%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68030 %T Investigating Protective and Risk Factors and Predictive Insights for Aboriginal Perinatal Mental Health: Explainable Artificial Intelligence Approach %A Wang,Guanjin %A Bennamoun,Hachem %A Kwok,Wai Hang %A Quimbayo,Jenny Paola Ortega %A Kelly,Bridgette %A Ratajczak,Trish %A Marriott,Rhonda %A Walker,Roz %A Kotz,Jayne %+ , School of Information Technology, Murdoch University, 90 South St, Murdoch WA, Perth, 6150, Australia, 61 89360735, Guanjin.Wang@murdoch.edu.au %K explainable AI %K perinatal mental health %K AI-assisted decision-making %K perinatal %K mental health %K artificial intelligence %K predictive %K depression %K anxiety %K maternal health %K maternal %K infant health %K infant %K Aboriginal %K woman %K psychological risk %K mother %K decision-making %K decision support %K machine learning %K psychological distress %K Aboriginal mothers %K risk factors %K Australia %K cultural strengths %K protective factors %K life events %K worries %K relationships %K childhood experiences %K domestic violence %K substance use %D 2025 %7 30.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Perinatal depression and anxiety significantly impact maternal and infant health, potentially leading to severe outcomes like preterm birth and suicide. Aboriginal women, despite their resilience, face elevated risks due to the long-term effects of colonization and cultural disruption. The Baby Coming You Ready (BCYR) model of care, centered on a digitized, holistic, strengths-based assessment, was co-designed to address these challenges. The successful BCYR pilot demonstrated its ability to replace traditional risk-based screens. However, some health professionals still overrely on psychological risk scores, often overlooking the contextual circumstances of Aboriginal mothers, their cultural strengths, and mitigating protective factors. This highlights the need for new tools to improve clinical decision-making. Objective: We explored different explainable artificial intelligence (XAI)–powered machine learning techniques for developing culturally informed, strengths-based predictive modeling of perinatal psychological distress among Aboriginal mothers. The model identifies and evaluates influential protective and risk factors while offering transparent explanations for AI-driven decisions. Methods: We used deidentified data from 293 Aboriginal mothers who participated in the BCYR program between September 2021 and June 2023 at 6 health care services in Perth and regional Western Australia. The original dataset includes variables spanning cultural strengths, protective factors, life events, worries, relationships, childhood experiences, family and domestic violence, and substance use. After applying feature selection and expert input, 20 variables were chosen as predictors. The Kessler-5 scale was used as an indicator of perinatal psychological distress. Several machine learning models, including random forest (RF), CatBoost (CB), light gradient-boosting machine (LightGBM), extreme gradient boosting (XGBoost), k-nearest neighbor (KNN), support vector machine (SVM), and explainable boosting machine (EBM), were developed and compared for predictive performance. To make the black-box model interpretable, post hoc explanation techniques including Shapley additive explanations and local interpretable model-agnostic explanations were applied. Results: The EBM outperformed other models (accuracy=0.849, 95% CI 0.8170-0.8814; F1-score=0.771, 95% CI 0.7169-0.8245; area under the curve=0.821, 95% CI 0.7829-0.8593) followed by RF (accuracy=0.829, 95% CI 0.7960-0.8617; F1-score=0.736, 95% CI 0.6859-0.7851; area under the curve=0.795, 95% CI 0.7581-0.8318). Explanations from EBM, Shapley additive explanations, and local interpretable model-agnostic explanations identified consistent patterns of key influential factors, including questions related to “Feeling Lonely,” “Blaming Herself,” “Makes Family Proud,” “Life Not Worth Living,” and “Managing Day-to-Day.” At the individual level, where responses are highly personal, these XAI techniques provided case-specific insights through visual representations, distinguishing between protective and risk factors and illustrating their impact on predictions. Conclusions: This study shows the potential of XAI-driven models to predict psychological distress in Aboriginal mothers and provide clear, human-interpretable explanations of how important factors interact and influence outcomes. These models may help health professionals make more informed, non-biased decisions in Aboriginal perinatal mental health screenings. %M 40306634 %R 10.2196/68030 %U https://www.jmir.org/2025/1/e68030 %U https://doi.org/10.2196/68030 %U http://www.ncbi.nlm.nih.gov/pubmed/40306634 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e71708 %T Immersive Virtual Reality eHealth Intervention to Reduce Anxiety and Depression in Pregnant Women: Randomized Controlled Trial %A Jimenez-Barragan,Marta %A Del Pino Gutierrez,Amparo %A Sauch Valmaña,Gloria %A Monistrol,Olga %A Monge Marcet,Carme %A Pallarols Badia,Mar %A Garrido,Ignasi %A Carmona Ruiz,Anna %A Porta Roda,Oriol %A Esquinas,Cristina %A Falguera Puig,Gemma %+ Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, Universitat de Barcelona, Feixa Llarga s/n 08907 Hospitalet de Llobregat, Barcelona, Spain, Barcelona, 08907, Spain, 34 934024256, marta.jim@gmail.com %K virtual reality %K eHealth %K pregnancy %K mental health %K anxiety %K depression %K randomized controlled trial %K antenatal care %D 2025 %7 30.4.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mental health during pregnancy is a critical factor influencing maternal and fetal outcomes. Anxiety and depression affect up to 30% of pregnant women, with significant consequences for maternal well-being and child development. Despite this, interventions during pregnancy remain limited, creating a need for innovative, accessible solutions. Objective: This study aimed to evaluate the effectiveness of an immersive virtual reality (IVR) eHealth intervention in reducing anxiety and depression symptoms in women during pregnancy. Methods: A 2-arm, randomized controlled trial was conducted across 5 primary care centers in Catalonia, Spain, between October 2021 and May 2024. The study included pregnant women (N=70) aged ≥18 years with moderate anxiety and depression symptoms (Edinburgh Postnatal Depression Scale [EPDS] scores: 9-12) at 12 to 14 weeks of gestation. They were randomly assigned (1:1) to an IVR intervention or standard care group. The intervention group engaged in daily 14-minute IVR mindfulness and relaxation sessions for 6 weeks. Mental health outcomes were assessed using the EPDS and State-Trait Anxiety Inventory. Results: The intervention group demonstrated significant reductions in EPDS scores, with a mean decrease from 11.32 (SD 0.96) to 7.25 (SD 1.32; P<.001), compared to an increase in the control group from 11.32 (SD 0.94) to 16.23 (SD 1.25; P<.001). Similarly, State-Trait Anxiety Inventory scores improved markedly in the intervention group (mean decrease from 57.94, SD 5.23 to 35.03, SD 6.12; coefficient –30.47, 95% CI −45.23 to −15.72; P<.001), while the control group experienced a nonsignificant increase (from 66.10, SD 5.89 to 72.91, SD 6.34; P=.68). High adherence rates were observed, with 79% (26/33) of participants completing ≥30 sessions. Participant satisfaction was high, with 87% (29/33) reporting being “very satisfied” with the intervention. Conclusions: The IVR eHealth intervention significantly reduced symptoms of anxiety and depression, demonstrating its potential as an accessible and effective tool for mental health support during pregnancy. High adherence and satisfaction levels underscore its feasibility and acceptability. Future research should explore the long-term effects and scalability of IVR interventions in diverse settings. Trial Registration: ClinicalTrials.gov NCT05756205; https://clinicaltrials.gov/study/NCT05756205 International Registered Report Identifier (IRRID): RR2-10.1186/s12912-023-01440-4 %M 40306641 %R 10.2196/71708 %U https://humanfactors.jmir.org/2025/1/e71708 %U https://doi.org/10.2196/71708 %U http://www.ncbi.nlm.nih.gov/pubmed/40306641 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64075 %T Exposure to and Engagement With Digital Psychoeducational Content and Community Related to Maternal Mental Health by Perinatal Persons and Mothers: Protocol for a Web-Based Survey With Optional Follow-Up %A Waring,Molly E %A McManus-Shipp,Katherine E %A Field,Christiana M %A Bhusal,Sandesh %A Perez,Asley %A Shapiro,Olivia %A Gaspard,Sophia A %A Dennis,Cindy-Lee %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Unit 1101, Storrs, CT, 06269, United States, 1 860 486 1446, molly.waring@uconn.edu %K social media %K podcasts %K blogs %K perinatal mental health %K maternal mental health %K digital health %K engagement %D 2025 %7 30.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Leveraging digital platforms may be an effective strategy for connecting perinatal persons and mothers with evidence-based information and support related to maternal mental health and peers. Momwell is a mom-centered model of care that provides psychoeducational content through several digital platforms, including social media, a podcast, and a blog. The aims of this project were to describe how perinatal persons and mothers engage with Momwell’s psychoeducational content and community; describe the perceived benefits of exposure to and engagement with content and community; examine associations between engagement with digital psychoeducational content and maternal mental health, parenting attitudes, and interparental relationships; and examine changes in mental health and parenting attitudes and concurrent engagement with Momwell’s digital psychoeducational content and community over 2 to 3 months. Objective: This paper aims to describe the design of a study of perinatal persons and mothers who are exposed to or engage with Momwell’s psychoeducational content and community and describe sample characteristics. Methods: Adults who engaged with Momwell on any of their digital platforms were recruited to complete a web-based survey in July 2023 to September 2023. Participants completed either a longer or shorter survey. Participants who provided permission to be recontacted were invited to complete a second survey 2 to 3 months later. The surveys included validated psychological measures, study-specific quantitative questions, and open-ended questions that assessed participant demographics, exposure to and engagement with Momwell’s psychoeducational content and community, maternal mental health, parenting relationships, parenting self-efficacy, and additional psychosocial and health measures. We outline planned analyses to achieve the aims of the project. Results: Data collection occurred from July 2023 to September 2023 (N=584). A subset of participants completed the optional second survey in October 2023 to December 2023 (N=246). Participants were >99% mothers (582/584, 99.7%); 45.5% (266/584) perinatal (59/584, 10.1% pregnant; 210/584, 36% post partum); and, on average, aged 32.4 (SD 3.9) years. In total, 59.1% (345/584) were from the United States, 35.6% (208/584) were from Canada, and 5.3% (31/584) were from other countries. The vast majority (552/584, 94.5%) followed Momwell on Instagram, 44.2% (258/584) listened to the Momwell podcast, and 41.1% (240/584) received their newsletter. Most participants had been exposed to Momwell’s psychoeducational content for at least 6 months across the different platforms (range 16/36, 44% on TikTok to 480/552, 87% on Instagram). Conclusions: Data from this study will provide insights into how pregnant persons and mothers use digital psychoeducational content and peer communities to support their mental health throughout the perinatal period and into the early years of motherhood. Leveraging digital platforms to disseminate evidence-based digital psychoeducational content related to maternal mental health and connect peers has the potential to change how we care for perinatal persons and mothers. International Registered Report Identifier (IRRID): DERR1-10.2196/64075 %M 40306643 %R 10.2196/64075 %U https://www.researchprotocols.org/2025/1/e64075 %U https://doi.org/10.2196/64075 %U http://www.ncbi.nlm.nih.gov/pubmed/40306643 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e68346 %T Genetic, Epidemiological, and Clinical Risk Factors for Perinatal Anxiety and Depression in Dubai: Protocol for a 2-Point Prospective Observational Study %A Tambawala,Zenab Yusuf %A Khan,Nusrat %A Saquib,Shabnam %A Lakshmanan,Jeyaseelan %A Atiomo,William %+ , Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates, 971 0557452369, drzenabtambawala@gmail.com %K perinatal anxiety %K perinatal depression %K genetic risk factors %K clinical risk factors %K depression %K anxiety %K antenatal depression %K postnatal depression %K antenatal anxiety %K postnatal anxiety %D 2025 %7 29.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Perinatal anxiety and depression can significantly impact maternal well-being, infant development, and mother-child bonding. There is a relative lack of research on the overall burden of and risk factors for perinatal and postpartum depression and anxiety in the Middle Eastern region. Objective: We aimed to investigate genetic, epidemiological, and clinical risk factors for anxiety and depression in antenatal and postnatal mothers. Methods: This study is a 2-point, cross-sectional, observational study of pregnant women at a tertiary care hospital in Dubai, United Arab Emirates. We will evaluate the point prevalence of depression and anxiety with the Edinburgh Postnatal Depression Scale, the Generalized Anxiety Disorder 7 scale, and the Holmes-Rahe Stress Inventory and analyze the risk factors in affected and unaffected women. The women will be evaluated with structured interviews, initially in the antenatal period (between 20 to 26 weeks) and again in the postnatal period (between 6 weeks to 6 months after delivery). Whole-genome sequencing will be conducted to comprehensively map genomes and detect variants associated with depression and anxiety after the initial interview. Social factors such as family characteristics and partner support, as well as lifestyle factors such as exercise, vitamin D intake, and obstetric factors, along with intrapartum and neonatal events affecting maternal mental health, will also be assessed. Results: We will assess the prevalence of depression, anxiety, stress, and risk factors in the antenatal and postnatal period between July 2025 and June 2026 at Dubai Hospital. The association of genetic, social, and demographic risk factors with depression and anxiety will be compared in women who screen positive for depression and anxiety and those who screen negative. Conclusions: This research aims to identify genetic variants associated with perinatal anxiety and depression in Middle Eastern women and to develop a comprehensive risk assessment tool for identifying women at high risk for perinatal anxiety and depression. International Registered Report Identifier (IRRID): PRR1-10.2196/68346 %M 40299496 %R 10.2196/68346 %U https://www.researchprotocols.org/2025/1/e68346 %U https://doi.org/10.2196/68346 %U http://www.ncbi.nlm.nih.gov/pubmed/40299496 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64882 %T A Mobile App–Based Intervention (Parentbot–a Digital Healthcare Assistant) for Parents: Secondary Analysis of a Randomized Controlled Trial %A Chua,Joelle Yan Xin %A Choolani,Mahesh %A Chee,Cornelia Yin Ing %A Yi,Huso %A Lalor,Joan Gabrielle %A Chong,Yap Seng %A Shorey,Shefaly %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, 14 Medical Drive, Block MD6, Level 5, Centre for Translational Medicine, Singapore, 117599, Singapore, 65 66011294, nurssh@nus.edu.sg %K perinatal %K mobile app %K app use %K survey response %K parents %K randomized controlled trial %K artificial intelligence %K AI %D 2025 %7 17.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile app–based interventions are viable methods of delivering perinatal care support to parents. A mobile app–based intervention entitled Parentbot–a Digital Healthcare Assistant (PDA) was developed and evaluated via a randomized controlled trial. PDA aimed to provide informational, socioemotional, and psychological support to parents across the perinatal period. As developing such interventions is resource intensive, it is important to evaluate participants’ use and the components that are appreciated by them. Objective: This study aims to examine the (1) relationship between participants’ characteristics and PDA use, (2) relationship between PDA use and parenting outcomes, and (3) relationship between participants’ characteristics and the time taken to respond to the surveys (survey response timing). Methods: This study is the secondary analysis of a randomized controlled trial. A convenient sample of 118 heterosexual couples (236 participants: n=118, 50% mothers and n=118, 50% fathers) from a public tertiary hospital in Singapore were recruited. Data were collected from November 2022 to August 2023. Descriptive statistics were used to summarize the parents’ characteristics and study variables. Linear mixed models were used to examine the effect of (1) participants’ sociodemographic characteristics on PDA use metrics, (2) use metrics on parenting outcomes, and (3) participants’ sociodemographic characteristics on the survey response timing. The Pearson correlation was also used to examine the linear relationships between the PDA use metrics and parenting outcomes. Results: The following parental characteristics were found to be associated with PDA use: antenatal course attendance, gender, religion, ethnicity, and the number of children. After adjusting for baseline values and sociodemographic covariates, only the viewing of educational materials was statistically significantly associated with improvements in parents’ anxiety (β=–0.48, 95% CI –0.94 to –0.009; P=.046), parent-child bonding (β=–0.10, 95% CI –0.19 to –0.01; P=.03), social support (β=0.31, 95% CI 0.08-0.54; P=.01), and parenting satisfaction (β=0.57, 95% CI 0.07-1.07; P=.03) at 1 month post partum. Moreover, parents’ age, ethnicity, grouping, and number of children were found to be related to the survey response timing. Conclusions: As the viewing of PDA’s educational materials was linked to improvements in parents’ perinatal well-being, the provision of educational resources should be prioritized in future app-based parenting interventions. Because the use of other PDA features, such as poster activities, forum posts, and reflection and gratitude exercises, had a limited effect in improving parents’ well-being, future interventions could explore alternative activities to better engage parents. Future mobile app–based parenting interventions could conduct similar evaluations on app use and the effectiveness of specific features to validate the findings of this study. %M 40245395 %R 10.2196/64882 %U https://www.jmir.org/2025/1/e64882 %U https://doi.org/10.2196/64882 %U http://www.ncbi.nlm.nih.gov/pubmed/40245395 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66439 %T Effects of Using a Smart Bassinet on the Mental Health of Military-Affiliated Pregnant Women: Protocol for a Randomized Controlled Sleep Health and Mood in Newly Expectant Military Mothers (SHINE) Trial %A Okun,Michele L %A Payne,Jennifer L %A Osborne,Lauren M %A Feliciano,Leilani %A Lac,Andrew %+ University of Colorado Colorado Springs, 1420 Austin Bluffs Parkway, Osborne A408, Colorado Springs, CO, 80918, United States, 1 4123028030, mokun@uccs.edu %K maternal health %K postpartum %K pregnancy %K sleep %K infant %K depression %K anxiety %K smart bassinet %K intervention %K prevention %K military %D 2025 %7 10.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum mood and anxiety disorders (PMADs) are higher among pregnant military service women (26%) and military spouses (12.2%) compared to the civilian population (10%-15%). This is partly due to military-specific factors, including deployment, which are known to increase risk. Important risk factors for PMADs include sleep disturbances, defined as sleep deprivation, insomnia, or poor sleep quality, which are more are common among military-affiliated pregnant women. Objective: This study describes a protocol for a new randomized controlled trial that aims to ameliorate the risk for PMADs through improving infant sleep or maternal sleep during the first 6 postdelivery months in a sample of military-affiliated women. Methods: This study is a 6-month, parallel-arm, randomized controlled trial. Pregnant women (N=342) in the third trimester will be randomized at 1:1 ratio to use a smart bassinet (SB) or a standard commercially available bassinet (HALO BassiNest Swivel Sleeper 3.0; traditional bassinet [TB]) for up to 6 months after delivery. Participants will have their infants sleep in the bassinet, complete monthly web-based questionnaires, and record sleep data with diary and actigraphy for both the participants and their infants for 1 week each postpartum month. Blood samples will also be collected at baseline (late pregnancy) and at 3 months and 6 months post partum to assess immune functioning. The primary outcomes for this study will be postpartum mood (depressive and anxiety symptoms) and infant and maternal sleep. In addition, we are evaluating whether SB has a significant impact on immune functioning—a marker that physiologically connects sleep and mood symptoms. Results: Recruitment for this study began in January 2025. Six separate mixed 2 (treatment vs control) × 6 (assessment period) multivariate analysis of variance and analysis of variance models will be conducted to test the hypotheses that SB will have a greater impact on infant and maternal sleep than TB, SB will be associated with a greater reduction in postpartum mood symptoms than TB, and immune system function will be less dysregulated in birthing individuals using SB compared to those using TB. Lastly, we will evaluate whether the elevated risk demonstrated by previously identified postpartum depression epigenetic biomarkers in the TTC9B and HP1BP3 genes can be modified with an SB. We hypothesize that the elevated risk will be reduced in SB compared to that in TB. Conclusions: At the conclusion of this project, we will have gained a thorough understanding of the capability of SB to positively affect infant and maternal sleep compared to the traditional sleep arrangement and its impact on maternal mood through 6 months post partum in military-affiliated women. The promotion of sleep health in both mothers and infants may be an accessible and amenable method to prevent PMADs. Trial Registration: ClinicalTrials.gov NCT06544941; https://clinicaltrials.gov/study/NCT06544941 International Registered Report Identifier (IRRID): PRR1-10.2196/66439 %M 40209215 %R 10.2196/66439 %U https://www.researchprotocols.org/2025/1/e66439 %U https://doi.org/10.2196/66439 %U http://www.ncbi.nlm.nih.gov/pubmed/40209215 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e42406 %T Factors Impacting Mobile Health Adoption for Depression Care and Support by Adolescent Mothers in Nigeria: Preliminary Focus Group Study %A Kola,Lola %A Fatodu,Tobi %A Kola,Manasseh %A Olayemi,Bisola A %A Adefolarin,Adeyinka O %A Dania,Simpa %A Kumar,Manasi %A Ben-Zeev,Dror %+ WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, P.M.B 3017 G.P.O, Ibadan, 23401, Nigeria, 234 (2) 2411768, lola_kola2004@yahoo.com %K adolescent perinatal depression %K primary care %K mHealth app %K user centered design %K smartphone %K human-centered design %K HCD %K depression %K postpartum %K perinatal %K postnatal %K teenage %K adolescent %K youth %K low-middle-income countries %K LMIC %K middle income %K adoption %K acceptability %K mobile health %K mHealth %K mobile app %K women’s health %K mental health %K depressive %D 2025 %7 9.