The American College of Obstetricians and Gynecologists (ACOG) now recommends screening for perinatal depression and anxiety, stating that “clinicians screen patients at least once during the perinatal period for depression and anxiety symptoms using a standard, validated tool.” Approximately 40 states have instituted guidelines and recommendations regarding screening for perinatal depression.
Despite existing screening and treatment recommendations, many women do not receive adequate care for perinatal mood and anxiety disorders. Numerous barriers may prevent effective care, including but not limited to delayed or missed screening at primary care appointments, failure to find and/or follow up with specially trained clinicians, and understaffed mental health facilities with long waitlists. Thus, there is an urgent need to develop and implement effective and scalable interventions for women with perinatal mood and anxiety disorders.
The HealthyMoms Online Program
A recent study looks at the feasibility and acceptability of a web-based intervention (HealthyMoms) for the treatment of women with mild to moderate postpartum depression (PPD). HealthyMoms is a secure psychoeducational e-health platform consisting of 19 self-guided learning modules focusing on emotional health, healthy living, mental fitness tools, and parenting. The HealthyMoms modules are grounded in cognitive-behavioral therapy (CBT) and mindfulness-based practices.
In a pilot randomized controlled trial (RCT), researchers enrolled women who had recently given birth and had mild to moderate postpartum depression and/or anxiety. Edinburgh Postnatal Depression Scale (EPDS) scores were between 10 and 19; scores on the Generalized Anxiety Disorder-7 scale (GAD-7) were above 10. All study participants were provided access to the web-based intervention. Women randomized to the intervention group also received up to seven coaching phone calls during the six months of follow up.
Coaching sessions were provided by women with bachelor’s degrees in psychology and/or experience in community organizations. The coaches were trained to provide information on the intervention, to listen reflectively, and to convey empathy to participants. The main goal of the coaching calls was to guide and encourage use of the web-based intervention and to promote the development of “SMART” (specific, measurable, achievable, realistic, time-limited) goals.
The study recruited 52 participants who were randomized to intervention (n=25) or the control group (n=27). At 6 months, 88% (22/25) of the participants in the intervention group and 59% (16/27) of the participants in the control group remained in the study. The intervention group had an average of 11 more website logins than the control group. Intervention group participants completed a mean of 6.2 coaching calls.
Because the study was small in size, estimates of the effect of the intervention on depression and anxiety at six months were imprecise; however, point estimates and confidence intervals were consistent with a moderate beneficial effect of the intervention on both depressive symptoms and anxiety with fully adjusted effects sizes of 0.51 and 0.56, respectively.
In this pilot RCT, the HealthyMoms web-based intervention accompanied by up to seven short telephone calls by a trained lay coach was a feasible, acceptable, and potentially effective intervention for women with mild to moderate postpartum depression and/or anxiety. The addition of coaching calls markedly increased engagement with the online intervention, but larger trials are needed to determine the effectiveness of this sort of intervention.
Ruta Nonacs, MD, PhD
Schwartz H, McCusker J, Da Costa D, Singh S, Baskaran S, Belzile E, Van Roost K. A pilot randomized controlled trial of a lay telephone coaching and web-based intervention for postpartum depression and anxiety: The MPOWER study. Internet Interv. 2022 Dec 23;31:100597.