It American College of Obstetricians and Gynecologists (ACOG) now recommends screening for perinatal depression and anxiety, noting that “clinicians screen patients for symptoms of depression and anxiety at least once in the perinatal period using a standard, validated instrument.” About 40 states have established guidelines and recommendations regarding screening for perinatal depression.
Despite existing screening and treatment recommendations, many women do not receive appropriate care for perinatal mood and anxiety disorders. Many barriers can prevent effective care, including, but not limited to, delayed or missed screening at primary care appointments, inability to find and/or follow-up with trained clinicians, and inadequate mental health staffing with long waiting lists. Thus, there is an urgent need to develop and implement effective and scalable interventions for women with perinatal mood and anxiety disorders.
HealthyMoms online program
A recent study examined the feasibility and acceptability of a web-based intervention (Healthy moms For the treatment of women with mild to moderate postpartum depression (PPD). Healthy moms is a secure psychoeducational e-health platform consisting of 19 self-paced learning modules focused on emotional health, healthy living, mental fitness tools, and mentoring. It Healthy moms modules are based on cognitive-behavioral therapy (CBT) and mindfulness-based practice.
In pilot randomized controlled trial (RCT), researchers enrolled women who had recently given birth and had mild to moderate postpartum depression and/or anxiety. Edinburgh Postpartum Depression Scale (EPDS) scores were between 10 and 19; Generalized Anxiety Disorder-7 (GAD-7) scores were above 10. All study participants were given access to the Internet intervention. Women randomized to the intervention group also received up to seven coaching phone calls over a six-month follow-up.
coaching sessions provided by women with bachelor’s degrees in psychology and/or experience in community organizations. Coaches were trained to provide information about the intervention, to listen reflectively, and to empathize with participants. The main purpose of the coaching calls was to guide and encourage the use of the web-based intervention and to promote the development of “SMART” (Specific, Measurable, Attainable, Realistic, Time-bound) goals.
The study recruited 52 participants who were randomized to the intervention (n=25) or control group (n=27). At 6 months, 88% (22/25) of intervention group participants and 59% (16/27) of control group participants remained in the study. On average, the intervention group had 11 more web visits than the control group. Participants in the intervention group completed an average 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 effect sizes of 0.51 and 0.56, respectively.
In this pilot RCT, Healthy moms A Web-based intervention accompanied by up to seven short phone calls by a trained professional instructor was a feasible, acceptable, and potentially effective intervention for women with mild to moderate postpartum depression and/or anxiety. The addition of coaching calls significantly increased engagement with the online intervention, but larger trials are needed to determine the effectiveness of this type 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 conventional telephone tutoring and Internet intervention for postpartum depression and anxiety. MPOWER study. Internet interview. December 23, 2022; 31:00 100597.