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth), the use of mobile technology in health care, is increasingly being used for mental health service delivery even in low- and middle-income countries to scale up treatment, and a variety of evidence supports their potential in different populations. Objective: This study aims to use the Social Cognitive Theory (SCT) as a lens to explain knowledge of mHealth use for mental health care, personal behavioral capabilities, and the external social contexts that can impact the adoption of an mHealth app for depression care among perinatal adolescents in Nigeria. Methods: At the preliminary stage of a user-centered design (UCD), 4 focus group discussions were conducted among 39 participants: 19 perinatal adolescents with a history of depression and 20 primary care providers. Guided by the SCT, a popular model used for predicting and explaining health behaviors, we documented participants’ knowledge of mHealth use for health purposes, advantages, and challenges to the adoption of an mHealth app by young mothers, and approaches to mitigate challenges. Data collection and analysis was an iterative process until saturation of all topic areas was reached. Results: The mean age for young mothers was 17.3 (SD 0.9) years and 48 (SD 5.8) years for care providers. Mistrust from relatives on mobile phone use for therapeutic purposes, avoidance of clinic appointments, and sharing of application contents with friends were some challenges to adoption identified in the study population. Supportive personal factors and expressions of self-efficacy on mobile app use were found to be insufficient for adoption. This is because there are social complications and disapprovals that come along with getting pregnant at a young age. Adequate engagement of parents, guardians, and partners on mHealth solutions by care providers was identified as necessary to the uptake of digital tools for mental health care in this population. Conclusions: The SCT guided the interpretations of the study findings. Young mothers expressed excitement at the use of mHealth technology to manage perinatal depression. Real-life challenges, however, need to be attended to for successful implementation of such interventions. Communications between care providers and patients’ relatives on the therapeutic use of mHealth are vital to the success of a mHealth mental health management plan for depression in young mothers in Nigeria. %M 40203299 %R 10.2196/42406 %U https://formative.jmir.org/2025/1/e42406 %U https://doi.org/10.2196/42406 %U http://www.ncbi.nlm.nih.gov/pubmed/40203299 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e72469 %T Chatbot to Support the Mental Health Needs of Pregnant and Postpartum Women (Moment for Parents): Design and Pilot Study %A McAlister,Kelsey %A Baez,Lara %A Huberty,Jennifer %A Kerppola,Marianna %K perinatal support %K human-centered design %K digital health %K maternal health %K chatbot %K digital tool %D 2025 %7 8.4.2025 %9 %J JMIR Form Res %G English %X Background: Maternal mental health disorders are prevalent, yet many individuals do not receive adequate support due to stigma, financial constraints, and limited access to care. Digital interventions, particularly chatbots, have the potential to provide scalable, low-cost support, but few are tailored specifically to the needs of perinatal individuals. Objective: This study aimed to (1) design and develop Moment for Parents, a tailored chatbot for perinatal mental health education and support, and (2) assess usability through engagement, usage patterns, and user experience. Methods: This study used a human-centered design to develop Moment for Parents, a rules-based chatbot to support pregnant and postpartum individuals. In phase 1, ethnographic interviews (n=43) explored user needs to inform chatbot development. In phase 2, a total of 108 pregnant and postpartum individuals were recruited to participate in a pilot test and had unrestricted access to the chatbot. Engagement was tracked over 8 months to assess usage patterns and re-engagement rates. After 1 month, participants completed a usability, relevance, and satisfaction survey, providing key insights for refining the chatbot. Results: Key themes that came from the ethnographic interviews in phase 1 included the need for trusted resources, emotional support, and better mental health guidance. These insights informed chatbot content, including mood-based exercises and coping strategies. Re-engagement was high (69/108, 63.9%), meaning users who had stopped interacting for at least 1 week returned to the chatbot at least once. A large proportion (28/69, 40.6%) re-engaged 3 or more times. Overall, 28/30 (93.3%) found the chatbot relevant for them, though some noted repetitive content and limited response options. Conclusions: The Moment for Parents chatbot successfully engaged pregnant and postpartum individuals with higher-than-typical retention and re-engagement patterns. The findings underscore the importance of flexible, mood-based digital support tailored to perinatal needs. Future research should examine how intermittent chatbot use influences mental health outcomes and refine content delivery to enhance long-term engagement and effectiveness. %R 10.2196/72469 %U https://formative.jmir.org/2025/1/e72469 %U https://doi.org/10.2196/72469 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e62841 %T Impact of a 6-Week Postpartum Text Messaging Program (Essential Coaching for Every Mother) at 6 Months: Follow-Up Study to a Randomized Controlled Trial %A Dol,Justine %A Campbell-Yeo,Marsha %A Aston,Megan %A McMillan,Douglas %A Grant,Amy K %K mHealth %K mobile health %K SMS text message %K text messages %K messaging %K self-efficacy %K postpartum depression %K postpartum anxiety %K social support %K intervention %K postpartum %K postnatal %K mental health %K parenting %K mother %K depression %K anxiety %K RCT %K randomized controlled trial %D 2025 %7 2.4.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Essential Coaching for Every Mother is an SMS text messaging program that positively improved parenting self-efficacy and reduced postpartum anxiety when measured immediately after intervention at 6 weeks postpartum. However, the impact of a short-term postpartum intervention over time is unknown. Objective: This study aims to compare parenting self-efficacy, postpartum anxiety symptoms, postpartum depression symptoms, and perceived social support at 6 months postpartum for mothers in the Essential Coaching for Every Mother trial. Methods: Participants (n=150) were randomized to Essential Coaching for Every Mother or control (usual care). Data were collected on parenting self-efficacy (primary outcome, Karitane Parenting Confidence Scale), postpartum anxiety symptoms (Postpartum Specific Anxiety Scale), postpartum depressive symptoms (Edinburgh Postnatal Depression Scale), and perceived social support (Multidimensional Scale of Perceived Social Support) at enrollment and 6-months postpartum. Data were analyzed using analyses of covariance and chi-square analysis. Results: A total of 139 women completed the primary outcome at 6 months and 136 completed secondary outcomes. At 6 months, there were no statistically significant differences between mothers in the intervention group and mothers in the control group on any of the outcomes. More mothers in the intervention group had higher postpartum anxiety scores (31/68, 45.6%) than mothers in the control group (16/68, 23.5%; P=.007). Conclusions: At 6 months postpartum, all mothers had similar scores on parenting self-efficacy, postpartum anxiety symptoms, postpartum depression symptoms, and social support. Thus, Essential Coaching for Every Mother improved parenting self-efficacy and reduced postpartum anxiety at 6 weeks, with all mothers having similar scores at 6 months postpartum. Trial Registration: ClincialTrials.gov NCT04730570; https://clinicaltrials.gov/study/NCT04730570 International Registered Report Identifier (IRRID): RR2-10.2196/27138 %R 10.2196/62841 %U https://pediatrics.jmir.org/2025/1/e62841 %U https://doi.org/10.2196/62841 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e64619 %T Extended Reality–Enhanced Mental Health Consultation Training: Quantitative Evaluation Study %A Hiley,Katherine %A Bi-Mohammad,Zanib %A Taylor,Luke %A Burgess-Dawson,Rebecca %A Patterson,Dominic %A Puttick-Whiteman,Devon %A Gay,Christopher %A Hiscoe,Janette %A Munsch,Chris %A Richardson,Sally %A Knowles-Lee,Mark %A Beecham,Celia %A Ralph,Neil %A Chatterjee,Arunangsu %A Mathew,Ryan %A Mushtaq,Faisal %+ School of Psychology, Faculty of Medicine & Health, University of Leeds, Woodhouse, Leeds, LS2 9JT, United Kingdom, 44 07525418924, f.mushtaq@leeds.ac.uk %K mental health %K training %K consultation %K extended reality %K virtual reality %K augmented reality %D 2025 %7 2.4.2025 %9 Original Paper %J JMIR Med Educ %G English %X Background: The use of extended reality (XR) technologies in health care can potentially address some of the significant resource and time constraints related to delivering training for health care professionals. While substantial progress in realizing this potential has been made across several domains, including surgery, anatomy, and rehabilitation, the implementation of XR in mental health training, where nuanced humanistic interactions are central, has lagged. Objective: Given the growing societal and health care service need for trained mental health and care workers, coupled with the heterogeneity of exposure during training and the shortage of placement opportunities, we explored the feasibility and utility of a novel XR tool for mental health consultation training. Specifically, we set out to evaluate a training simulation created through collaboration among software developers, clinicians, and learning technologists, in which users interact with a virtual patient, “Stacey,” through a virtual reality or augmented reality head-mounted display. The tool was designed to provide trainee health care professionals with an immersive experience of a consultation with a patient presenting with perinatal mental health symptoms. Users verbally interacted with the patient, and a human instructor selected responses from a repository of prerecorded voice-acted clips. Methods: In a pilot experiment, we confirmed the face validity and usability of this platform for perinatal and primary care training with subject-matter experts. In our follow-up experiment, we delivered personalized 1-hour training sessions to 123 participants, comprising mental health nursing trainees, general practitioner doctors in training, and students in psychology and medicine. This phase involved a comprehensive evaluation focusing on usability, validity, and both cognitive and affective learning outcomes. Results: We found significant enhancements in learning metrics across all participant groups. Notably, there was a marked increase in understanding (P<.001) and motivation (P<.001), coupled with decreased anxiety related to mental health consultations (P<.001). There were also significant improvements to considerations toward careers in perinatal mental health (P<.001). Conclusions: Our findings show, for the first time, that XR can be used to provide an effective, standardized, and reproducible tool for trainees to develop their mental health consultation skills. We suggest that XR could provide a solution to overcoming the current resource challenges associated with equipping current and future health care professionals, which are likely to be exacerbated by workforce expansion plans. %M 40173446 %R 10.2196/64619 %U https://mededu.jmir.org/2025/1/e64619 %U https://doi.org/10.2196/64619 %U http://www.ncbi.nlm.nih.gov/pubmed/40173446 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e64826 %T Informatics Interventions for Maternal Morbidity: Scoping Review %A Inderstrodt,Jill %A Stumpff,Julia C %A Smollen,Rebecca C %A Sridhar,Shreya %A El-Azab,Sarah A %A Ojo,Opeyemi %A Bowns,Brendan %A Haggstrom,David A %+ Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd., Indianapolis, IN, 46202, United States, 1 3176903316, ji3@iu.edu %K scoping review %K maternal morbidity %K medical informatics %K clinical informatics %K mother %K pregnant %K perinatal %K GDM %K preeclampsia %K maternity %K gestational diabetes mellitus %D 2025 %7 25.3.2025 %9 Review %J Interact J Med Res %G English %X Background: Women have been entering pregnancy less healthy than previous generations, placing them at increased risk for pregnancy complications. One approach to ensuring effective monitoring and treatment of at-risk women is designing technology-based interventions that prevent maternal morbidities and treat perinatal conditions. Objective: This scoping review evaluates what informatics interventions have been designed and tested to prevent and treat maternal morbidity. Methods: MEDLINE, Embase, and Cochrane Library were searched to identify relevant studies. The inclusion criteria were studies that tested a medical or clinical informatics intervention; enrolled adult women; and addressed preeclampsia, gestational diabetes mellitus (GDM), preterm birth, Centers for Disease Control and Prevention–defined severe maternal morbidity, or perinatal mental health conditions. Demographic, population, and intervention data were extracted to characterize the technologies, conditions, and populations addressed. Results: A total of 80 studies were identified that met the inclusion criteria. Many of the studies tested for multiple conditions. Of these, 73% (60/82) of the technologies were tested for either GDM or perinatal mental health conditions, and 15% (12/82) were tested for preeclampsia. For technologies, 32% (28/87) of the technologies tested were smartphone or tablet applications, 26% (23/87) were telehealth interventions, and 14% (12/87) were remote monitoring technologies. Of the many outcomes measured by the studies, almost half (69/140, 49%) were patient physical or mental health outcomes. Conclusions: Per this scoping review, most informatics interventions address three conditions: GDM, preeclampsia, and mental health. There may be opportunities to treat other potentially lethal conditions like postpartum hemorrhage using proven technologies such as mobile apps. Ample gaps in the literature exist concerning the use of informatics technologies aimed at maternal morbidity. There may be opportunities to use informatics for lesser-targeted conditions and populations. %M 40132184 %R 10.2196/64826 %U https://www.i-jmr.org/2025/1/e64826 %U https://doi.org/10.2196/64826 %U http://www.ncbi.nlm.nih.gov/pubmed/40132184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67386 %T Internet-Based Cognitive Behavioral Therapy for Preventing Postpartum Depressive Symptoms Among Pregnant Individuals With Depression: Multicenter Randomized Controlled Trial in China %A Duan,Chen-Chi %A Zhang,Chen %A Xu,Hua-Lin %A Tao,Jing %A Yu,Jia-Le %A Zhang,Dan %A Wu,Shan %A Zeng,Xiu %A Zeng,Wan-Ting %A Zhang,Zhi-Yin %A Dennis,Cindy-Lee %A Liu,Han %A Wu,Jia-Ying %A Mol,Ben Willem J %A Huang,He-Feng %A Wu,Yan-Ting %+ Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, No.419, Fangxie Rd, Shanghai, 200000, China, 86 17321218018, yanting_wu@163.com %K antenatal depression %K postpartum depression %K internet-based cognitive behavioral therapy %K randomized controlled trial %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Women are particularly vulnerable to depression during pregnancy, which is one of the strongest risk factors for developing postpartum depression (PPD). Addressing antenatal depressive symptoms in these women is crucial for preventing PPD. However, little is known about the effectiveness of internet-based cognitive behavioral therapy (ICBT) in preventing PPD in this high-risk group. Objective: This study aims to evaluate the short- and long-term effects of ICBT in preventing PPD among women with antenatal depressive symptoms. Methods: Participants were screened for antenatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) and randomly allocated (1:1) to either the ICBT group (receiving weekly online modules starting antenatally and continuing into early postpartum) or the control group (observed without treatment). Follow-up assessments were conducted up to 12 months postpartum, and data were analyzed using generalized estimating equations. The primary outcome was the prevalence of depressive symptoms at 6 weeks postpartum. A subgroup analysis based on the severity of antenatal depressive symptoms was also performed. The secondary outcomes included the long-term effects of ICBT on maternal depression, as well as its impact on anxiety, sleep quality, social support, parenting stress, co-parenting relationships, and infant development. Results: Between August 2020 and September 2021, 300 pregnant individuals were recruited from 5 centers across China. No significant differences were observed in depressive symptoms at 6 weeks postpartum (P=.18) or at any longer-term follow-up time points (P=.18). However, a post hoc subgroup analysis showed that participants with antenatal EPDS scores of 10-12 in the ICBT group had a lower risk of developing depression during the first year postpartum (odds ratio 0.534, 95% CI 0.313-0.912; P=.02), but this was not observed for participants with more severe depression. Additionally, this subgroup demonstrated higher levels of co-parenting relationships (P=.02). Conclusions: Among individuals with antenatal depression, ICBT did not prevent the development of PPD. However, ICBT may be a preferable option for those with mild to moderate antenatal depressive symptoms. Future research is needed to explore modifications to ICBT to address more severe depressive symptoms. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000033433; https://www.chictr.org.cn/showproj.html?proj=54482 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06728-5 %M 40053801 %R 10.2196/67386 %U https://www.jmir.org/2025/1/e67386 %U https://doi.org/10.2196/67386 %U http://www.ncbi.nlm.nih.gov/pubmed/40053801 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59461 %T Feasibility of a Mobile App–Based Cognitive-Behavioral Perinatal Skills Program: Protocol for Nonrandomized Pilot Trial %A Temkin-Yu,Andrea B %A Ayaz,Aliza %A Blicker,Ella %A Liu,Michael X %A Oh,Ace %A Siegel,Isabelle E %A Seewald,Meredith J %A Hermann,Alison D %A Givrad,Soudebah %A Baez,Lara M %A Osborne,Lauren M %A Green,Cori M %A Schier,Maddy M %A Davis,Alexandra M %A Zhu,Shasha %A Falk,Avital %A Bennett,Shannon M %+ Psychiatry Department, Weill Cornell Medicine, 525 E 68th Street, New York, NY, 10065, United States, 1 6402038301, andreabtemkin@gmail.com %K perinatal mood and anxiety disorders %K apps %K smartphones %K digital intervention %K cognitive behavioral therapy %K feasibility %K pilot trial %K mobile phones %D 2025 %7 28.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental illness is one of the top causes of preventable pregnancy-related deaths in the United States. There are many barriers that interfere with the ability of perinatal individuals to access traditional mental health care. Digital health interventions, including app-based programs, have the potential to increase access to useful tools for these individuals. Although numerous mental health apps exist, there is little research on developing programs to address the unique needs of perinatal individuals. In an effort to fill this gap, a multidisciplinary team of experts in psychology, psychiatry, obstetrics, and pediatric primary care collaborated to develop the novel Perinatal Skills Program within Maya, a flexible and customizable cognitive-behavioral skills app. Maya-Perinatal Skills Program (M-PSP) uses evidence-based strategies to help individuals manage their mood and anxiety symptoms during pregnancy and post partum. Objective: This pilot study aims to assess the feasibility, acceptability, and usability of M-PSP and explore links between program use and symptoms of anxiety and low mood. Methods: This single-arm trial will recruit 50 pregnant or postpartum individuals with mild-to-moderate anxiety or mood symptoms. Participants will be recruited from a variety of public and private insurance-based psychiatry, obstetrics, and primary care clinics at a large academic medical center located in New York City. Participants will complete all sessions of M-PSP and provide feedback. Outcome measures will include qualitative and quantitative assessments of feasibility, acceptability, and usability, passively collected program usage data, and symptom measures assessing mood, anxiety, and trauma. Planned data analysis includes the use of the grounded theory approach to identify common themes in qualitative feedback, as well as an exploration of possible associations between quantitative data regarding program use and symptoms. Results: The recruitment began on August 2023. As of October 2024, a total of 32 participants have been enrolled. The recruitment will continue until 50 participants have been enrolled. Conclusions: Digital health interventions, like M-PSP, have the potential to create new pathways to reach individuals struggling with their mental health. The results of this study will be the groundwork for future iterations of M-PSP in the hopes of providing an accessible and helpful tool for pregnant and postpartum individuals. Trial Registration: ClinicalTrials.gov NCT05897619; https://classic.clinicaltrials.gov/ct2/show/NCT05897619 International Registered Report Identifier (IRRID): PRR1-10.2196/59461 %M 39874578 %R 10.2196/59461 %U https://www.researchprotocols.org/2025/1/e59461 %U https://doi.org/10.2196/59461 %U http://www.ncbi.nlm.nih.gov/pubmed/39874578 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60829 %T Designing the First Pregnancy Guaranteed Income Program in the United States: Qualitative Needs Assessment and Human-Centered Design to Develop the Abundant Birth Project %A Karasek,Deborah %A Williams,Jazzmin C %A Taylor,Michaela A %A De La Cruz,Monica M %A Arteaga,Stephanie %A Bell,Sabra %A Castillo,Esperanza %A Chand,Maile A %A Coats,Anjeanette %A Hubbard,Erin M %A Love-Goodlett,Latriece %A Powell,Breezy %A Spellen,Solaire %A Malawa,Zea %A Gomez,Anu Manchikanti %+ Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall, MC 7400, Berkeley, CA, 94720-7400, United States, 1 510 6420722, anugomez@berkeley.edu %K maternal and child health %K economics %K public health %K qualitative research methods %K programs (evaluation and funding) %K community-centered %K pregnancy %K first pregnancy %K behavioral interventions %K racial health %K financial stress %K Abundant Birth Project %K infant health %K infant %K Black %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Racial inequities in pregnancy outcomes persist despite investments in clinical, educational, and behavioral interventions, indicating that a new approach is needed to address the root causes of health disparities. Guaranteed income during pregnancy has the potential to narrow racial health inequities for birthing people and infants by alleviating financial stress. Objective: We describe community-driven formative research to design the first pregnancy-guaranteed income program in the United States—the Abundant Birth Project (ABP). Informed by birth equity and social determinants of health perspectives, ABP targets upstream structural factors to improve racial disparities in maternal and infant health. Methods: The research team included community researchers, community members with lived experience as Black or Pacific Islander pregnant, and parenting people in the San Francisco Bay Area. The team conducted needs assessment interviews and facilitated focus groups with participants using human-centered design methods. Needs assessment participants later served as co-designers of the ABP program and research, sharing their experiences with financial hardships and government benefits programs and providing recommendations on key program elements, including fund disbursement, eligibility, and amount. Results: Housing affordability and the high cost of living in San Francisco emerged as significant sources of stress in pregnancy. Participants reported prohibitively low income eligibility thresholds and burdensome enrollment processes as challenges or barriers to existing social services. These insights guided the design of prototypes of ABP’s program components, which were used in a design sprint to determine the final components. Based on this design process, the ABP program offered US $1000/month for 12 months to pregnant Black and Pacific Islander people, selected through a lottery called an abundance drawing. Conclusions: The formative design process maximized community input and shared decision-making to co-design a guaranteed income program for Black and Pacific Islander women and people. Our upstream approach and community research model can inform the development of public health and social service programs. %M 39869889 %R 10.2196/60829 %U https://formative.jmir.org/2025/1/e60829 %U https://doi.org/10.2196/60829 %U http://www.ncbi.nlm.nih.gov/pubmed/39869889 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63564 %T LoVE4MUM Mobile App to Prevent Postpartum Depression: Protocol for a Pilot Randomized Controlled Trial %A Kamarudin,Siti Sabrina %A Idris,Idayu Badilla %A Sharip,Shalisah %A Ahmad,Norfazilah %+ Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Malaysia, 60 91455887 ext 5888, idayubadilla.idris@ukm.edu.my %K postpartum depression %K mHealth intervention %K mobile phone %K prevention %K self-guided %K virtual engagement %K engagement %K maternal %K protocol %K randomized controlled trial %K postpartum %K depression %K maternal %K well-being %K mobile health %K preventive care %K mobile app %K mental health literacy %K postpartum care %D 2025 %7 27.