-severe range. There was significant variation in the post-study frequency of scores exceeding the threshold indicative of mild-to-severe depressive symptoms, such that more women receiving only GP management remained above the cut-off score after treatment (p = .028). However, all three treatment conditions were accompanied by significant reductions in depressive symptoms and mean post-study BDI-II scores were similar between groups. Compliance was high in all three groups. Women rated the treatments as highly effective. Rates of both referral to the study (51%), and subsequent treatment uptake (40%) were low. CONCLUSIONS: Data from this small study suggest that GP management of PND when augmented by a CBT-counselling package may be successful in reducing depressive symptoms in more patients compared to GP management alone. The relatively low rates of referral and treatment uptake, suggest that help-seeking remains an issue for many women with PND, consistent with previous research.

Towards parenthood: an antenatal intervention to reduce depression, anxiety and parenting difficulties.

BACKGROUND: There have been few antenatal interventions aimed at preparing women for the transition to parenthood and previous attempts to intervene antenatally to prevent postnatal depression and anxiety have had limited impact. METHODS: We evaluated the effectiveness of an antenatal intervention which targeted risk factors for poor postnatal adjustment, with the dual aim of reducing both postnatal symptoms of depression/anxiety and parenting difficulties (a nine-unit self-guided workbook with weekly telephone support). Based on an initial feasibility study (n=200) which confirmed a low level of help-seeking among distressed women during pregnancy, an additional community networking component was developed aimed at increasing social support and access to health professionals to facilitate treatment of current antenatal depression/anxiety, if present. In the evaluation of a second version of the intervention, pregnant women (n=143) were randomly allocated to receive either the intervention or routine care. RESULTS: Following the antenatal intervention there were significantly fewer cases scoring above threshold for mild-to-severe depression/anxiety symptoms postnatally compared to routine care, along with a trend towards reduced parenting stress. The community networking component appeared helpful and women with higher baseline depression scores showed higher levels of help-seeking in both intervention and routine care groups. LIMITATIONS: It was not possible to evaluate the efficacy of individual program components separately. CONCLUSIONS: The findings provide support for the effectiveness of the Towards Parenthood intervention both as a preparation for parenthood program and in reducing symptoms of postnatal depression/anxiety.

Adverse relationship processes: the attempts of women with bulimia nervosa symptoms to fit the perceived ideal of intimate partners.

OBJECTIVE: This study drew together research on anxious attachment, self-silencing, self-consciousness during sexual activity and bulimic symptoms. METHOD: A mixed community/university sample of 225 women aged 18-63 (M = 30.24, SD = 10.44) and involved in an intimate relationship completed questionnaires. RESULTS: Adverse relationship processes were significantly associated and each was also associated with bulimic symptoms. Self-consciousness during sexual activity was the best predictor of bulimic symptoms, followed by anxious attachment. Self-silencing was redundant when the other relationship processes were included in the regression. General psychopathology mediated the association between self-silencing and bulimic symptoms, and partially mediated associations between bulimic symptoms and both anxious attachment and self-consciousness during sexual activity. DISCUSSION: Women with bulimic symptoms attempt to change themselves by engaging in adverse processes in intimate relationships to meet the perceived expectations of their partners. Targeting these relationship processes in therapy might further add to the success of relationship-oriented treatments (e.g. interpersonal therapy).