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum depression remains a significant concern, posing substantial challenges to maternal well-being, infant health, and the mother-infant bond, particularly in the face of barriers to traditional support and interventions. Previous studies have shown that mobile health (mHealth) interventions offer an accessible means to facilitate early detection and management of mental health issues while at the same time promoting preventive care. Objective: This study aims to evaluate the effectiveness of the Leveraging on Virtual Engagement for Maternal Understanding & Mood-enhancement (LoVE4MUM) mobile app, which was developed based on the principles of cognitive behavioral therapy and psychoeducation and serves as an intervention to prevent postpartum depression. Methods: This single-blinded, pilot randomized controlled trial includes 64 mothers recruited from the postnatal ward and randomized using a 1:1 ratio to receive either postpartum care (treatment as usual) or postpartum care (treatment as usual) plus the self-guided LoVE4MUM mobile app. The primary outcome is the effectiveness of the mobile app at improving postpartum depression. Secondary outcomes are changes in the mental health literacy score and negative automatic thoughts, which are collected using a self-reported questionnaire. Results: Patient recruitment began on September 1, 2024. As of January 1, 2025, recruitment was successfully completed, with a total of 72 participants enrolled: 36 in the intervention group and 36 in the control group . The final results are anticipated to be available by March 2025, and publication is expected by the end of 2025. Conclusions: By examining the LoVE4MUM app alongside standard postpartum care, this pilot randomized controlled trial seeks to offer preliminary evidence on the potential of mHealth tools to improve maternal mental health as well as to reduce postpartum depression symptoms. The findings are expected to contribute to the future development of effective, accessible, and scalable interventions for mothers. Trial Registration: ClinicalTrials.gov NCT06366035; https://clinicaltrials.gov/study/NCT06366035 International Registered Report Identifier (IRRID): PRR1-10.2196/63564 %M 39869891 %R 10.2196/63564 %U https://www.researchprotocols.org/2025/1/e63564 %U https://doi.org/10.2196/63564 %U http://www.ncbi.nlm.nih.gov/pubmed/39869891 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e58649 %T Interpretable Machine Learning Model for Predicting Postpartum Depression: Retrospective Study %A Zhang,Ren %A Liu,Yi %A Zhang,Zhiwei %A Luo,Rui %A Lv,Bin %K postpartum depression %K machine learning %K predictive model %K risk factors %K XGBoost %K extreme gradient boosting %K PPD %D 2025 %7 20.1.2025 %9 %J JMIR Med Inform %G English %X Background: Postpartum depression (PPD) is a prevalent mental health issue with significant impacts on mothers and families. Exploring reliable predictors is crucial for the early and accurate prediction of PPD, which remains challenging. Objective: This study aimed to comprehensively collect variables from multiple aspects, develop and validate machine learning models to achieve precise prediction of PPD, and interpret the model to reveal clinical implications. Methods: This study recruited pregnant women who delivered at the West China Second University Hospital, Sichuan University. Various variables were collected from electronic medical record data and screened using least absolute shrinkage and selection operator penalty regression. Participants were divided into training (1358/2055, 66.1%) and validation (697/2055, 33.9%) sets by random sampling. Machine learning–based predictive models were developed in the training cohort. Models were validated in the validation cohort with receiver operating curve and decision curve analysis. Multiple model interpretation methods were implemented to explain the optimal model. Results: We recruited 2055 participants in this study. The extreme gradient boosting model was the optimal predictive model with the area under the receiver operating curve of 0.849. Shapley Additive Explanation indicated that the most influential predictors of PPD were antepartum depression, lower fetal weight, elevated thyroid-stimulating hormone, declined thyroid peroxidase antibodies, elevated serum ferritin, and older age. Conclusions: This study developed and validated a machine learning–based predictive model for PPD. Several significant risk factors and how they impact the prediction of PPD were revealed. These findings provide new insights into the early screening of individuals with high risk for PPD, emphasizing the need for comprehensive screening approaches that include both physiological and psychological factors. %R 10.2196/58649 %U https://medinform.jmir.org/2025/1/e58649 %U https://doi.org/10.2196/58649 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58265 %T A Mindfulness-Based App Intervention for Pregnant Women: Qualitative Evaluation of a Prototype Using Multiple Case Studies %A Rizzi,Silvia %A Pavesi,Maria Chiara %A Moser,Alessia %A Paolazzi,Francesca %A Marchesoni,Michele %A Poggianella,Stefania %A Gadotti,Erik %A Forti,Stefano %+ Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461312415, srizzi@fbk.eu %K mindfulness %K promoting well-being %K pregnancy %K eHealth %K mHealth %K mobile apps %K development %K usability %K user-centered design %K well-being %K maternal health %K digital health %K intervention %K design %K preliminary testing %K technology-based %K interview %K multidisciplinary approach %K mother %K women %K WhatsApp %K email %K midwife %D 2025 %7 17.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnancy is a complex period characterized by significant transformations. How a woman adapts to these changes can affect her quality of life and psychological well-being. Recently developed digital solutions have assumed a crucial role in supporting the psychological well-being of pregnant women. However, these tools have mainly been developed for women who already present clinically relevant psychological symptoms or mental disorders. Objective: This study aimed to develop a mindfulness-based well-being intervention for all pregnant women that can be delivered electronically and guided by an online assistant with wide reach and dissemination. This paper aimed to describe a prototype technology-based mindfulness intervention’s design and development process for pregnant women, including the exploration phase, intervention content development, and iterative software development (including design, development, and formative evaluation of paper and low-fidelity prototypes). Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=15), domain experts including mindfulness experts (n=2), communication experts (n=2), and psychologists (n=3), and target users including pregnant women (n=2), mothers with young children (n=2), and midwives (n=4). User-centered and service design methods, such as interviews and usability testing, were included to ensure user involvement in each phase. Domain experts evaluated a paper prototype, while target users evaluated a low-fidelity prototype. Intervention content was developed by psychologists and mindfulness experts based on the Mindfulness-Based Childbirth and Parenting program and adjusted to an electronic format through multiple iterations with stakeholders. Results: An 8-session intervention in a prototype electronic format using text, audio, video, and images was designed. In general, the prototypes were evaluated positively by the users involved. The questionnaires showed that domain experts, for instance, positively evaluated chatbot-related aspects such as empathy and comprehensibility of the terms used and rated the mindfulness traces present as supportive and functional. The target users found the content interesting and clear. However, both parties regarded the listening as not fully active. In addition, the interviews made it possible to pick up useful suggestions in order to refine the intervention. Domain experts suggested incorporating auditory components alongside textual content or substituting text entirely with auditory or audiovisual formats. Debate surrounded the inclusion of background music in mindfulness exercises, with opinions divided on its potential to either distract or aid in engagement. The target users proposed to supplement the app with some face-to-face meetings at crucial moments of the course, such as the beginning and the end. Conclusions: This study illustrates how user-centered and service designs can be applied to identify and incorporate essential stakeholder aspects in the design and development process. Combined with evidence-based concepts, this process facilitated the development of a mindfulness intervention designed for the end users, in this case, pregnant women. %M 39625414 %R 10.2196/58265 %U https://formative.jmir.org/2025/1/e58265 %U https://doi.org/10.2196/58265 %U http://www.ncbi.nlm.nih.gov/pubmed/39625414 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56601 %T Development and Evaluation of a Mindfulness-Based Mobile Intervention for Perinatal Mental Health: Randomized Controlled Trial %A Park,Sehwan %A Cho,Hee Young %A Park,Jin Young %A Chung,Kyungmi %A Jhung,Kyungun %+ Department of Psychiatry, Catholic Kwandong University International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100 Beon-gil, Incheon, 22711, Republic of Korea, 82 1090563807, kyungun12@gmail.com %K anxiety %K perinatal mental health %K depression %K mobile health care %K mindfulness %K mobile phone %D 2025 %7 17.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Perinatal mental health problems, such as anxiety, stress, and depression, warrant particularly close monitoring and intervention, but they are often unaddressed in both obstetric and psychiatric clinics, with limited accessibility and treatment resources. Mobile health interventions may provide an effective and more accessible solution for addressing perinatal mental health. Development and evaluation of a mobile mental health intervention specifically for pregnant women are warranted. Objective: This study aimed to evaluate the effectiveness of a 4-week, self-administered mobile mindfulness intervention in reducing anxiety, depression, and stress, and improving emotional well-being, maternal-fetal attachment, and mindfulness skills in a general population of pregnant women. Methods: Pregnant women were recruited and randomized to an intervention or a wait-list control group. The intervention group participated in a self-administered 4-week smartphone-based mindfulness program. Anxiety, depression, and stress were assessed as primary outcomes at baseline and postintervention. Secondary outcomes were mental health well-being, maternal-fetal attachment, and skills of mindfulness. The usability of the mobile intervention was also evaluated. Results: A total of 133 pregnant women were randomly assigned to the intervention (n=66) or the control group (n=67). The overall dropout rate was 30% (39/133). Anxiety scores of the intervention group significantly decreased from baseline to postintervention (P=.03, Wilcoxon Signed-Rank test), whereas no significant changes were observed in the control group. Depression and stress scores showed no significant changes. Emotional well-being significantly improved in the intervention group (P=.01). Improvements were observed in maternal-fetal attachment, particularly in attributing characteristics to the fetus (P=.003) and in differentiating the self from the fetus (P=.006). Mindfulness awareness also showed significant improvement (P=.008). Significant between-group effects were identified for mindfulness awareness (P=.006) and attributing characteristics to the fetus (P=.002). After applying the false discovery rate corrections, within-group improvements in emotional well-being, maternal-fetal attachment, and mindfulness awareness remained significant, while between-group differences for emotional well-being and differentiation were not significant. Conclusions: A mobile mindfulness program effectively reduced anxiety and improved emotional well-being, maternal-fetal attachment, and mindfulness awareness in the general population of pregnant women. Mobile interventions may offer a cost-effective and feasible method for promoting perinatal mental health. Trial Registration: Clinical Research Information Service KCT0007166; https://tinyurl.com/458vfc4r %M 39823585 %R 10.2196/56601 %U https://www.jmir.org/2025/1/e56601 %U https://doi.org/10.2196/56601 %U http://www.ncbi.nlm.nih.gov/pubmed/39823585 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59154 %T Considering Comorbidities and Individual Differences in Testing a Gaming Behavioral Activation App for Perinatal Depression and Anxiety: Open Trial Pilot Intervention Study %A Hamlett,Gabriella E %A Schrader,Chloe %A Ferguson,Craig %A Kobylski,Lauren A %A Picard,Rosalind %A Locascio,Joseph J %A McNally,Richard J %A Cohen,Lee S %A Vanderkruik,Rachel %K perinatal anxiety %K perinatal depression %K behavioral activation %K digital mental health %K mobile phone %D 2025 %7 14.1.2025 %9 %J JMIR Form Res %G English %X Background: There is increasing interest in the development of scalable digital mental health interventions for perinatal populations to increase accessibility. Mobile behavioral activation (BA) is efficacious for the treatment of perinatal depression; however, the effect of comorbid anxiety and depression (CAD) on symptom trajectories remains underexplored. This is important given that at least 10% of women in the perinatal period experience CAD. Objective: We assessed whether there were differences in symptom trajectories in pregnant participants with CAD as compared to those with depression only (ie, major depressive disorder [MDD]) during intervention with a BA mobile gaming app. Methods: Pregnant adults with either CAD (n=10) or MDD (n=7) used a BA app for 10 weeks and completed biweekly symptom severity questionnaires for depression and anxiety. We assessed whether baseline diagnoses were associated with differential symptom trajectories across the study with mixed effects longitudinal models. Results: When controlling for baseline symptoms, results revealed a significant interaction between baseline diagnosis and the quadratic component of study week on anxiety (β=.18, SE 0.07; t62=2.61; P=.01), revealing a tendency for anxiety in the CAD group to increase initially and then decrease at an accelerated rate, whereas MDD symptoms were relatively stable across time. There was a significant effect of linear time on depression (β=−.39, SE 0.11; t68=−3.51; P=.001), showing that depression declined steadily across time for both groups. There was a significant effect of baseline diagnosis on depression (β=−8.53, SE 3.93; t13=−2.17; P=.05), suggesting that those with MDD had higher follow-up depression compared to those with CAD when holding other predictors constant. Conclusions: The app was beneficial in reducing depression symptoms in perinatal individuals with different comorbidity profiles. With respect to anxiety symptom trajectories, however, there was more variability. The app may be especially effective for the treatment of anxiety symptoms among individuals with CAD, as it encourages in-the-moment ecologically relevant exposure to anxiety-provoking stimuli. Despite no significant group difference in baseline anxiety symptoms, the MDD group did not have a significant reduction in their anxiety symptoms across the study period, and some individuals had an increase in anxiety. Findings may point to opportunities for the augmentation of BA gaming apps for those with MDD to more effectively target anxiety symptoms. Overall, findings suggest there may be value in considering comorbidities and individual variations in participants when developing scalable mobile interventions for perinatal populations. %R 10.2196/59154 %U https://formative.jmir.org/2025/1/e59154 %U https://doi.org/10.2196/59154 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 17 %N %P e51602 %T E-Screening for Prenatal Depression in Kampala, Uganda Using the Edinburgh Postnatal Depression Scale: Survey Results %A Namatovu,Hasifah Kasujja %A Magumba,Mark Abraham %A Akena,Dickens %K perinatal %K prenatal %K antenatal %K antepartum %K depression %K Edinburgh Postnatal Depression Scale %D 2025 %7 14.1.2025 %9 %J Online J Public Health Inform %G English %X Background: Perinatal depression remains a substantial public health challenge, often overlooked or incorrectly diagnosed in numerous low-income nations. Objective: The goal of this study was to establish statistical baselines for the prevalence of perinatal depression in Kampala and understand its relationship with key demographic variables. Methods: We employed an Android-based implementation of the Edinburgh Postnatal Depression Scale (EPDS) to survey 12,913 women recruited from 7 government health facilities located in Kampala, Uganda. We used the standard EPDS cutoff, which classifies women with total scores above 13 as possibly depressed and those below 13 as not depressed. The χ2 test of independence was used to determine the most influential categorical variables. We further analyzed the most influential categorical variable using odds ratios. For continuous variables such as age and the weeks of gestation, we performed a simple correlation analysis. Results: We found that 21.5% (2783/12,913, 95% CI 20.8%‐22.3%) were possibly depressed. Respondents’ relationship category was found to be the most influential variable (χ21=806.9, P<.001; Cramer’s V=0.25), indicating a small effect size. Among quantitative variables, we found a weak negative correlation between respondents’ age and the total EPDS score (r=−0.11, P<.001). Similarly, a weak negative correlation was also observed between the total EPDS score and the number of previous children of the respondent (r=−0.07, P<.001). Moreover, a weak positive correlation was noted between weeks of gestation and the total EPDS score (r=0.02, P=.05) Conclusions: This study shows that demographic factors such as spousal employment category, age, and relationship status have an influence on the respondents’ EPDS scores. These variables may serve as proxies for latent factors such as financial stability and emotional support. %R 10.2196/51602 %U https://ojphi.jmir.org/2025/1/e51602 %U https://doi.org/10.2196/51602 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65611 %T Postpartum Remote Health Coaching Intervention for Individuals With a Hypertensive Disorder of Pregnancy: Proof-of-Concept Study %A Borrowman,Jaclyn D %A Carr,Lucas J %A Pierce,Gary L %A Story,William T %A Gibbs,Bethany Barone %A Whitaker,Kara M %K cardiovascular disease %K postpartum %K hypertensive disorders of pregnancy %K intervention %K physical activity intervention %K proof-of-concept %K cardiovascular health %K CVD risk %K cardiovascular disease risk %K feasibility %K acceptability %K health coaching %K women's health %K postnatal %D 2025 %7 8.1.2025 %9 %J JMIR Form Res %G English %X Background: Cardiovascular disease (CVD) is the leading cause of death among women in America. Hypertensive disorders of pregnancy (HDP) negatively impact acute and long-term cardiovascular health, with approximately 16% of all pregnancies affected. With CVD 2‐4 times more likely after HDP compared to normotensive pregnancies, effective interventions to promote cardiovascular health are imperative. Objective: With postpartum physical activity (PA) interventions after HDP as an underexplored preventative strategy, we aimed in this study to assess (1) the feasibility and acceptability of a remotely delivered PA intervention for individuals with HDP 3‐6 months postpartum and (2) changes in average steps per day, skills related to PA behavior, and postpartum blood pressure (BP). Methods: A remotely delivered 14-week health coaching intervention was designed based on prior formative work. The health coaching intervention called the Hypertensive Disorders of Pregnancy Postpartum Exercise (HyPE) intervention was tested for feasibility and acceptability with a single-arm proof-of-concept study design. A total of 19 women who were 3‐6 months postpartum HDP; currently inactive; 18 years of age or older; resided in Iowa; and without diabetes, kidney disease, and CVD were enrolled. Feasibility was assessed by the number of sessions attended and acceptability by self-reported satisfaction with the program. Changes in steps achieved per day were measured with an activPAL4 micro, PA behavior skills via validated surveys online, and BP was assessed remotely with a research-grade Omron Series 5 (Omron Corporation) BP monitor. Results: Participants at enrollment were on average 30.3 years of age, 4.1 months postpartum, self-identified as non-Hispanic White (14/17, 82%), in a committed relationship (16/17, 94%), and had a bachelor’s degree (9/17, 53%). A total of 140 of 152 possible health coaching sessions were attended by those who started the intervention (n=19, 92%). Intervention completers (n=17) indicated they were satisfied with the program (n=17, 100%) and would recommend it to others (n=17, 100%). No significant changes in activPAL measured steps were observed from pre- to posttesting (mean 138.40, SD 129.40 steps/day; P=.75). Significant improvements were observed in PA behavior skills including planning (mean 5.35, SD 4.97 vs mean 15.06, SD 3.09; P<.001) and monitoring of PA levels (mean 7.29, SD 3.44 vs mean 13.00, SD 2.45; P<.001). No significant decreases were observed for systolic (mean –1.28, SD 3.59 mm Hg; Hedges g=–0.26; P=.16) and diastolic BP (mean –1.80, SD 5.03 mm Hg; Hedges g=–0.44; P=.12). Conclusions: While PA behaviors did not change, the intervention was found to be feasible and acceptable among this sample of at-risk women. After additional refinement, the intervention should be retested among a larger, more diverse, and less physically active sample. Trial Registration: ClinicalTrials.gov NCT06019715; https://clinicaltrials.gov/study/NCT06019715 %R 10.2196/65611 %U https://formative.jmir.org/2025/1/e65611 %U https://doi.org/10.2196/65611 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65912 %T Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research %A Hossain,Aniqa Tasnim %A Rahman,Md Hafizur %A Manna,Ridwana Maher %A Akter,Ema %A Islam,SM Hasibul %A Hossain,Md Alamgir %A Ara,Tasnu %A Usmani,Nasimul Ghani %A Chandra,Pradip %A Khan,Maruf Ahmed %A Rahman,SM Mustafizur %A Ahmed,Helal Uddin %A Mozumder,Muhammad Kamruzzaman %A Juthi,Jesmin Mahmuda %A Shahrin,Fatema %A Shams,Sadia Afrose %A Afroze,Fahmida %A Banu,Mukta Jahan %A Ameen,Shafiqul %A Jabeen,Sabrina %A Ahmed,Anisuddin %A Amin,Mohammad Robed %A Arifeen,Shams El %A Shomik,Mohammad Sohel %A Rahman,Ahmed Ehsanur %+ International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Dhaka, 1212, Bangladesh, 880 1716543128, aniqa.hossain@icddrb.org %K Wellbeing Centers %K antepartum %K postpartum %K depression %K anxiety %K implementation %D 2025 %7 3.1.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Globally, 10% of pregnant women and 13% of postpartum women experience mental disorders. In Bangladesh, nearly 50% of mothers face common mental disorders, but mental health services and trained professionals to serve their needs are scarce. To address this, the government of Bangladesh’s Non-Communicable Disease Control program initiated “Wellbeing Centers,” telemental health services in selected public hospitals. Objective: This study examines implementation outcomes, including adoption, accessibility, acceptability, feasibility, usefulness, need, experience, perception, and expectations of the Wellbeing Centers, with a focus on antepartum and postpartum women. Methods: Between January 2023 and August 2024, we interviewed 911 antepartum and postpartum women receiving mental health services and 168 health care providers at 6 Wellbeing Centers in 4 districts in Bangladesh. Data collection involved both quantitative and qualitative methods. Implementation outcomes were measured following the World Health Organization’s implementation research framework. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 questionnaires. Descriptive statistics and adjusted odds ratios (aORs) with 95% CIs were used to evaluate the implementation outcomes. Qualitative information was obtained through in-depth interviews and key-informant interviews. Results: Almost all health care providers (165/168, 98.2%) reported that the Wellbeing Centers were feasible to implement in their health facilities; however, about half (84/168, 50%) felt that trained staff to operate them were insufficient. Almost all women agreed that the Wellbeing Centers were acceptable (906/911, 99.8%), useful (909/911, 99.8%), and enhanced access to mental health care (906/911, 99.5%). Patients visiting district-level hospitals had higher odds of access (aOR 1.5, 95% CI 1.1-2.0) to Wellbeing Centers. Moreover, 77.4% (705/911) of women experienced depression symptoms, and 76.7% (699/911) experienced anxiety symptoms. About 51.8% (472/911) experienced tiredness or lack of energy, 50.9% (464/911) felt nervous, anxious, or on edge, 57.2% (521/911) felt worried, and 3.8% (35/911) had suicidal ideation almost every day. Patients visiting district hospitals had higher odds (aOR 2.6, 95% CI 1.8-3.78) of depression and anxiety symptoms compared to the patients visiting subdistrict-level hospitals. Decreasing trends in Patient Health Questionnaire-9 scores (from mean 14.4, SD 0.47 to mean 12.9, SD 0.47) and Generalized Anxiety Disorder-7 scores (from mean 13.3, SD 0.49 to mean 12.5, SD 0.48) between 2 counseling sessions indicated improved mental health in the antepartum and postpartum women. The Wellbeing Centers’ services were appreciated for their privacy and being free and accessible. However, stigma, postpartum illness, and long waiting times prevented some women from using these services. Conclusions: To our knowledge, this is the first implementation research assessing telemental health in public health facilities involving trained psychologists and psychiatrists. Our study highlighted the increased accessibility, feasibility, acceptability, and utility of Wellbeing Centers for antepartum and postpartum women in Bangladesh, supporting their scale-up in similar settings. %M 39753209 %R 10.2196/65912 %U https://pediatrics.jmir.org/2025/1/e65912 %U https://doi.org/10.2196/65912 %U http://www.ncbi.nlm.nih.gov/pubmed/39753209 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53720 %T Perceived Experiences and Needs of Digital Resources Among Postpartum Women in the United Arab Emirates: Qualitative Focus Group Study %A Hanach,Nivine %A Saqan,Roba %A Radwan,Hadia %A Baniissa,Wegdan %A de Vries,Nanne %+ Faculty of Health, Medicine, and Life Sciences, Care and Public Health Research Institute, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, Netherlands, 31 43 388 5655, n.hanach@maastrichtuniversity.nl %K digital health %K social support %K telemedicine %K postpartum women %K focus group %K maternal health %K postpartum mental health %K postpartum depression %K emotional support %K health information %D 2024 %7 16.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The postpartum period is a critical phase in a woman's life, marked by various physical, psychological, and social challenges. In light of the rapid proliferation and uptake of digital technologies, particularly in the United Arab Emirates (UAE), mothers increasingly seek informational and emotional support from digital resources. No previous study has thoroughly explored the usage of various digital resources beyond telehealth services in the UAE. This literature gap is particularly relevant for the postpartum period, which remains largely understudied in the UAE. Objective: This study aims to delve into the digital experiences of postpartum women in the UAE by exploring the types of resources they navigate and the purposes those resources serve. In addition, it seeks to identify their perspectives and needs regarding digital resources that support their postpartum journey. Methods: Four focus groups were conducted synchronously on the web, involving a total of 27 multicultural mothers (mean age 32.47, SD 4.56 years), between 2 and 12 months post partum and living in the UAE. Descriptive interpretive thematic analysis was used to analyze the data. Results: Sixteen out of 27 women exhibited severe depressive symptoms at the time of the discussions (Edinburgh Postnatal Depression Scale score of >12). Two main themes were generated from the analysis: (1) Mothers’ Experiences with Digital Resources: Participants valued digital resources for providing immediate information, convenience, and support. They primarily used these resources to seek information on infant health, parenting advice, and emotional support through web-based communities. However, the abundance of conflicting information and the pressure to conform to health recommendations often created stress and anxiety. (2) The Perceived Need for Digital Resources: Despite their extensive use of digital resources, mothers articulated the need for a reliable UAE government digital platform tailored specifically to postpartum care, offering trusted information on infant health and postpartum mental well-being. They also emphasized the need for tailored postpartum telemedicine services and moderated web-based discussion forums to foster peer support among mothers. Conclusions: This study reveals the multifaceted role of digital resources in supporting mothers during the postpartum period, highlighting unmet needs that present opportunities for advancing postpartum care in the UAE. It demonstrates the importance of developing reliable digital solutions for postpartum women, especially regarding mental health and to enhance access to care through tailored telemedicine services. Collaborative efforts are required to ensure the implementation of user-centered digital platforms. Future research should focus on the diverse needs of postpartum women, including cultural sensitivity, the feasibility of telemedicine services, and the integration of partner support in digital interventions to improve maternal health outcomes. %M 39680428 %R 10.2196/53720 %U https://www.jmir.org/2024/1/e53720 %U https://doi.org/10.2196/53720 %U http://www.ncbi.nlm.nih.gov/pubmed/39680428 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e63143 %T Optimizing a Novel Smartphone App to Prevent Postpartum Depression Adapted From an Evidence-Based Cognitive Behavioral Therapy Program: Qualitative Study %A Lewkowitz,Adam K %A Guillen,Melissa %A Ursino,Katrina %A Baker,Rackeem %A Lum,Liana %A Battle,Cynthia L %A Ware,Crystal %A Ayala,Nina K %A Clark,Melissa %A Ranney,Megan L %A Miller,Emily S %A Guthrie,Kate M %K cognitive behavioral therapy %K mothers and babies program %K digital health %K postpartum depression %K smartphone application %K FRAME for intervention adaptation %K Framework for Modification and Adaptation %K behavioral therapy %K mental health apps %D 2024 %7 9.12.2024 %9 %J JMIR Hum Factors %G English %X Background: Low-income pregnant patients are at high risk of postpartum depression (PPD). Mothers and Babies (MB) is a cognitive behavioral therapy–based program that prevents up to 50% of de novo PPD when provided in person to low-income Spanish- and English-speaking people who are pregnant without depression. MB is limited by the need for trained personnel to support it. Transforming MB into a smartphone app may mitigate this key barrier. Objective: We aimed to use qualitative data from target end users to create and optimize MBapp, a novel app centered on the MB program. Methods: Draft wireframes of MBapp were created in English and Spanish with cognitive behavioral therapy–based modules adapted from MB. These wireframes included several features shown previously to sustain app engagement: (1) push notifications delivered at participant-preferred times; (2) text-, graphic-, and video-based content; and (3) gamification with digital rewards for app engagement. English- or Spanish-speaking individuals with public health insurance who were between 32 weeks gestation and 6 months post partum and owned smartphones were eligible to consent for individual in-depth interviews. Individuals with prior or current depression were excluded. Interviews were recorded, transcribed, and analyzed using deductive and inductive codes to characterize opinions about MBapp and perceptions of challenges and facilitators of use of MBapp or other perinatal or mental health apps. End user feedback led to major modifications to the wireframes. Each of these changes was categorized according to the FRAME (Framework for Modification and Adaptation), an established method of systematically reporting adaptations and modifications to evidence-based interventions via end user feedback. Recruitment ceased with content saturation, defined as 3 successive participants providing only positive feedback on MBapp’s wireframe, without further suggestions for improvement. Results: A total of 25 interviews were completed. Participants were racially and ethnically diverse, generally representing our target end user population, and 48% (n=12) of interviews were conducted in Spanish. Participants’ suggestions to improve MBapp were categorized within the FRAME as adaptations that improved either content or context to optimize reach, retention, engagement, and fit for end users. Specifically, the following features were added to MBapp secondary to end user feedback: (1) audio narration; (2) “ask a clinician” nonurgent questions; (3) on-demand module summaries accessible upon module completion; and (4) choice to defer assessments and start the next module. Participants also provided insights into features of perinatal or mental health apps they found appealing or unappealing to understand preferences, challenges, and negotiables or nonnegotiables for MBapp. Conclusions: Adapting MBapp to incorporate end users’ perspectives optimized our digital PPD prevention intervention, ideally increasing its appeal to future users. Our team’s next steps will confirm that MBapp is a feasible, acceptable intervention among English- and Spanish-speaking perinatal people at risk of PPD. %R 10.2196/63143 %U https://humanfactors.jmir.org/2024/1/e63143 %U https://doi.org/10.2196/63143 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53236 %T Investigating the Effectiveness of Technology-Based Distal Interventions for Postpartum Depression and Anxiety: Systematic Review and Meta-Analysis %A Brocklehurst,Sarah P %A Morse,Alyssa R %A Cruwys,Tegan %A Batterham,Philip J %A Leach,Liana %A Robertson,Alysia M %A Sahib,Aseel %A Burke,Colette T %A Nguyen,Jessica %A Calear,Alison L %+ Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Acton, Canberra, 2601, Australia, 61 2 6125 8406, alison.calear@anu.edu.au %K postpartum %K depression %K anxiety %K birth %K adoptive %K parents %K mobile phone %D 2024 %7 19.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Postpartum anxiety and depression are common in new parents. While effective interventions exist, they are often delivered in person, which can be a barrier for some parents seeking help. One approach to overcoming these barriers is the delivery of evidence-based self-help interventions via websites, smartphone apps, and other digital media. Objective: This study aims to evaluate the effectiveness of technology-based distal interventions in reducing or preventing symptoms of postpartum depression or anxiety in male and female birth and adoptive parents, explore the effectiveness of technology-based distal interventions in increasing social ties, and determine the level of adherence to and satisfaction with technology-based distal interventions. Methods: A systematic review and series of meta-analyses were conducted. Three electronic bibliographic databases (PsycINFO, PubMed, and Cochrane Library) were searched for randomized controlled trials evaluating technology-based distal interventions for postpartum depression or anxiety in birth and adoptive parents. Searches were updated on August 1, 2023, before conducting the final meta-analyses. Data on trial characteristics, effectiveness, adherence, satisfaction, and quality were extracted. Screening and data extraction were conducted by 2 reviewers. Risk of bias was assessed using the Joanna Briggs Institute quality rating scale for randomized controlled trials. Studies were initially synthesized qualitatively. Where possible, studies were also quantitatively synthesized through 5 meta-analyses. Results: Overall, 18 articles met the inclusion criteria for the systematic review, with 14 (78%) providing sufficient data for a meta-analysis. A small significant between-group effect on depression favored the intervention conditions at the postintervention (Cohen d=–0.28, 95% CI –0.41 to –0.15; P<.001) and follow-up (Cohen d=–0.27, 95% CI –0.52 to –0.02; P=.03) time points. A small significant effect on anxiety also favored the intervention conditions at the postintervention time point (Cohen d=–0.29, 95% CI –0.48 to –0.10; P=.002), with a medium effect at follow-up (Cohen d=–0.47, 95% CI –0.88 to –0.05; P=.03). The effect on social ties was not significant at the postintervention time point (Cohen d=0.04, 95% CI –0.12 to 0.21; P=.61). Effective interventions tended to be web-based cognitive behavioral therapy programs with reminders. Adherence varied considerably between studies, whereas satisfaction tended to be high for most studies. Conclusions: Technology-based distal interventions are effective in reducing symptoms of postpartum depression and anxiety in birth mothers. Key limitations of the reviewed evidence include heterogeneity in outcome measures, studies being underpowered to detect modest effects, and the exclusion of key populations from the evidence base. More research needs to be conducted with birth fathers and adoptive parents to better ascertain the effectiveness of interventions in these populations, as well as to further assess the effect of technology-based distal interventions on social ties. Trial Registration: PROSPERO CRD42021290525; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=290525 %M 39561361 %R 10.2196/53236 %U https://www.jmir.org/2024/1/e53236 %U https://doi.org/10.2196/53236 %U http://www.ncbi.nlm.nih.gov/pubmed/39561361 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53744 %T Web-Based Intervention (SunnysideFlex) to Promote Resilience to Posttraumatic Stress Disorder Symptoms During Pregnancy: Development and Pilot Study %A Paltell,Katherine C %A Duffecy,Jennifer %A Maki,Pauline M %A Edalatian Zakeri,Shiva %A Vujanovic,Anka A %A Berenz,Erin C %+ Department of Psychology, University of Illinois at Chicago, 1007 W Harrison St, M/C 285, Chicago, IL, 60607, United States, 1 312 315 0808, kpaltell@uic.edu %K trauma %K posttraumatic stress disorder %K pregnancy %K perinatal %K web-based intervention %K stress %K postpartum %K depression %K child health %K treatment %K behavioral therapy %K SunnysideFlex %D 2024 %7 1.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 4% to 8% of pregnant individuals meet the criteria for current posttraumatic stress disorder (PTSD), a known risk factor for a multitude of adverse maternal and child health outcomes. However, PTSD is rarely detected or treated in obstetric settings. Moreover, available prenatal PTSD treatments require in-person services that are often inaccessible due to barriers to care. Thus, web-based interventions offer great potential in extending PTSD treatment to high-risk pregnant individuals by providing affordable, accessible care. However, there are currently no web-based interventions designed specifically for the treatment of PTSD symptoms during pregnancy. Objective: This study aims to develop and pilot a 6-week, web-based, cognitive behavioral therapy intervention for PTSD, SunnysideFlex, in a sample of 10 pregnant women with current probable PTSD. Consistent with established guidelines for developing and testing novel interventions, the focus of this pilot study was to evaluate the initial feasibility and acceptability of the SunnysideFlex intervention and preintervention to postintervention changes in PTSD and depression symptoms. This approach will allow for early refinement and optimization of the SunnysideFlex intervention to increase the odds of success in a larger-scale clinical trial. Methods: The SunnysideFlex intervention adapted an existing web-based platform for postpartum depression, Sunnyside for Moms, to include revised, trauma-focused content. A total of 10 pregnant women in weeks 16 to 28 of their pregnancy who reported lifetime interpersonal trauma exposure (ie, sexual or physical assault) and with current probable PTSD (scores ≥33 per the PTSD checklist for DSM-5) were enrolled in the SunnysideFlex intervention. Assessments took place at baseline and 6 weeks (postintervention). Results: All participants were retained through the postintervention assessment period. Engagement was high; participants on average accessed 90% of their lessons, logged on to the platform at least weekly, and reported a generally positive user experience. Moreover, 80% (8/10) of participants demonstrated clinically meaningful reductions in PTSD symptoms from baseline to postintervention, and 50% (5/10) of participants no longer screened positive for probable PTSD at postintervention. Most (6/10, 60%) of the participants maintained subclinical depression symptoms from baseline to postintervention. Conclusions: Findings from this small pilot study indicate that SunnysideFlex may be a feasible and acceptable mechanism for delivering PTSD intervention to high-risk, trauma-exposed pregnant women who might otherwise not have opportunities for services. Larger-scale trials of the intervention are necessary to better understand the impact of SunnysideFlex on PTSD symptoms during pregnancy and the postpartum period. %M 39485381 %R 10.2196/53744 %U https://formative.jmir.org/2024/1/e53744 %U https://doi.org/10.2196/53744 %U http://www.ncbi.nlm.nih.gov/pubmed/39485381 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56882 %T A Tailored Postpartum eHealth Physical Activity Intervention for Individuals at High Risk of Postpartum Depression—the POstpartum Wellness Study (POW): Protocol and Data Overview for a Randomized Controlled Trial %A Ramsey,Maya %A Oberman,Nina %A Quesenberry Jr,Charles P %A Kurtovich,Elaine %A Gomez Chavez,Lizeth %A Chess,Aaloni %A Brown,Susan Denise %A Albright,Cheryl L %A Bhalala,Mibhali %A Badon,Sylvia E %A Avalos,Lyndsay A %+ Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr., Pleasanton, CA, 94588, United States, 1 5108210300, Lyndsay.A.Avalos@kp.org %K postpartum depression %K depression %K eHealth %K online workout videos %K exercise videos %K physical activity %K wellness %K health promotion %K digital interventions %D 2024 %7 29.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum depression (PPD) is associated with significant health consequences for the parent and child. Current recommendations for PPD prevention require intense health care system resources. Evidence-based interventions for PPD prevention that do not further burden the health care system are needed. Evidence suggests that physical activity (PA) can generally reduce depressive symptoms. Technology-based interventions may help decrease common barriers to PA. Objective: This study aims to report the protocol and provide a data overview of the POstpartum Wellness study (POW)—an effectiveness trial evaluating whether an eHealth PA intervention tailored for postpartum individuals increased PA and decreased depressive symptoms among individuals at high PPD risk. Methods: This remote parallel-group randomized controlled trial included postpartum individuals with a history of depression or at least moderate current depressive symptoms not meeting the PPD diagnostic threshold and with low PA levels from an integrated health care delivery system. Participants were randomized to an eHealth PA intervention or usual care. The intervention group received access to a library of web-based workout videos designed for postpartum individuals, which included interaction with their infants. At baseline and follow-up (3 and 6 months), PA was measured using questionnaires and a wrist-worn accelerometer. Depressive symptoms were measured using the Patient Health Questionnaire-8 (PHQ-8). Data were collected to assess exploratory outcomes of sleep, perceived stress, anxiety, parent-infant bonding, and infant development. Results: The study was funded in January 2020. Participants were enrolled via REDCap (Research Electronic Data Capture) or telephonically between November 2020 and September 2022; data collection ended in April 2023. Randomized participants (N=99) were 4 months post partum at baseline with moderately severe depressive symptoms (mean PHQ-8 score 12.6, SD 2.2). Intervention (n=50) and usual care (n=49) groups had similar sociodemographic characteristics, months post partum, baseline depressive symptoms, number of children at home, and prepregnancy PA levels. Retention in assessments was ≥66% for questionnaires and ≥48% for accelerometry, with modest differences by group. At 3-month follow-up, 73 of 99 (74%) participants (intervention: 35/50, 70%; usual care: 38/49, 78%) completed questionnaires; 53 of 99 (54%) wore the accelerometer for 7 days (27 of 50 (54%) intervention, 26 of 49 (53%) usual care). At 6-month follow-up, 66 of 99 (67%) participants (30 of 50 (60%) intervention, 36 of 49 (73%) usual care) completed questionnaires and 43 of 99 (43%) wore the accelerometer for 7 days (21 of 50 (42%) intervention, 22 of 49 (45%) usual care). Data analysis is completed, and a manuscript with these findings is currently under review for publication. Conclusions: The POW trial evaluates the effectiveness of an eHealth PA intervention for improving depressive symptoms and increasing PA among postpartum individuals at high PPD risk. Results have implications for the design and delivery of behavioral interventions among vulnerable patients. Trial Registration: ClinicalTrials.gov NCT04414696; https://clinicaltrials.gov/ct2/show/NCT04414696 International Registered Report Identifier (IRRID): DERR1-10.2196/56882 %M 39470705 %R 10.2196/56882 %U https://www.researchprotocols.org/2024/1/e56882 %U https://doi.org/10.2196/56882 %U http://www.ncbi.nlm.nih.gov/pubmed/39470705 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e53786 %T Predictors of Participation in a Perinatal Text Message Screening Protocol for Maternal Depression and Anxiety: Prospective Cohort Study %A Barnwell,Julia %A Hénault Robert,Cindy %A Nguyen,Tuong-Vi %A Davis,Kelsey P %A Gratton,Chloé %A Elgbeili,Guillaume %A Pham,Hung %A Meaney,Michael J %A Montreuil,Tina C %A O'Donnell,Kieran J %+ Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT, 06520, United States, 1 203 785 2540, kieran.odonnell@yale.edu %K perinatal mental health %K digital screening %K maternal depression %K maternal anxiety %K text messaging %K mHealth %K mobile health %K pregnancy %K mobile phone %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Universal screening for depression and anxiety in pregnancy has been recommended by several leading medical organizations, but the implementation of such screening protocols may overburden health care systems lacking relevant resources. Text message screening may provide a low-cost, accessible alternative to in-person screening assessments. However, it is critical to understand who is likely to participate in text message–based screening protocols before such approaches can be implemented at the population level. Objective: This study aimed to examine sources of selection bias in a texting–based screening protocol that assessed symptoms of depression and anxiety across pregnancy and into the postpartum period. Methods: Participants from the Montreal Antenatal Well-Being Study (n=1130) provided detailed sociodemographic information and completed questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (State component of the State-Trait Anxiety Inventory [STAI-S]) at baseline between 8 and 20 weeks of gestation (mean 14.5, SD 3.8 weeks of gestation). Brief screening questionnaires, more suitable for delivery via text message, assessing depression (Whooley Questions) and anxiety symptoms (Generalized Anxiety Disorder 2-Item questionnaire) were also collected at baseline and then via text message at 14-day intervals. Two-tailed t tests and Fisher tests were used to identify maternal characteristics that differed between participants who responded to the text message screening questions and those who did not. Hurdle regression models were used to test if individuals with a greater burden of depression and anxiety at baseline responded to fewer text messages across the study period. Results: Participants who responded to the text messages (n=933) were more likely than nonrespondents (n=114) to self-identify as White (587/907, 64.7% vs 39/96, 40.6%; P<.001), report higher educational attainment (postgraduate: 268/909, 29.5% vs 15/94, 16%; P=.005), and report higher income levels (CAD $150,000 [a currency exchange rate of CAD $1=US $0.76 is applicable] or more: 176/832, 21.2% vs 10/84, 11.9%; P<.001). There were no significant differences in symptoms of depression and anxiety between the 2 groups at baseline or postpartum. However, baseline depression (EPDS) or anxiety (STAI-S) symptoms did predict the total number of text message time points answered by participants, corresponding to a decrease of 1% (eβ=0.99; P<.001) and 0.3% (eβ=0.997; P<.001) in the number of text message time points answered per point increase in EPDS or STAI-S score, respectively. Conclusions: Findings from this study highlight the feasibility of text message–based screening protocols with high participation rates. However, our findings also highlight how screening and service delivery via digital technology could exacerbate disparities in mental health between certain patient groups. %M 39361419 %R 10.2196/53786 %U https://pediatrics.jmir.org/2024/1/e53786 %U https://doi.org/10.2196/53786 %U http://www.ncbi.nlm.nih.gov/pubmed/39361419 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56319 %T Developing a Guided Web App for Postpartum Depression Symptoms: User-Centered Design Approach %A Franco,Pamela %A Olhaberry,Marcia %A Muzard,Antonia %A Harismendy,Ángeles %A Kelders,Saskia %+ Centre for eHealth & Well-being Research, Department of Psychology, Health & Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 0 534899180, s.m.kelders@utwente.nl %K internet-based intervention %K postpartum depression %K user-centered development %K perinatal mental health %K user-centered design %K mobile phone %D 2024 %7 19.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychological internet-based interventions have shown promise in preventing and treating perinatal depression, but their effectiveness can be hindered by low user engagement. This challenge often arises from a misalignment between technology attributes, user needs, and context. A user-centered, iterative approach involving all stakeholders is recommended. Objective: In this paper, we aimed to develop a user-friendly psychological internet-based intervention aimed at addressing the symptoms of perinatal depression through an iterative, user-centered approach. Methods: The development process followed the Center for eHealth Research and Disease Management Roadmap phases of contextual inquiry, value specification, and design. It involved a comprehensive literature review, 2 surveys, 10 focus groups, 5 usability interviews, and 1 technical pilot. Results: The contextual inquiry revealed a demand for accessible interventions for perinatal mental health, with internet-based solutions seen as viable options. Insights from the literature influenced intervention content and features. Stakeholders’ openness to the intervention became evident during this phase, along with the integration of the first set of values. Initially, we assessed the broader perinatal context to identify the optimal period for the intervention. On the basis of the findings and practical considerations, we decided to specifically target postpartum depression symptoms. The value specification phase further defined the central values and translated them into requirements. In the design phase, feedback was obtained on the user experience of an early digital prototype and on the prototype’s final version. The resulting intervention, named Mamá, te entiendo (“Mom, I get you”), is a guided web app based on cognitive behavioral therapy principles, integrating elements from attachment and mentalization theories. It aims to reduce depressive symptoms in women during the first months postpartum and consists of 6 core sequential modules, along with 3 additional modules, including 5 case examples illustrating depressive symptoms and therapeutic techniques. The intervention provides homework exercises and offers users the opportunity to receive feedback from an e-coach through the web app. Conclusions: This study emphasizes the importance of a user-centered and iterative development process for psychological internet-based interventions. This process helps clarify user needs and provides valuable feedback on service design and quality, ultimately having the potential to enhance the utility and, presumably, the effectiveness of the intervention. The Discussion section shares valuable insights from the project, such as the value of the requirement sessions. %M 39159447 %R 10.2196/56319 %U https://formative.jmir.org/2024/1/e56319 %U https://doi.org/10.2196/56319 %U http://www.ncbi.nlm.nih.gov/pubmed/39159447 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53508 %T Exploring User Experiences of the Mom2B mHealth Research App During the Perinatal Period: Qualitative Study %A Bilal,Ayesha-Mae %A Pagoni,Konstantina %A Iliadis,Stavros I %A Papadopoulos,Fotios C %A Skalkidou,Alkistis %A Öster,Caisa %+ Department of Medical Sciences, Psychiatry, Uppsala University, Academic Hospital, Entrance 10, Floor 4, Uppsala, 751 85, Sweden, 46 737240915, ayesha.bilal@uu.se %K digital phenotyping %K smartphone app %K mHealth %K mobile health %K qualitative study %K user experience %K usability %K perinatal depression %K depression %K app %K user %K users %K qualitative %K perinatal %K mobile app %K clinical research %K acceptability %K behavioral data %K depressive symptoms %K interview %K pregnant %K postpartum %K women %K thematic analysis %K well-being %K monitor %K mobile phone %D 2024 %7 8.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Perinatal depression affects a significant number of women during pregnancy and after birth, and early identification is imperative for timely interventions and improved prognosis. Mobile apps offer the potential to overcome barriers to health care provision and facilitate clinical research. However, little is known about users’ perceptions and acceptability of these apps, particularly digital phenotyping and ecological momentary assessment apps, a relatively novel category of apps and approach to data collection. Understanding user’s concerns and the challenges they experience using the app will facilitate adoption and continued engagement. Objective: This qualitative study explores the experiences and attitudes of users of the Mom2B mobile health (mHealth) research app (Uppsala University) during the perinatal period. In particular, we aimed to determine the acceptability of the app and any concerns about providing data through a mobile app. Methods: Semistructured focus group interviews were conducted digitally in Swedish with 13 groups and a total of 41 participants. Participants had been active users of the Mom2B app for at least 6 weeks and included pregnant and postpartum women, both with and without depression symptomatology apparent in their last screening test. Interviews were recorded, transcribed verbatim, translated to English, and evaluated using inductive thematic analysis. Results: Four themes were elicited: acceptability of sharing data, motivators and incentives, barriers to task completion, and user experience. Participants also gave suggestions for the improvement of features and user experience. Conclusions: The study findings suggest that app-based digital phenotyping is a feasible and acceptable method of conducting research and health care delivery among perinatal women. The Mom2B app was perceived as an efficient and practical tool that facilitates engagement in research as well as allows users to monitor their well-being and receive general and personalized information related to the perinatal period. However, this study also highlights the importance of trustworthiness, accessibility, and prompt technical issue resolution in the development of future research apps in cooperation with end users. The study contributes to the growing body of literature on the usability and acceptability of mobile apps for research and ecological momentary assessment and underscores the need for continued research in this area. %M 39115893 %R 10.2196/53508 %U https://formative.jmir.org/2024/1/e53508 %U https://doi.org/10.2196/53508 %U http://www.ncbi.nlm.nih.gov/pubmed/39115893 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50098 %T A Digital Behavioral Activation Intervention (JuNEX) for Pregnant Women With Subclinical Depression Symptoms: Explorative Co-Design Study %A Mancinelli,Elisa %A Gabrielli,Silvia %A Salcuni,Silvia %+ Department of Developmental and Socialization Psychology, University of Padova, Via Venezia 8, Padova, 35131, Italy, 39 3342799698, elisa.mancinelli@phd.unipd.it %K digital intervention %K behavioral activation %K feasibility %K pregnancy %K subclinical depression symptoms %D 2024 %7 16.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital interventions are gaining increasing interest due to their structured nature, ready availability, and self-administered capabilities. Perinatal women have expressed a desire for such interventions. In this regard, behavioral activation interventions may be particularly suitable for digital administration. Objective: This study aims to exploratorily investigate and compare the feasibility of the internet-based self-help guided versus unguided version of the Brief Behavioral Activation Treatment for Depression-Revised, an empirically supported in-person behavioral activation protocol, targeting pregnant women with subclinical depression symptoms. A user-centered design is used, whereby data are collected with the intent of evaluating how to adjust the intervention in line with pregnant women’s needs. Usability and user engagement were evaluated. Methods: A total of 11 Italian pregnant women with subclinical depressive symptoms based on the Patient Health Questionnaire-9 (scoring<15) participated in this study; of them, 6 (55%) women were randomly assigned to the guided group (age: mean 32.17, SD 4.36 years) and 5 (45%) to the unguided group (age: mean 31, SD 4.95 years). The Moodle platform was used to deliver the interventions in an e-learning format. It consisted of 6 core modules and 3 optional modules; the latter aimed at revising the content of the former. In the guided group, each woman had weekly chats with their assigned human guide to support them in the homework revisions. The intervention content included text, pictures, and videos. Semistructured interviews were conducted, and descriptive statistics were analyzed. Results: Collectively, the data suggest that the guided intervention was better accepted than the unguided one. However, the high rates of dropout (at T6: guided group: 3/6, 50%; unguided: 4/5, 80%) suggest that a digital replica of Behavioral Activation Treatment for Depression-Revised may not be feasible in an e-learning format. The reduced usability of the platform used was reported, and homework was perceived as too time-consuming and effort-intensive. Moreover, the 6 core modules were deemed sufficient for the intervention’s goals, suggesting that the 3 optional modules could be eliminated. Nevertheless, participants from both groups expressed satisfaction with the content and found it relevant to their pregnancy experiences. Conclusions: Overall, the findings have emphasized both the intervention’s merits and shortcomings. Results highlight the unsuitability of replicating an in-person protocol digitally as well as of the use of nonprofessional tools for the implementation of self-help interventions, ultimately making the intervention not feasible. Pregnant women have nonetheless expressed a desire to receive psychological support and commented on the possibilities of digital psychosocial supports, particularly those that are app-based. The information collected and the issues identified here are important to guide the development and co-design of a more refined platform for the intervention deployment and to tailor the intervention’s content to pregnant women’s needs. %M 38753421 %R 10.2196/50098 %U https://humanfactors.jmir.org/2024/1/e50098 %U https://doi.org/10.2196/50098 %U http://www.ncbi.nlm.nih.gov/pubmed/38753421 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53890 %T A Mindfulness-Based App Intervention for Pregnant Women: Protocol for a Pilot Feasibility Study %A Rizzi,Silvia %A Poggianella,Stefania %A Pavesi,Maria Chiara %A Gios,Lorenzo %A Bincoletto,Giorgia %A Scolari,Isabella %A Paoli,Claudia %A Marroni,Debora %A Tassinari,Irene %A Baietti,Barbara %A Gianatti,Anna %A Albertini,Veronica %A Burlon,Barbara %A Chiodega,Vanda %A Endrizzi,Barbara %A Benini,Elena %A Guella,Chiara %A Gadotti,Erik %A Forti,Stefano %A Taddei,Fabrizio %+ Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461312415, srizzi@fbk.eu %K mindfulness %K promoting well-being %K pregnancy %K eHealth %K mobile health %K mHealth %K mobile apps %K development %K usability %K user-centered design %K mindfulness based %K intervention %K pregnant women %K pregnant %K feasibility study %K well-being %K women %K quality of life %K psychological symptoms %K digital solution %K virtual coach %K smartphone %K mobile phone %D 2024 %7 10.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pregnancy is a complex time characterized by major transformations in a woman, which impact her physical, mental, and social well-being. How a woman adapts to these changes can affect her quality of life and psychological well-being. The literature indicates that pregnant women commonly experience psychological symptoms, with anxiety, stress, and depression being among the most frequent. Hence, promoting a healthy lifestyle focused on women’s psychological well-being is crucial. Recently developed digital solutions have assumed a crucial role in supporting psychological well-being in physiologically pregnant women. Therefore, the need becomes evident for the development and implementation of digital solutions, such as a virtual coach implemented in a smartphone, as a support for the psychological well-being of pregnant women who do not present psychological and psychiatric disorders. Objective: This study aims to assess the feasibility, acceptability, and utility of a mindfulness-based mobile app. The primary objective is to explore the feasibility of using a virtual coach, Maia, developed within the TreC Mamma app to promote women’s psychological well-being during pregnancy through a psychoeducational module based on mindfulness. Finally, through the delivery of this module, the level of psychological well-being will be explored as a secondary objective. Methods: This is a proof-of-concept study in which a small sample (N=50) is sufficient to achieve the intended purposes. Recruitment will occur within the group of pregnant women belonging to the pregnancy care services of the Trento Azienda Provinciale per i Servizi Sanitari di Trento. The convenience sampling method will be used. Maia will interact with the participating women for 8 weeks, starting from weeks 24 and 26 of pregnancy. Specifically, there will be 2 sessions per week, which the woman can choose, to allow more flexibility toward her needs. Results: The psychoeducational pathway is expected to lead to significant results in terms of usability and engagement in women’s interactions with Maia. Furthermore, it is anticipated that there will be improvements in psychological well-being and overall quality of life. The analysis of the data collected in this study will be mainly descriptive, orientated toward assessing the achievement of the study objectives. Conclusions: Literature has shown that women preferred web-based support during the perinatal period, suggesting that implementing digital interventions can overcome barriers to social stigma and asking for help. Maia can be a valuable resource for regular psychoeducational support for women during pregnancy. International Registered Report Identifier (IRRID): RR1-10.2196/53890 %M 38567964 %R 10.2196/53890 %U https://www.researchprotocols.org/2024/1/e53890 %U https://doi.org/10.2196/53890 %U http://www.ncbi.nlm.nih.gov/pubmed/38567964 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54622 %T Harnessing Consumer Wearable Digital Biomarkers for Individualized Recognition of Postpartum Depression Using the All of Us Research Program Data Set: Cross-Sectional Study %A Hurwitz,Eric %A Butzin-Dozier,Zachary %A Master,Hiral %A O'Neil,Shawn T %A Walden,Anita %A Holko,Michelle %A Patel,Rena C %A Haendel,Melissa A %+ Department of Genetics, University of North Carolina at Chapel Hill, 120 Mason Farm Road, Chapel Hill, NC, 27599, United States, 1 9198436475, eric_hurwitz@med.unc.edu %K wearable device %K All of Us %K postpartum depression %K machine learning %K Fitbit %K mobile phone %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Postpartum depression (PPD) poses a significant maternal health challenge. The current approach to detecting PPD relies on in-person postpartum visits, which contributes to underdiagnosis. Furthermore, recognizing PPD symptoms can be challenging. Therefore, we explored the potential of using digital biomarkers from consumer wearables for PPD recognition. Objective: The main goal of this study was to showcase the viability of using machine learning (ML) and digital biomarkers related to heart rate, physical activity, and energy expenditure derived from consumer-grade wearables for the recognition of PPD. Methods: Using the All of Us Research Program Registered Tier v6 data set, we performed computational phenotyping of women with and without PPD following childbirth. Intraindividual ML models were developed using digital biomarkers from Fitbit to discern between prepregnancy, pregnancy, postpartum without depression, and postpartum with depression (ie, PPD diagnosis) periods. Models were built using generalized linear models, random forest, support vector machine, and k-nearest neighbor algorithms and evaluated using the κ statistic and multiclass area under the receiver operating characteristic curve (mAUC) to determine the algorithm with the best performance. The specificity of our individualized ML approach was confirmed in a cohort of women who gave birth and did not experience PPD. Moreover, we assessed the impact of a previous history of depression on model performance. We determined the variable importance for predicting the PPD period using Shapley additive explanations and confirmed the results using a permutation approach. Finally, we compared our individualized ML methodology against a traditional cohort-based ML model for PPD recognition and compared model performance using sensitivity, specificity, precision, recall, and F1-score. Results: Patient cohorts of women with valid Fitbit data who gave birth included <20 with PPD and 39 without PPD. Our results demonstrated that intraindividual models using digital biomarkers discerned among prepregnancy, pregnancy, postpartum without depression, and postpartum with depression (ie, PPD diagnosis) periods, with random forest (mAUC=0.85; κ=0.80) models outperforming generalized linear models (mAUC=0.82; κ=0.74), support vector machine (mAUC=0.75; κ=0.72), and k-nearest neighbor (mAUC=0.74; κ=0.62). Model performance decreased in women without PPD, illustrating the method’s specificity. Previous depression history did not impact the efficacy of the model for PPD recognition. Moreover, we found that the most predictive biomarker of PPD was calories burned during the basal metabolic rate. Finally, individualized models surpassed the performance of a conventional cohort-based model for PPD detection. Conclusions: This research establishes consumer wearables as a promising tool for PPD identification and highlights personalized ML approaches, which could transform early disease detection strategies. %M 38696234 %R 10.2196/54622 %U https://mhealth.jmir.org/2024/1/e54622 %U https://doi.org/10.2196/54622 %U http://www.ncbi.nlm.nih.gov/pubmed/38696234 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51066 %T Acceptability and Utility of a Digital Group Intervention to Prevent Perinatal Depression in Youths via Interactive Maternal Group for Information and Emotional Support (IMAGINE): Pilot Cohort Study %A Ronen,Keshet %A Gewali,Anupa %A Dachelet,Kristin %A White,Erica %A Jean-Baptiste,Marimirca %A Evans,Yolanda N %A Unger,Jennifer A %A Tandon,S Darius %A Bhat,Amritha %+ Department of Global Health, University of Washington, 3980 15th Avenue North East, Seattle, WA, 98195, United States, 1 2066854363, keshet@uw.edu %K perinatal depression %K youth %K mHealth %K digital health %K acceptability %K utility %K depression %K pilot study %K pregnancy %K postpartum %K prevention %K cognitive behavioral therapy %K psychoeducation %K mixed methods %K manage %K mood %K mobile phone %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Perinatal depression (depression during pregnancy or the first year postpartum) affects 10%-25% of perinatal individuals, with a higher risk among youths aged <25 years. The Mothers and Babies Course (MB) is an evidence-based intervention for the prevention of perinatal depression, grounded in cognitive behavioral therapy, attachment theory, and psychoeducation. Objective: We developed a digital adaptation of MB (Interactive Maternal Group for Information and Emotional Support [IMAGINE]) and evaluated it in a pre-post mixed methods pilot among young perinatal people in the United States. Methods: IMAGINE was a structured digital group of up to 7 participants, with scheduled MB content and open discussion for 12 weeks, facilitated by a social worker. Scheduled content included asynchronous SMS text messages, graphics, prerecorded videos, mood polls, and optional weekly synchronous video calls. Eligible participants were pregnant or ≤80 days postpartum, aged 16 to 24 years, had access to a smartphone, spoke English, and had a Patient Health Questionnaire score <10. Participants were recruited throughout the United States from August 2020 to January 2021 through paid social media ads, in-person outreach at clinics, and respondent-driven sampling. Participants completed quantitative questionnaires at enrollment and 3 months, and qualitative interviews at 3 months. We determined uptake, acceptability (by Acceptability of Intervention Measure score), and utility (by use of cognitive behavioral therapy skills). We compared depression symptoms (by Patient Health Questionnaire score), social support (by abbreviated Social Support Behavior score), and perceived stress (by Perceived Stress Score) between enrollment and follow-up by paired 2-tailed t test. Results: Among 68 individuals who contacted this study, 22 were screened, 13 were eligible, and 10 enrolled, for an uptake of 76.9%. Furthermore, 4 (40%) participants were pregnant at enrollment. Participants had a median age of 17.9 (IQR 17.4-21.7) years, 6 (67%) identified as Black, 5 (56%) Latinx, and 6 (67%) using Medicaid health insurance. Further, 9 (90%) participants completed follow-up. Among these, the mean acceptability score was 4.3 out of 5 (SD 0.6) and all participants said they would recommend IMAGINE to a friend. Participants reported using a median of 7 of 11 skills (IQR 5-7 skills) at least half the days. We found no significant changes in depression symptoms, perceived stress, or social support. Qualitatively, participants reported one-to-one support from the facilitator, connection with other parents, and regular mood reflection were especially helpful aspects of the intervention. Additionally, participants reported that the intervention normalized their mental health challenges, improved their ability to manage their mood, and increased their openness to mental health care. Conclusions: This pilot study provides promising evidence of the acceptability and utility of IMAGINE among perinatal youths. Our study’s small sample size did not detect changes in clinical outcomes; our findings suggest IMAGINE warrants larger-scale evaluation. %M 38306159 %R 10.2196/51066 %U https://formative.jmir.org/2024/1/e51066 %U https://doi.org/10.2196/51066 %U http://www.ncbi.nlm.nih.gov/pubmed/38306159 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44029 %T Testing a Behavioral Activation Gaming App for Depression During Pregnancy: Multimethod Pilot Study %A Vanderkruik,Rachel C %A Ferguson,Craig %A Kobylski,Lauren A %A Locascio,Joseph J %A Hamlett,Gabriella E %A Killenberg,Parker C %A Lewis,Robert %A Jones,Noah %A Rossa,Ella T %A Dineen,Hannah %A Picard,Rosalind %A Cohen,Lee S %+ Center for Women's Mental Health, Massachusetts General Hospital, 185 Cambridge St, Ste 2200, Boston, MA, 02114, United States, 1 781 691 9071, rvanderkruik@mgh.harvard.edu %K perinatal depression %K pregnancy %K behavioral activation %K mobile app %K digital intervention %K mobile phone %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression during pregnancy is increasingly recognized as a worldwide public health problem. If untreated, there can be detrimental outcomes for the mother and child. Anxiety is also often comorbid with depression. Although effective treatments exist, most women do not receive treatment. Technology is a mechanism to increase access to and engagement in mental health services. Objective: The Guardians is a mobile app, grounded in behavioral activation principles, which seeks to leverage mobile game mechanics and in-game rewards to encourage user engagement. This study seeks to assess app satisfaction and engagement and to explore changes in clinical symptoms of depression and anxiety among a sample of pregnant women with elevated depressive symptoms. Methods: This multimethod pilot test consisted of a single-arm, proof-of-concept trial to examine the feasibility and acceptability of The Guardians among a pregnant sample with depression (N=18). Participation included two web-based study visits: (1) a baseline assessment to collect demographic and obstetric information and to assess clinical symptoms and (2) an exit interview to administer follow-up measures and explore user experience. Participants completed biweekly questionnaires (ie, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7) during the trial to assess depression and anxiety symptom severity. App satisfaction was measured using 2 self-report scales (ie, Mobile Application Rating Scale and Player Experience of Needs Satisfaction scale). Engagement with The Guardians was captured using game interaction metric data. We used backward-eliminated mixed effects longitudinal models to examine the effects of app engagement and satisfaction and length of time in the study on symptoms of depression and anxiety. Content analysis was conducted on qualitative data from exit interviews. Results: The 15-day and 30-day overall app retention rates were 26.6% and 15.1%, respectively. Mixed effects models found significant negative main effects of week in study (β=−.35; t61=−3.05; P=.003), number of activities completed (β=−.12; t61=−2.05; P=.04), days played (β=−.12; t58=−2.9; P=.005), and satisfaction, according to the Mobile Application Rating Scale (β=−3.05; t45=−2.19; P=.03) on depressive symptoms. We have reported about similar analyses for anxiety. There is preliminary evidence suggesting harder activities are associated with greater mood improvement than easier activities. Qualitative content analysis resulted in feedback falling under the following themes: activities, app design, engagement, fit of the app with lifestyle, perceived impact of the app on mood, and suggestions for app modifications. Conclusions: Preliminary results from this multimethod study of The Guardians indicate feasibility and acceptability among pregnant women with depression. Retention and engagement levels were more than double those of previous public mental health apps, and use of the app was associated with significant decrease in depressive symptom scores over the 10-week trial. The Guardians shows promise as an effective and scalable digital intervention to support women experiencing depression. %M 38277191 %R 10.2196/44029 %U https://formative.jmir.org/2024/1/e44029 %U https://doi.org/10.2196/44029 %U http://www.ncbi.nlm.nih.gov/pubmed/38277191 %0 Journal Article %@ 2561-6722 %I %V 6 %N %P e46982 %T Dropout or Drop-In Experiences in an Internet-Delivered Intervention to Prevent Depression and Enhance Subjective Well-Being During the Perinatal Period: Qualitative Study %A Valla,Lisbeth %A Haga,Silje Marie %A Garthus-Niegel,Susan %A Drozd,Filip %K perinatal depression %K internet intervention %K dropout %K well-being %K perinatal period %D 2023 %7 22.12.2023 %9 %J JMIR Pediatr Parent %G English %X Background: The perinatal period is a vulnerable time when women are at increased risk of depression. “Mamma Mia” is a universal preventive internet-delivered intervention offered to pregnant women, with the primary goals of preventing the onset or worsening of depression and enhancing subjective well-being during the perinatal period. However, treatment dropout from internet-delivered interventions is often reported. Objective: The study aim was to acquire an understanding of the different experiences among participants who dropped out of the Mamma Mia intervention during pregnancy, compared to participants who dropped out during the postpartum follow-up phase. Methods: A total of 16 women from a larger randomized controlled trial (Mamma Mia) participated in individual semistructured interviews following a strengths, weaknesses, opportunities, and threats format. Of the 16 participants included, 8 (50%) women dropped out early from the intervention during pregnancy (pregnancy group), whereas 8 (50%) women dropped out later, after giving birth (postpartum follow-up group). Data were analyzed using the framework approach. Results: The results showed that there were differences between the groups. In general, more participants in the postpartum follow-up group reported that the program was user-friendly. They became more aware of their own thoughts and feelings and perceived that the program had provided them with more new knowledge and practical information than participants in the pregnancy group. Participants in both groups suggested several opportunities for improving the program. Conclusions: There were differences between women who dropped out of the intervention during pregnancy and the postpartum follow-up phase. The reported differences between groups should be further examined. %R 10.2196/46982 %U https://pediatrics.jmir.org/2023/1/e46982 %U https://doi.org/10.2196/46982 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49243 %T Phenotypic Environmental Sensitivity and Mental Health During Pregnancy and Post Partum: Protocol for the Experiences of Pregnancy Longitudinal Cohort Study %A Rioux,Charlie %A Fulp,Delaney C %A Haley,Parker N %A LaBelle,Jenna L %A Aasted,Mary E %A Lambert,Kasie K %A Donohue,Madison T %A Mafu,Nkatheko T %+ Department of Psychology, University of Oklahoma, 455 W Lindsey Street, Dale Hall Tower, Room 705, Norman, OK, 73019-2007, United States, 1 405 325 4511, charlie.rioux@ou.edu %K anxiety %K biological sensitivity to context %K depression %K diathesis-stress %K highly sensitive person %K moderation %K resilience %K sensory processing reactivity %K substance use %K vantage sensitivity %D 2023 %7 6.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental health problems during pregnancy and post partum are common and associated with negative short- and long-term impacts on pregnant individuals, obstetric outcomes, and child socioemotional development. Socio-environmental factors are important predictors of perinatal mental health, but the effects of the environment on mental health are heterogeneous. The differential susceptibility theory and the environmental sensitivity framework suggest that individuals differ in their degree of sensitivity to positive and negative environments, which can be captured by individual phenotypes such as temperament and personality. While there is strong evidence for these models in childhood, few studies examined them in adults, and they were not examined in pregnancy. Objective: The primary objective of the Experiences of Pregnancy study is to explore whether childhood and current environments are associated with mental health and well-being in pregnancy and whether these effects depend on individual sensitivity phenotypes (personality). This study also aims to gather important psychosocial and health data for potential secondary data analyses and integrative data analyses. Methods: We will conduct a longitudinal cohort study. The study was not registered elsewhere, other than this protocol. Participants will be recruited through social media advertisements linking to the study website, followed by an eligibility call on Zoom (Zoom Video Communications). Participants must be aged 18 years or older, currently residing in the United States as citizens or permanent residents, and currently planning to continue the pregnancy. A minimum of 512 participants will be recruited based on power analyses for the main objectives. Since the data will also be a resource for secondary analyses, up to 1000 participants will be recruited based on the available budget. Participants will be in their first trimester of pregnancy, and they will be followed at each trimester and once post partum. Data will be obtained through self-reported questionnaires assessing demographic factors; pregnancy-related factors; delivery, labor, and birth outcomes; early infant feeding; individual personality factors; childhood and current environments; mental health and well-being; attachment; and infant temperament. A series of measures were taken to safeguard the study from web robots and fraudulent participants, as well as to reduce legal and social risks for participants following Dobbs v. Jackson. Results: The study received ethics approval in April 2023 from the University of Oklahoma-Norman Campus Institutional Review Board. Recruitment occurred from May to August 2023, with 3 follow-ups occurring over 10 months. Conclusions: The Experiences of Pregnancy study will extend theories of environmental sensitivity, mainly applied in children to the perinatal period. This will help better understand individual sensitivity factors associated with risk, resilience, plasticity, and receptivity to negative and positive environmental influences during pregnancy for pregnant individuals. International Registered Report Identifier (IRRID): PRR1-10.2196/49243 %M 38055312 %R 10.2196/49243 %U https://www.researchprotocols.org/2023/1/e49243 %U https://doi.org/10.2196/49243 %U http://www.ncbi.nlm.nih.gov/pubmed/38055312 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51824 %T Video-Delivered Family Therapy for Perinatal Women With Depressive Symptoms and Family Conflict: Feasibility, Acceptability, Safety, and Tolerability Results From a Pilot Randomized Trial %A Cluxton-Keller,Fallon %A Hegel,Mark T %A Donnelly,Craig L %A Bruce,Martha L %+ Department of Psychiatry, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 650 4726, Fallon.P.Cluxton-Keller@dartmouth.edu %K perinatal depression %K family conflict %K family therapy %K family %K conflict %K depression %K depressive %K perinatal %K pregnant %K pregnancy %K video %K videos %K feasibility %K safety %K acceptability %K tolerability %K tolerable %K families %K satisfaction %K resilience %K psychotherapy %D 2023 %7 3.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Although individual-level treatments exist for pregnant and postpartum women with depression, family conflict is a significant factor that can contribute to the development and severity of perinatal depressive symptoms. Yet, there is a lack of research on family therapy for perinatal women with moderate to severe depressive symptoms and family conflict. Further, research is needed on the feasibility, acceptability, safety, and tolerability of family therapies for perinatal depression that are delivered using Health Insurance Portability and Accountability Act–compliant videoconferencing technology (VCT). Objective: This paper describes the feasibility, acceptability, safety, and tolerability of a VCT-based family therapeutic intervention, Resilience Enhancement Skills Training (REST), for perinatal women with moderate to severe depressive symptoms and moderate to high conflict with their family members. Methods: This paper includes data from an ongoing randomized trial that compares an experimental family therapeutic intervention (REST) to standard of care (VCT-based problem-solving individual therapy) for the treatment of moderate to severe depressive symptoms in perinatal women with moderate to high family conflict. Both interventions were delivered by masters-level therapists using VCT. A total of 83 perinatal women and their adult family members (N=166 individuals) were recruited for participation in the study. Feasibility, defined as therapist adherence to ≥80% of REST session content, was assessed in audio-recorded sessions by 2 expert raters. Acceptability was defined as ≥80% of families completing REST, including completion of ≥80% homework assignments and family report of satisfaction with REST. Completion of REST was assessed by review of therapist session notes, and satisfaction was assessed by participant completion of a web-based questionnaire. The Beck Depression Inventory-Second Edition was administered to perinatal women by research assistants (blind to study group assignment) to assess safety, defined as a reduction in depressive symptoms during the treatment phase. The Family Environment Scale-Family Conflict subscale was administered by therapists to participants during the treatment phase to assess tolerability, defined as a reduction in family conflict during the treatment phase. Results: On average, the therapists achieved 90% adherence to REST session content. Of the families who started REST, 84% (32/38) of them completed REST, and on average, they completed 89% (8/9) of the homework assignments. Families reported satisfaction with REST. The results showed that REST is safe for perinatal women with moderate to severe depressive symptoms, and none discontinued due to worsened depressive symptoms. The results showed that REST is well tolerated by families, and no families discontinued due to sustained family conflict. Conclusions: The results show that REST is feasible, acceptable, safe, and tolerable for families. These findings will guide our interpretation of REST’s preliminary effectiveness upon completion of outcome data collection. Trial Registration: ClinicalTrials.gov NCT04741776; https://clinicaltrials.gov/ct2/show/NCT04741776 %M 37921846 %R 10.2196/51824 %U https://formative.jmir.org/2023/1/e51824 %U https://doi.org/10.2196/51824 %U http://www.ncbi.nlm.nih.gov/pubmed/37921846 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51132 %T The Mood, Mother and Child Study: Protocol for a Prospective Longitudinal Study and Randomized Controlled Trial %A Mills-Koonce,W Roger %A Grewen,Karen %A O’Shea,Nisha Gottredson %A Pearson,Brenda %A Strange,Chelsea Grace %A Meltzer-Brody,Samantha E %A Guintivano,Jerry Dolph %A Stuebe,Alison M %+ School of Education, The University of North Carolina at Chapel Hill, Peabody Hall, CB 3500, Chapel Hill, NC, 27599-3500, United States, 1 919 962 6605, mills-koonce@unc.edu %K maternal depression %K oxytocin %K hypothalamic-pituitary-adrenal axis %K HPA axis %K parenting %K executive functioning %K socioemotional development %D 2023 %7 26.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Perinatal depression affects >400,000 mother-child dyads in the United States every year and is associated with numerous adverse maternal and child developmental outcomes. Previous research implicates the dysregulation of oxytocin and the hypothalamic-pituitary-adrenal (HPA) axis functioning in mothers and children as potential mechanisms mediating or moderating the transmission of risk associated with maternal depression. Objective: The Mood, Mother and Child study will examine the psychobiological sources of risk and resilience within mother-child dyads affected by maternal depression. This manuscript describes (1) the study rationale and aims, (2) the research design and procedures and how they were altered in response to the COVID-19 pandemic, and (3) the data analysis plan to test the study hypotheses. Methods: This is a prospective longitudinal study with an embedded randomized controlled trial that examines (1) correlations among postpartum depression and anxiety symptoms, maternal and child oxytocin and HPA axis functioning, and child developmental outcomes and (2) the causal relationship between exogenous oxytocin and HPA reactivity. This study is funded by the National Institute of Child Health and Human Development with institutional review board approval. Results: Recruitment and data collection have commenced, and the expected results will be available in 2024. Analyses are presented for testing the proposed hypotheses. Conclusions: The unique combination of a prospective longitudinal research design with an embedded randomized controlled trial will allow the Mood, Mother and Child study to apply a developmental lens to the study of maternal depression and anxiety symptoms from birth to middle childhood and the psychobiological mechanisms promoting risk and resiliency for both mother and child outcomes. This will be the first study that simultaneously evaluates (1) the role of oxytocin using multiple methodologies, (2) the causal relationships between exogenous oxytocin and HPA axis functioning among mothers with differing levels of depression and anxiety symptoms, and (3) the multiple mediating and moderating roles of parenting behaviors and maternal and child psychobiological characteristics. The goals of these aims are to provide insights into the psychobiological effects of oxytocin in women and inform future clinical trials to treat perinatal mood disorders. Trial Registration: ClinicalTrials.gov NCT03593473; https://classic.clinicaltrials.gov/ct2/show/NCT03593473 International Registered Report Identifier (IRRID): DERR1-10.2196/51132 %M 37883133 %R 10.2196/51132 %U https://www.researchprotocols.org/2023/1/e51132 %U https://doi.org/10.2196/51132 %U http://www.ncbi.nlm.nih.gov/pubmed/37883133 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49240 %T Clinical Accuracy of Large Language Models and Google Search Responses to Postpartum Depression Questions: Cross-Sectional Study %A Sezgin,Emre %A Chekeni,Faraaz %A Lee,Jennifer %A Keim,Sarah %+ Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, United States, 1 614 722 3179, emre.sezgin@nationwidechildrens.org %K mental health %K postpartum depression %K health information seeking %K large language model %K GPT %K LaMDA %K Google %K ChatGPT %K artificial intelligence %K natural language processing %K generative AI %K depression %K cross-sectional study %K clinical accuracy %D 2023 %7 11.9.2023 %9 Research Letter %J J Med Internet Res %G English %X %M 37695668 %R 10.2196/49240 %U https://www.jmir.org/2023/1/e49240 %U https://doi.org/10.2196/49240 %U http://www.ncbi.nlm.nih.gov/pubmed/37695668 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42686 %T Changes in Intrapersonal Factors of Participants in the Pregnancy Remote Monitoring Study Who Are at Risk for Pregnancy-Induced Hypertension: Descriptive Quantitative Study %A Lanssens,Dorien %A Vandenberk,Thijs %A Storms,Valerie %A Thijs,Inge %A Grieten,Lars %A Bamelis,Lotte %A Gyselaers,Wilfried %A Tang,Eileen %A Luyten,Patrick %+ Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt, 3500, Belgium, 32 494919476, dorien.lanssens@uhasselt.be %K intrapersonal factors %K peripartum period %K pregnancy %K pregnancy-induced hypertension %K remote monitoring %D 2023 %7 6.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The peripartum period, defined as the period from the beginning of the gestation until 1 year after the delivery, has long been shown to be potentially associated with increased levels of stress and anxiety with regard to one’s transition to the status of parent and the accompanying parental tasks. Yet, no research to date has investigated changes in intrapersonal factors during the peripartum period in women at risk for pregnancy-induced hypertension (PIH). Objective: The aim of this study is to explore and describe changes in intrapersonal factors in participants at risk for PIH. Methods: We used an explorative design in which 3 questionnaires were sent by email to 110 participants the day following enrollment in the Pregnancy Remote Monitoring program for pregnant women at risk for PIH. Women were invited to complete the questionnaires at the beginning of their participation in the Pregnancy Remote Monitoring project (mostly at 14 weeks of gestation) and after approaching 32 weeks of gestational age (GA). The Generalized Anxiety Disorder-7 Scale (GAD-7) and the Patient Health Questionnaire-9 were used to assess anxiety and depression, and adaptation of the Pain Catastrophizing Scale was used to measure trait pain catastrophizing. Results: Scores were significantly higher at 32 weeks of GA than at the moment of enrollment (GAD-7 score=7, range 4-11 vs 5, range 3-8; P=.01; and Patient Health Questionnaire-9 score=6, range 4-10 vs 4, range 2-7; P<.001). The subscale scores of the Pain Catastrophizing Scale were all lower at 32 weeks of GA compared with 14 weeks of GA (rumination: 4, range 1-6 vs 5, range 2-9.5; P=.11; magnification: 3, range 1-5.5 vs 4, range 3-7; P=.04; and helplessness: 5, range 2-9 vs 6, range 3.5-12; P=.06). The proportion of women with a risk for depression (GAD-7 score >10) was 13.3% (10/75) at enrollment and had increased to 35.6% (26/75) at 32 weeks of GA. Conclusions: This study shows that pregnant women at risk for PIH have higher levels of stress and anxiety at 32 weeks of GA than at the moment of enrollment. Further research is recommended to investigate potential strategies to help pregnant women at risk for PIH manage feelings of stress and anxiety. Trial Registration: ClinicalTrials.gov NCT03246737; https://clinicaltrials.gov/study/NCT03246737 %M 37672324 %R 10.2196/42686 %U https://www.jmir.org/2023/1/e42686 %U https://doi.org/10.2196/42686 %U http://www.ncbi.nlm.nih.gov/pubmed/37672324 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46061 %T Relationship Factors in Internet-Delivered Psychological Interventions for Veterans Experiencing Postpartum Depression: Qualitative Analysis %A Solness,Cara L %A Holdefer,Paul J %A Hsu,Ti %A Thomas,Emily B K %A O'Hara,Michael W %+ Department of Psychiatry, School of Medicine, University of Colorado, 1890 N Revere Court, Anschutz Medical Campus, Aurora, CO, 80045, United States, 1 319 331 3566, cara.solness@cuanschutz.edu %K internet-delivered treatment %K postpartum depression %K therapeutic alliance %K qualitative methodology %K veteran %D 2023 %7 15.8.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet-delivered psychological interventions (IPIs) have been shown to be effective for a variety of psychological concerns, including postpartum depression. Human-supported programs produce better adherence and larger effect sizes than unsupported programs; however, what it is about support that affects outcomes is not well understood. Therapeutic alliance is one possibility that has been found to contribute to outcomes; however, the specific mechanism is not well understood. Participant perspectives and qualitative methodology are nearly absent from the IPI alliance research and may help provide new directions. Objective: In this study, we aimed to provide participant perspectives on engagement with an IPI for postpartum depression to help inform alliance research, development of new IPIs, and inform resource allocation. Methods: A qualitative methodology was used to explore participant perspectives of veteran women’s engagement with the MomMoodBooster program, a human-supported internet-delivered intervention for postpartum depression. Participants were asked 4 open-ended questions with the 3-month postintervention survey, “In what ways did you find the MomMoodBooster most helpful?” “How do you think the MomMoodBooster could have been improved?” “In what ways did you find the personal coach calls to be helpful?” and “How do you think the personal coach calls could have been improved?” Results: Data were collected from 184 participants who responded to at least 1 of the open-ended questions. These were analyzed using thematic analysis and a process of reaching a consensus among coders. The results suggest that not only the engagement with the support person is perceived as a significant contributor to participant experiences while using the MomMoodBooster content but also the relationship factors are particularly meaningful. The results provide insights into the specific qualities of the support person that were perceived as most impactful, such as warmth, empathy and genuineness, and feeling normalized and supported. In addition, the results provide insight into the specific change processes that can be targeted through support interactions, such as encouraging self-reflection and self-care and challenging negative thinking. Conclusions: These data emphasize the importance of relationship factors between support persons and an IPI program for postpartum depression. The findings suggest that focusing on specific aspects of the alliance and the therapeutic relationship could yield fruitful directions for the training of support personnel and for future alliance-based research of internet-delivered treatments. %M 37581917 %R 10.2196/46061 %U https://mental.jmir.org/2023/1/e46061 %U https://doi.org/10.2196/46061 %U http://www.ncbi.nlm.nih.gov/pubmed/37581917 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e11623 %T Examining Feasibility, Acceptability, and Preliminary Outcomes of a Culturally Adapted Evidence-Based Postpartum Depression Preventive Intervention for Women in Doha, Qatar: Protocol for a Randomized Controlled Trial %A Ahmed,Sawssan R %A Watt,Felice %A Mahfoud,Ziyad Riyad %A Korayem,Mona %A Buhmaid,Sara %A Alberry,Medhat %A Ibrahim,Ibrahim Mamoun %A Tandon,S Darius %+ Department of Psychology, California State University-Fullerton, 800 N. State College Blvd., Fullerton, CA, 92832, United States, 1 657 278 2173, saahmed@fullerton.edu %K postpartum depression %K intervention %K prevention %K cultural adaptation %K Arabic %D 2023 %7 11.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum depression and anxiety are the 2 most common perinatal mental health disorders, with prevalence rates higher among women living in the Middle East than in most Western countries. The negative outcomes associated with postpartum depression and anxiety are profound and include less responsive parenting and compromised infant and young child development. Although interventions exist to prevent postpartum depression and anxiety, to date, there have been no studies that have attempted to prevent postpartum depression or anxiety among Arabic-speaking women in the Middle East, including Qatar. Objective: The purpose of this study is to conduct a randomized controlled trial (RCT) of an evidence-based postpartum depression preventive intervention—Mothers and Babies (MB)—culturally adapted for use with Arabic-speaking women in Doha, Qatar. MB is guided by a cognitive behavioral therapy framework that focuses on increasing pleasant activities, promoting healthy thought patterns, and increasing the type and frequency of personal contacts. MB is tailored to specific needs and issues related to pregnancy and the postpartum period. Methods: A multidisciplinary and multiethnic investigator team adapted MB to promote cultural and contextual fit for Arabic-speaking women. Intervention concepts were reviewed to ensure core content would be understood by Arabic-speaking women in Qatar. Subsequently, images, activities, and examples in the intervention manuals were adapted, as needed, to make the content more relevant to Arab culture. To deliver the adapted intervention, 30 Arabic-speaking individuals with mental health backgrounds were trained. The adapted intervention was subsequently pilot-tested with 10 pregnant women receiving prenatal care at Sidra Hospital in Doha. We are now conducting an RCT to examine the effectiveness of the adapted intervention. We plan to enroll 210 pregnant individuals who are Arabic-speaking, with 1:1 randomization to the MB intervention or usual prenatal care. Among the enrolled participants, a stratified subsample of 40 pregnant women with diabetes is being recruited. Data collection will take place at baseline and a 6-month follow-up. The primary outcomes are depressive and anxiety symptoms and perceived stress. Diabetes self-care is the exploratory outcome for the subsample of individuals with diabetes. Intervention implementation will be assessed via client and provider surveys during and after intervention delivery. Power and sample size were calculated using a 2-sided 5% effort rate and assumed analyses on the individual level, accounting for attrition of 20%. Results: The cultural adaptation and pilot study of the adapted MB intervention are completed. A total of 157 women have been enrolled in the RCT as of March 31, 2023. Conclusions: This study is highly innovative, as it is the first study to our knowledge to examine the effectiveness of an evidence-based postpartum depression preventive intervention in the Middle East. Limitations include a single follow-up time point and a small subsample of individuals with diabetes. Trial Registration: ClinicalTrials.gov NCT04442529; https://www.clinicaltrials.gov/study/NCT04442529 International Registered Report Identifier (IRRID): DERR1-10.2196/11623 %M 37566449 %R 10.2196/11623 %U https://www.researchprotocols.org/2023/1/e11623 %U https://doi.org/10.2196/11623 %U http://www.ncbi.nlm.nih.gov/pubmed/37566449 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44500 %T Acceptability of an mHealth App for Monitoring Perinatal and Postpartum Mental Health: Qualitative Study With Women and Providers %A Varma,Deepthi S %A Mualem,Maya %A Goodin,Amie %A Gurka,Kelly K %A Wen,Tony Soo-Tung %A Gurka,Matthew J %A Roussos-Ross,Kay %+ Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610, United States, 1 352 294 5941, dvarma@ufl.edu %K perinatal mental health %K mobile health %K mHealth %K mobile apps %K ecological momentary assessment %K EMA %K mobile phone %D 2023 %7 7.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Up to 15% of pregnant and postpartum women commonly experience undiagnosed and untreated mental health conditions, such as depression and anxiety, which may result in serious health complications. Mobile health (mHealth) apps related to mental health have been previously used for early diagnosis and intervention but not among pregnant and postpartum women. Objective: This study aims to assess the acceptability of using mHealth to monitor and assess perinatal and postpartum depression and anxiety. Methods: Focus group discussions with pregnant and postpartum women (n=20) and individual interviews with health care providers (n=8) were conducted to inform the acceptability of mHealth and determine its utility for assessing perinatal and postpartum mood symptoms. Participants were recruited via purposive sampling from obstetric clinics and the surrounding community. A semistructured interview guide was developed by an epidemiologist with qualitative research training in consultation with an obstetrician. The first author conducted all focus group discussions and provider interviews either in person or via Zoom (Zoom Video Communications, Inc) depending on the COVID-19 protocol that was in place during the study period. All interviews were audio recorded with consent; transcribed; and uploaded for coding to ATLAS.ti 8 (ATLAS.ti Scientific Software Development Gmb H), a qualitative data analysis and retrieval software. Data were analyzed using the deductive content analysis method using a set of a priori codes developed based on the interview guide. Methodological rigor and quality were ensured by adopting a systematic approach during the implementation, data collection, data analysis, and reporting of the data. Results: Almost all women and providers had downloaded and used at least 1 health app. The respondents suggested offering short questions in layperson language that could be understood by women of all educational levels and offering no more than 2 to 3 assessments per day at preferred timings decided by the women themselves. They also suggested that the women themselves receive the alerts first, with other options being family members, spouses, or friends if the women themselves did not respond within 24 to 72 hours. Customization and snooze features were strongly endorsed by women and providers to improve acceptability and utility. Women mentioned competing demands on their time during the postpartum period, fatigue, privacy, and the security of mental health data as concerns. Health care professionals highlighted the long-term sustainability of app-based mood assessment and monitoring as an important challenge. Conclusions: The findings from this study show that mHealth would be acceptable to pregnant and postpartum women for monitoring mood symptoms. This could inform the development of clinically meaningful and inexpensive tools for facilitating the continuous monitoring of, the early diagnosis of, and an early intervention for mood disorders in this vulnerable population. %M 37285185 %R 10.2196/44500 %U https://formative.jmir.org/2023/1/e44500 %U https://doi.org/10.2196/44500 %U http://www.ncbi.nlm.nih.gov/pubmed/37285185 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42777 %T Translating Research Evidence Into Marketplace Application: Cohort Study of Internet-Based Intervention Platforms for Perinatal Depression %A Zeng,Zhen %A Peng,Jiale %A Liu,Lu %A Gong,Wenjie %+ HER Team and XiangYa School of Public Health, Central South University, 238 shangmayuanling, XiangYa Rd, Kaifu District, Changsha, Hunan, 410078, China, 86 13607445252, gongwenjie@csu.edu.cn %K cohort %K digital health %K internet-based intervention platform %K mhealth %K perinatal depression %K quality assessment %D 2023 %7 17.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based intervention platforms may improve access to mental health care for women with perinatal depression (PND). Though the majority of platforms in the market lack an evidence base, a small number of them are supported by research evidence. Objective: This study aims to assess the current status of internet-based PND intervention platforms supported by published evidence, understand the reasons behind the disappearance of any of these previously accessible platforms, examine adjustments made by those active platforms between research trials and market implementation, and evaluate their current quality. Methods: A cohort of internet-based PND intervention platforms was first identified by systematic searches in multiple academic databases from database inception until March 26, 2021. We searched on the World Wide Web and the iOS and Android app stores to assess which of these were available in the marketplace between April and May 2021. The basic characteristics of all platforms were collected. For inaccessible platforms, inquiries were made via email to the authors of publications to determine the reasons for their unavailability. We compared the intervention-related information of accessible platforms in the marketplace with that reported in original publications and conducted quality assessments using the App Evaluation Model of the American Psychiatric Association. Fisher exact tests were used to compare the functional characteristics in publications of available and unavailable platforms and to investigate potential associations between functional adjustments or quality indices and platform survival time. Results: Out of 35 platforms supported by research evidence, only 19 (54%) were still accessible in the marketplace. The main reason for platforms disappearing was the termination of research projects. No statistically significant differences were found in functional characteristics between available and unavailable platforms. A total of 18 (95%) platforms adapted their core functions from what was reported in related publications. The adjustments included changes to intervention methods (11/19, 58%), target population (10/19, 53%), human resources for intervention support (9/19, 47%), mood assessment and monitoring (8/19, 42%), communication modality (4/19, 21%), and platform type (2/19, 11%). Quality issues across platforms included low frequency of update, lack of crisis management mechanism, poor user interactivity, and weak evidence base or absence of citation of supporting evidence. Platforms that survived longer than 10 years had a higher tendency to use external resources from third parties compared to those that survived less than 10 years (P=.04). No significant differences were found for functional adjustments or other quality indices. Conclusions: Internet-based platforms supported by evidence were not effectively translated into real-world practice. It is unclear if adjustments to accessible platforms made during actual operation may undermine the proven validity of the original research. Future research to explore the reasons behind the success of the implementation of evidence-based platforms in the marketplace is warranted. %M 37067855 %R 10.2196/42777 %U https://www.jmir.org/2023/1/e42777 %U https://doi.org/10.2196/42777 %U http://www.ncbi.nlm.nih.gov/pubmed/37067855 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e45616 %T A Family-Based Collaborative Care Model for Treatment of Depressive and Anxiety Symptoms in Perinatal Women: Results From a Pilot Study %A Cluxton-Keller,Fallon %A Olson,Ardis %+ Department of Psychiatry, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 650 4726, Fallon.P.Cluxton-Keller@dartmouth.edu %K anxiety %K depression %K family treatment %K infant care %K maternal health %K parenting %K pediatric primary care %K perinatal anxiety %K perinatal care %K perinatal depression %K video therapy %K women's health %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Untreated perinatal depression and anxiety can have detrimental consequences on family function. Logistical barriers prevent many perinatal women from accessing treatment, and these barriers are compounded for women residing in rural areas. This paper describes a Family-Based Collaborative Care Model (FBCCM) that is designed to bypass barriers to increase access to care for depressed and anxious perinatal women in rural regions of the United States. The FBCCM includes the following two components: (1) a 10-session video-delivered family therapy treatment for perinatal depression and anxiety and (2) a video-delivered infant care provider training on addressing the parenting needs of depressed and anxious mothers. Objective: This paper describes the feasibility of implementing the FBCCM with families and infant care providers. Findings are presented on the preliminary effectiveness of the video-delivered family therapy treatment in reducing maternal depressive and anxiety symptoms, and family conflict. Methods: This pilot study was carried out using an implementation-effectiveness hybrid trial design without a comparison group. Changes in maternal depressive symptoms, maternal anxiety symptoms, and family conflict were measured at posttreatment, 3 months, and 6 months later. Results: On average, mothers (n=24) attended 9.79 (SD 1.02) sessions. On average, their family members (n=24) attended 9.42 (SD 1.28) sessions. A total of 31 infant care providers attended the training on addressing the parenting needs of depressed and anxious mothers. Mothers reported a significant reduction in depressive symptoms (P<.001) and anxiety symptoms (P<.001) from baseline to the 6-month follow-up. Mothers reported a significant reduction in conflict (P<.001), and their family members also reported a significant reduction in conflict (P=.007) from baseline to the 6-month follow-up. Conclusions: The findings from this study provide support for the feasibility and preliminary effectiveness of the FBCCM. The findings will be used to inform a larger study of the FBCCM. %M 37052997 %R 10.2196/45616 %U https://pediatrics.jmir.org/2023/1/e45616 %U https://doi.org/10.2196/45616 %U http://www.ncbi.nlm.nih.gov/pubmed/37052997 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e39253 %T The Efficacy of Be a Mom, a Web-Based Intervention to Prevent Postpartum Depression: Examining Mechanisms of Change in a Randomized Controlled Trial %A Carona,Carlos %A Pereira,Marco %A Araújo-Pedrosa,Anabela %A Canavarro,Maria Cristina %A Fonseca,Ana %+ Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, University of Coimbra, Colégio Novo St., Coimbra, 3000-115, Portugal, 351 239851450, ccarona@fpce.uc.pt %K Be a Mom %K randomized controlled trial %K postpartum depression %K web-based interventions %K cognitive behavioral therapy %K prevention %K mobile phone %D 2023 %7 17.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Postpartum depression (PPD) is treatable and preventable, but most women do not seek professional help for their perinatal depressive symptoms. One increasingly popular approach of improving access to care is the use of web-based intervention programs. Objective: The objective of this study was 2-fold: first, to assess the efficacy of Be a Mom, a brief web-based selective or indicated preventive intervention, in reducing depressive and anxiety symptoms of women at high risk for PPD; and second, to examine mechanisms of change linking modifiable self-regulatory skills (ie, emotion regulation, self-compassion, and psychological flexibility) to improved perinatal mental health outcomes. Methods: This 2-arm, open-label randomized controlled trial involved a sample of 1053 perinatal women presenting high risk for PPD who were allocated to the Be a Mom intervention group or a waitlist control group and completed self-report measures at baseline and postintervention assessments. Univariate latent change score models were computed to determine changes over time in adjustment processes and outcomes, with a multigroup-model approach to detect differences between the intervention and control groups and a 2-wave latent change score model to examine whether changes in processes were related to changes in outcomes. Results: Be a Mom was found to be effective in reducing depressive (intervention group: µΔ=–3.35; P<.001 vs control group: µΔ=–1.48; P<.001) and anxiety symptoms (intervention group: µΔ=–2.24; P<.001 vs control group: µΔ=–0.43; P=.04) in comparison with the control group, where such changes were inexistent or much smaller. All 3 psychological processes under study improved statistically significantly in posttreatment assessments: emotion regulation ability (Δχ23=12.3; P=.007) and psychological flexibility (Δχ23=34.9; P<.001) improved only in the intervention group, and although self-compassion increased in both groups (Δχ23=65.6; P<.001), these improvements were considerably greater in the intervention group. Conclusions: These results suggest that Be a Mom, a low-intensity cognitive behavioral therapy program, is a promising first-line intervention for helping perinatal women, particularly those with early-onset PPD symptoms. Trial Registration: ClinicalTrials.gov NCT03024645; https://clinicaltrials.gov/ct2/show/NCT03024645 %M 36930182 %R 10.2196/39253 %U https://mental.jmir.org/2023/1/e39253 %U https://doi.org/10.2196/39253 %U http://www.ncbi.nlm.nih.gov/pubmed/36930182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41793 %T Association Between Social Networking Site Use Intensity and Depression Among Chinese Pregnant Women: Cross-sectional Study %A Wang,Rui %A Cong,Shengnan %A Sha,Lijuan %A Sun,Xiaoqing %A Zhu,Rong %A Feng,Jingyi %A Wang,Jianfang %A Tang,Xiaomei %A Zhao,Dan %A Zhu,Qing %A Fan,Xuemei %A Ren,Ziqi %A Zhang,Aixia %+ Department of Nursing, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfei Alley, Qinhuai District, Nanjing, 210004, China, 86 13401920998, zhangaixia@njmu.edu.cn %K antenatal depression %K social network site %K social media %K WeChat %K upward social comparison %K rumination %D 2023 %7 15.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite extensive debates about the mental health impacts of the use of social networking sites (SNSs), including WeChat, the association and mechanisms between social interaction of WeChat use intensity and antenatal depression are unclear. Objective: We aimed to test the mediating roles of upward social comparison on social interaction of WeChat and rumination in the association between social interaction of WeChat use intensity and antenatal depression. Methods: A cross-sectional survey was conducted in four hospitals with the self-reported measures of social interaction of WeChat use intensity, upward social comparison on social interaction of WeChat, rumination, antenatal depression, and control variables. The mediation analysis was performed through Model 6 from the PROCESS macro 4.0 in SPSS 26. Results: Results from 2661 participants showed that antenatal depression was unrelated to social interaction of WeChat use intensity (P=.54), but was significantly positively related to the attitude toward social interaction of WeChat (P=.01). The direct effect of attitude toward social interaction of WeChat use on antenatal depression was not statistically significant (β=–.03, P=.05). The results supported an indirect relationship between attitude toward social interaction of WeChat use and antenatal depression via (1) upward social comparison on social interaction of WeChat (indirect effect value=0.04, 95% CI 0.03 to 0.06); (2) rumination (indirect effect value=–0.02, 95% CI –0.04 to –0.01); and (3) upward social comparison on social interaction of WeChat and rumination in sequence (indirect effect value=0.07, 95% CI 0.06 to 0.08). Conclusions: Our findings highlight the necessity of focusing on attitudes toward SNS use, and the importance of upward social comparison and rumination in understanding the effect of SNS use on antenatal depression. %M 36920458 %R 10.2196/41793 %U https://www.jmir.org/2023/1/e41793 %U https://doi.org/10.2196/41793 %U http://www.ncbi.nlm.nih.gov/pubmed/36920458 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40937 %T Digital Behavioral Activation Interventions During the Perinatal Period: Scoping Review %A Mancinelli,Elisa %A Dell'Arciprete,Gaia %A Pattarozzi,Davide %A Gabrielli,Silvia %A Salcuni,Silvia %+ Department of Developmental and Socialization Psychology, University of Padova, Via Venezia 8, Padova, 35121, Italy, 39 3342799698, elisa.mancinelli@phd.unipd.it %K behavioral activation %K eHealth %K perinatal care %K depression symptoms %K scoping review %K mobile phone %D 2023 %7 28.2.2023 %9 Review %J JMIR Pediatr Parent %G English %X Background: Pregnancy is a complex period that implies many biopsychosocial changes, and the way women adapt to these changes impacts their well-being and the chances of developing mental health problems. During the perinatal period, women have expressed a preference for support delivered on the web. In this regard, interventions such as behavioral activation (BA), which are brief and structured psychosocial interventions, seem particularly suited to be delivered through digital solutions. Objective: This study aimed to map the literature investigating digital BA interventions deployed during the perinatal period. We paid particular attention to the methodological underpinnings of the studies, the potential impact of BA interventions on symptoms other than depression, and the existence of differences occurring when these interventions were administered during pregnancy versus the postpartum period. Methods: A systematic search compliant with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines was conducted considering 5 bibliographic databases; reference lists and key journals were also screened by 2 independent authors following a double-blind approach. Results: A total of 7 studies published between 2013 and 2022 were included. In total, 2 studies were protocols for randomized controlled trials, 5 were empirical studies, and 1 was a qualitative study. All studies focused on the postpartum period, except for 1 that focused on the broader perinatal period. Promising effects on depression symptoms were reported but not on other psychosocial symptoms. Low intervention adherence has emerged, whereas the usability associated with the digital means used to deploy interventions was scarcely addressed; moreover, information on the digital platforms used was poorly reported overall. Conclusions: Our findings highlight the scarcity and preliminary nature of digital BA interventions deployed during the perinatal period, where the focus seems more on treatment rather than prevention. Moreover, future studies should also consider and address usability and user engagement, given their relevance to intervention efficacy. %M 36853756 %R 10.2196/40937 %U https://pediatrics.jmir.org/2023/1/e40937 %U https://doi.org/10.2196/40937 %U http://www.ncbi.nlm.nih.gov/pubmed/36853756 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43800 %T Prevalence and Associated Factors of Maternal Depression and Anxiety Among African Immigrant Women in Alberta, Canada: Quantitative Cross-sectional Survey Study %A Nwoke,Chinenye Nmanma %A Awosoga,Oluwagbohunmi A %A McDonald,Sheila %A Bonifacio,Glenda T %A Leung,Brenda M Y %+ Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada, 1 4035617125, chinenye.nwoke@uleth.ca %K African women %K immigrant women %K mental health %K pregnancy %K postpartum health %K depression %K anxiety %D 2023 %7 20.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Although there is a significant body of evidence on maternal mental health, an inadequate focus has been placed on African immigrant women. This is a significant limitation given the rapidly changing demographics in Canada. The prevalence of maternal depression and anxiety among African immigrant women in Alberta and Canada, as well as the associated risk factors, are not well understood and remain largely unknown. Objective: The purpose of this study was to investigate the prevalence and associated factors of maternal depression and anxiety among African immigrant women living in Alberta, Canada up to 2 years postpartum. Methods: This cross-sectional study surveyed 120 African immigrant women within 2 years of delivery in Alberta, Canada from January 2020 to December 2020. The English version of the Edinburgh Postnatal Depression Scale-10 (EPDS-10), the Generalized Anxiety Disorder-7 (GAD-7) scale, and a structured questionnaire regarding associated factors were administered to all participants. A cutoff score of 13 on the EPDS-10 was indicative of depression, while a cutoff score of 10 on the GAD-7 scale was indicative of anxiety. Multivariable logistic regression was used to determine the factors significantly associated with maternal depression and anxiety. Results: Among the 120 African immigrant women, 27.5% (33/120) met the EPDS-10 cutoff score for depression and 12.1% (14/116) met the GAD-7 cutoff score for anxiety. The majority of respondents with maternal depression were younger (18/33, 56%), had a total household income of CAD $60,000 or more (US $45,000 or more; 21/32, 66%), rented their homes (24/33, 73%), had an advanced degree (19/33, 58%), were married (26/31, 84%), were recent immigrants (19/30, 63%), had friends in the city (21/31, 68%), had a weak sense of belonging in the local community (26/31, 84%), were satisfied with their settlement process (17/28, 61%), and had access to a regular medical doctor (20/29, 69%). In addition, the majority of respondents with maternal anxiety were nonrecent immigrants (9/14, 64%), had friends in the city (8/13, 62%), had a weak sense of belonging in the local community (12/13, 92%), and had access to a regular medical doctor (7/12, 58%). The multivariable logistic regression model identified demographic and social factors significantly associated with maternal depression (maternal age, working status, presence of friends in the city, and access to a regular medical doctor) and maternal anxiety (access to a regular medical doctor and sense of belonging in the local community). Conclusions: Social support and community belonging initiatives may improve the maternal mental health outcomes of African immigrant women. Given the complexities immigrant women face, more research is needed on a comprehensive approach for public health and preventive strategies regarding maternal mental health after migration, including increasing access to family doctors. %M 36808093 %R 10.2196/43800 %U https://formative.jmir.org/2023/1/e43800 %U https://doi.org/10.2196/43800 %U http://www.ncbi.nlm.nih.gov/pubmed/36808093 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40008 %T African Immigrant Mothers’ Views of Perinatal Mental Health and Acceptability of Perinatal Mental Health Screening: Quantitative Cross-sectional Survey Study %A Nwoke,Chinenye Nmanma %A Awosoga,Oluwagbohunmi A %A McDonald,Sheila %A Bonifacio,Glenda T %A Leung,Brenda M Y %+ Faculty of Health Sciences, University of Lethbridge, 4401 University Drive West, Lethbridge, AB, T1K 3M4, Canada, 1 403 561 7125, chinenye.nwoke@uleth.ca %K African women %K perinatal mental health %K screening %K anxiety %K mental health literacy %K pregnancy %K postpartum %K depression %K acceptability %K knowledge %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health disorders are the most common perinatal conditions. They affect mothers, babies, partners, and support networks. However, <15% of pregnant and postpartum women seek timely help for their mental health care. Low perinatal mental health knowledge and universal screening unacceptability are cited as important deterrents to obtaining timely mental health care. Objective: The purpose of this quantitative cross-sectional study was 2-fold: (1) to determine African immigrant mothers’ views of perinatal mental health and to identify predictors of those views and (2) to identify African immigrant mothers’ views regarding perinatal mental health screening and to determine factors associated with those views. Methods: A cross-sectional survey was conducted using a convenience sample of African immigrant women from the province of Alberta, Canada. Respondents were eligible to participate if they were aged ≥18 years, had a live birth, and the infant was aged ≤2 years. Questions were drawn from the Edinburgh Postnatal Depression Scale, the Generalized Anxiety Disorder-7 scale, and additional questions were developed using the Alberta Maternal Mental Health 2012 survey as a guide and tested to reflect the immigrant context. Descriptive and multivariable regression analyses were conducted. Results: Among the 120 respondents, 46.5% (53/114) were aged 31-35 years, 76.1% (89/117) were employed or on maternity leave, 92.5% (111/120) were married, and 55.6% (65/117) had younger infants aged 0 to 12 months. Significantly more respondents had higher levels of knowledge of postnatal (109/115, 94.8%) than prenatal (57/110, 51.2%) mental health (P<.001). Only 25.4% (28/110) of the respondents accurately identified that prenatal anxiety or depression could negatively impact child development. Personal knowledge of postpartum anxiety and depression was a significant predictor of prenatal and postnatal mental health knowledge. Most respondents strongly agreed or agreed that all women should be screened in the prenatal (82/109, 75.2%) and postnatal (91/110, 82.7%) periods. Respondents reported that their partner would be their first choice when seeking help and support. The acceptability of postnatal screening was a significant predictor of prenatal mental health knowledge (P<.001), whereas the acceptability of prenatal screening was a significant predictor of postnatal mental health knowledge (P=.03). Prenatal mental health knowledge was a significant predictor of both prenatal (P<.001) and postnatal (P=.001) screening acceptability. Conclusions: Although African mothers’ knowledge of postnatal mental health is high, their prenatal mental health knowledge and its influence on child development are limited. Perinatal mental health interventions for African immigrant mothers in Alberta should target these knowledge gaps. The high acceptability of universal perinatal mental health screening among African mothers provides a promising strategy for perinatal mental health literacy initiatives to achieve optimal perinatal mental health. %M 36705944 %R 10.2196/40008 %U https://formative.jmir.org/2023/1/e40008 %U https://doi.org/10.2196/40008 %U http://www.ncbi.nlm.nih.gov/pubmed/36705944 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e38879 %T Assessing the Racial and Socioeconomic Disparities in Postpartum Depression Using Population-Level Hospital Discharge Data: Longitudinal Retrospective Study %A Liu,Star %A Ding,Xiyu %A Belouali,Anas %A Bai,Haibin %A Raja,Kanimozhi %A Kharrazi,Hadi %+ Johns Hopkins University School of Medicine, 2024 E Monument St. S 1-200, Baltimore, MD, 21205, United States, 1 470 538 5974, sliu197@jhmi.edu %K health disparity %K hospital discharge summary %K phenotyping %K data quality %K vulnerable population %K postpartum depression %K maternal health %D 2022 %7 17.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In the United States, >3.6 million deliveries occur annually. Among them, up to 20% (approximately 700,000) of women experience postpartum depression (PPD) according to the Centers for Disease Control and Prevention. Absence of accurate reporting and diagnosis has made phenotyping of patients with PPD difficult. Existing literature has shown that factors such as race, socioeconomic status, and history of substance abuse are associated with the differential risks of PPD. However, limited research has considered differential temporal associations with the outcome. Objective: This study aimed to estimate the disparities in the risk of PPD and time to diagnosis for patients of different racial and socioeconomic backgrounds. Methods: This is a longitudinal retrospective study using the statewide hospital discharge data from Maryland. We identified 160,066 individuals who had a hospital delivery from 2017 to 2019. We applied logistic regression and Cox regression to study the risk of PPD across racial and socioeconomic strata. Multinomial regression was used to estimate the risk of PPD at different postpartum stages. Results: The cumulative incidence of PPD diagnosis was highest for White patients (8779/65,028, 13.5%) and lowest for Asian and Pacific Islander patients (248/10,760, 2.3%). Compared with White patients, PPD diagnosis was less likely to occur for Black patients (odds ratio [OR] 0.31, 95% CI 0.30-0.33), Asian or Pacific Islander patients (OR 0.17, 95% CI 0.15-0.19), and Hispanic patients (OR 0.21, 95% CI 0.19-0.22). Similar findings were observed from the Cox regression analysis. Multinomial regression showed that compared with White patients, Black patients (relative risk 2.12, 95% CI 1.73-2.60) and Asian and Pacific Islander patients (relative risk 2.48, 95% CI 1.46-4.21) were more likely to be diagnosed with PPD after 8 weeks of delivery. Conclusions: Compared with White patients, PPD diagnosis is less likely to occur in individuals of other races. We found disparate timing in PPD diagnosis across different racial groups and socioeconomic backgrounds. Our findings serve to enhance intervention strategies and policies for phenotyping patients at the highest risk of PPD and to highlight needs in data quality to support future work on racial disparities in PPD. %M 36103575 %R 10.2196/38879 %U https://pediatrics.jmir.org/2022/4/e38879 %U https://doi.org/10.2196/38879 %U http://www.ncbi.nlm.nih.gov/pubmed/36103575 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e41697 %T A Video-Delivered Family Therapeutic Intervention for Perinatal Women With Clinically Significant Depressive Symptoms and Family Conflict: Indicators of Feasibility and Acceptability %A Cluxton-Keller,Fallon %A Hegel,Mark T %+ Department of Psychiatry, Geisel School of Medicine, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 650 4724, Fallon.P.Cluxton-Keller@dartmouth.edu %K family intervention %K perinatal %K postnatal %K depression %K conflict %K telehealth %K family conflict %K family therapy %K family therapist %K video conferencing %K teleconference %K teleconferencing %K telemedicine %K virtual care %K mental health %K psychological health %K digital health intervention %K parenting %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Variation in family therapeutic intervention fidelity has an impact on outcomes. The use of video conferencing technology can strengthen therapist fidelity to family therapeutic interventions. Objective: This article explores indicators of feasibility and acceptability for a video-delivered family therapeutic intervention for perinatal women with depressive symptoms and family conflict. The objectives of this article are to describe indicators of feasibility, including therapist fidelity to the intervention and technological factors that relate to implementation of the intervention, as well as indicators of acceptability for participants of the intervention. Methods: The data included in this article are from an ongoing randomized trial of the Resilience Enhancement Skills Training (REST) video-delivered family therapeutic intervention. Participant recruitment and data collection are still underway for this clinical trial. Of the 106 participants who are currently enrolled in this study, 54 (51%) have been randomized to receive REST from May 2021 through July 2022. Currently, 2 therapists are delivering the intervention, and the training procedures for therapists are summarized herein. Therapist fidelity to the family therapeutic intervention was assessed in 67 audio recorded sessions. The training procedures were summarized for use of video conferencing technology by therapists and the 54 study participants. Knowledge of the video conferencing technology features was assessed in therapists and study participants by the number of attempts required to use the features. Participant responsiveness to the intervention was assessed by the percentage of attended sessions and percentage of complete homework assignments. Results: To date, both therapists have demonstrated high fidelity to the family therapeutic intervention and used all video conferencing technology features on their first attempt. The current participants required 1 to 3 attempts to use 1 or more of the video conferencing technology features. About 59% (n=32) of the current participants immediately accessed the features on the first attempt. Our results show that perinatal women attended all sessions, and their family members attended 80% of the sessions. To date, participants have completed 80% of the homework assignments. Conclusions: These early findings describe indicators of the feasibility and acceptability of the video-delivered family therapeutic intervention for use with this high priority population. Upon completion of recruitment and data collection, a subsequent article will include a mixed methods process evaluation of the feasibility and acceptability of the video-delivered family therapeutic intervention. Trial Registration: ClinicalTrials.gov NCT04741776; https://clinicaltrials.gov/ct2/show/NCT04741776 %M 36194458 %R 10.2196/41697 %U https://formative.jmir.org/2022/10/e41697 %U https://doi.org/10.2196/41697 %U http://www.ncbi.nlm.nih.gov/pubmed/36194458 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e37216 %T Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy for Symptoms of Postpartum Anxiety and Depression: Feasibility Randomized Controlled Trial %A Suchan,Victoria %A Peynenburg,Vanessa %A Thiessen,David %A Nugent,Marcie %A Dear,Blake %A Titov,Nickolai %A Hadjistavropoulos,Heather %+ Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 306 585 5133, hadjista@uregina.ca %K postpartum depression %K postpartum anxiety %K internet-delivered cognitive behavioral therapy %K transdiagnostic %K therapist assistance %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Postpartum depression (PPD) and postpartum anxiety (PPA) are often comorbid and are associated with significant personal and economic costs. Fewer than half of the mothers experiencing PPD or PPA symptoms receive face-to-face treatment, suggesting a need for alternative delivery formats such as internet-delivered cognitive behavioral therapy (ICBT). Objective: This pilot study aimed to examine the impact of a therapist-assisted, transdiagnostic ICBT program on symptoms of PPD and PPA, as there is only one previous study on transdiagnostic ICBT with this population, which did not include therapist assistance. Methods: Clients endorsing the symptoms of PPD or PPA (N=63) were randomized to an 8-week transdiagnostic ICBT course (Wellbeing Course for New Moms) or to treatment as usual (TAU). Clients completed measures of depression, anxiety, stress, postnatal bonding, and relationship satisfaction, as well as measures of treatment satisfaction and therapeutic alliance, before treatment, after treatment, and at the 1-month follow-up. Outcome measures were also completed at the 6-month follow-up for clients who completed the ICBT course. Results: Both the ICBT and TAU groups experienced statistically significant improvements over time. The ICBT group experienced larger improvements after treatment and at the 1-month follow-up on more measures than the TAU group, with medium between-group Cohen d effects on primary outcome measures for anxiety (Cohen d=0.65, 95% CI 0.13-1.17), PPD (Cohen d=0.52, 95% CI 0.01-1.04), and depression (Cohen d=0.56, 95% CI 0.05-1.08), and on secondary outcome measures of overall distress (Cohen d=0.69, 95% CI 0.17-1.21), anxiety (Cohen d=0.59, 95% CI 0.07-1.11), and stress (Cohen d=0.76, 95% CI 0.23-1.28). Time-by-group interactions for proportional reductions between groups over time were only significant after treatment and at the 1-month follow-up for the primary anxiety measure (P=.006). This study was underpowered for detecting small or medium effects. Overall, clients perceived the treatment as credible, and 95% (21/22) of the clients were satisfied with the treatment content and therapist support. Conclusions: Findings from this pilot study provide preliminary support for transdiagnostic ICBT in treating PPD and PPA symptoms to improve access to psychological treatments. Trial Registration: ClinicalTrials.gov NCT04012580; https://clinicaltrials.gov/ct2/show/NCT04012580 %M 36066958 %R 10.2196/37216 %U https://formative.jmir.org/2022/9/e37216 %U https://doi.org/10.2196/37216 %U http://www.ncbi.nlm.nih.gov/pubmed/36066958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33411 %T Women’s Preferences and Design Recommendations for a Postpartum Depression Psychoeducation Intervention: User Involvement Study %A Siddhpuria,Shailee %A Breau,Genevieve %A Lackie,Madison E %A Lavery,Brynn M %A Ryan,Deirdre %A Shulman,Barbara %A Kennedy,Andrea L %A Brotto,Lori A %+ Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 6th Floor, Vancouver, BC, V5Z 1M9, Canada, 1 604 875 4111 ext 68898, lori.brotto@vch.ca %K postpartum %K depression %K perinatal mental health %K patient engagement %K women’s health %K qualitative %K psychoeducation %K digital tools %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Postpartum depression (PPD) is one of the leading causes of maternal morbidity, affecting up to 18% of Canadian new mothers. Yet, PPD often remains untreated due to numerous barriers in access to care, including location and cost. Development of eHealth interventions in collaboration with patient partners offers an exciting opportunity to fill this care gap and provide effective and affordable care to new parents across British Columbia. Objective: Our aim was to determine the content and design preferences of women previously diagnosed with PPD to inform changes to the development of a web-enabled intervention for education and management of PPD. Methods: Webpage prototypes were created to mimic the web-enabled resource using findings from completed focus group research that assessed what women want in a web-enabled support resource for PPD. A convenience sample of women aged >18 years and previously diagnosed with PPD was recruited. Feedback was collected on the content and design of the prototypes via semistructured interviews and online surveys. Qualitative, inductive analytic, and quantitative methods were used. Results: A total of 9 women (mean age 37.2 years, SD 4.8 years) completed the interview and a majority of the survey. The following 6 themes were identified: (1) inefficacy of text-heavy layouts, (2) highlighting key information, (3) clarity/understandability of the language, (4) finding support groups, (5) validation and immediate help for feelings of isolation, and (6) helpfulness and accessibility of the resource. Each theme identified elements of content or design that were either effective or may be improved upon. Most women (8/9, 89%) favored content relating to foundational knowledge of PPD, such as symptoms and management options. The layout, language, and content were found to be generally easy to understand, clear, trustworthy, and helpful. Conclusions: Six key areas were identified by women previously diagnosed with PPD, as requiring focus in a web-enabled psychoeducation program. Consistent with past research, this study also found that support and enthusiasm for web-enabled programs support PPD management as an adjunct to other evidence-based treatments. %M 35737435 %R 10.2196/33411 %U https://formative.jmir.org/2022/6/e33411 %U https://doi.org/10.2196/33411 %U http://www.ncbi.nlm.nih.gov/pubmed/35737435 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e33625 %T OptimalMe Intervention for Healthy Preconception, Pregnancy, and Postpartum Lifestyles: Protocol for a Randomized Controlled Implementation Effectiveness Feasibility Trial %A Harrison,Cheryce L %A Brammall,Bonnie R %A Garad,Rhonda %A Teede,Helena %+ Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, 43-51 Kanooka Grove, Clayton, 3168, Australia, 61 8572 2662, cheryce.harrison@monash.edu %K preconception %K pregnancy %K postpartum %K weight %K obesity prevention %K womens health %K intervention %K implementation %D 2022 %7 9.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Reproductive-aged women are a high-risk population group for accelerated weight gain and obesity development, with pregnancy recognized as a critical contributory life-phase. Healthy lifestyle interventions during the antenatal period improve maternal and infant health outcomes, yet translation and implementation of such interventions into real-world health care settings remains limited. Objective: We aim to generate key implementation learnings to inform the feasibility of future scale up and determine the effectiveness of intervention delivery methods on engagement, experience, acceptability, knowledge, risk perception, health literacy, and modifiable weight-related health behaviors in women during preconception, pregnancy, and postpartum periods. Methods: This randomized hybrid implementation effectiveness study will evaluate the penetration, reach, feasibility, acceptability, adoption, and fidelity of a healthy lifestyle intervention (OptimalMe) implemented into, and in partnership with, private health care. Individual health outcomes associated with implementation delivery mode, including knowledge, risk perception, health literacy, self-management, and health behaviors, are secondary outcomes. A total of 300 women aged 18 to 44 years, who are not pregnant but wish to conceive within the next 12 months, and with access to the internet will be recruited. All participants will receive the same digital lifestyle intervention, OptimalMe, which is supported by health coaching and text messages during preconception, pregnancy, and postpartum periods. We will use a parallel 2-arm design to compare telephone with videoconference remote delivery methods for health coaching. Methods are theoretically underpinned by the Consolidated Framework for Implementation Research and outcomes based on the Reach, Engagement, Adaptation, Implementation and Maintenance framework. Results: The study was approved on August 16, 2019 and has been registered. Recruitment commenced in July 2020, and data collection is ongoing. Results are expected to be published in 2022. Conclusions: The study’s design aligns with best practice implementation research. Results will inform translation of evidence from randomized controlled trials on healthy lifestyle interventions into practice targeting women across preconception, pregnancy, and postpartum periods. Learnings will target consumers, program facilitators, health professionals, services, and policy makers to inform future scale up to ultimately benefit the health of women across these life-phases. Trial Registration: Australian and New Zealand Clinical Trial Registry ACTRN12620001053910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378243&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/33625 %M 35679115 %R 10.2196/33625 %U https://www.researchprotocols.org/2022/6/e33625 %U https://doi.org/10.2196/33625 %U http://www.ncbi.nlm.nih.gov/pubmed/35679115 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e32226 %T Feasibility of a Web-Based Intervention to Prevent Perinatal Depression and Promote Human Milk Feeding: Randomized Pilot Trial %A Pezley,Lacey %A Tussing-Humphreys,Lisa %A Koenig,Mary Dawn %A Maki,Pauline %A Odoms-Young,Angela %A Freels,Sally %A DiPiazza,Brittany %A Cann,Felicity %A Cares,Kate %A Depa,Courtney %A Klejka,Gintare %A Lima Oliveira,Manoela %A Prough,Jilian %A Roe,Taylor %A Buscemi,Joanna %A Duffecy,Jennifer %+ Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, United States, 1 312 355 5521, lwissl2@uic.edu %K breastfeeding %K chestfeeding %K perinatal %K depression %K anxiety %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mothers who identify as Black or African American are more likely to report depressed moods in late pregnancy and early postpartum and have the lowest rates of human milk feeding compared with all other racial groups in the United States. Internet interventions offer the potential to extend preventative and supportive services as they address key barriers, particularly for those navigating the complex and vulnerable early postpartum period. However, there is limited evidence on the feasibility of such interventions for preventing perinatal mental health disorders and improving human milk feeding outcomes in Black mothers. Objective: This pilot study aimed to assess the feasibility and preliminary findings of a web-based cognitive behavioral therapy–based internet intervention, with and without human milk feeding education and support, to prevent perinatal depression and promote human milk feeding in Black mothers. Methods: Participants were Black-identifying individuals between 20 and 28 weeks of pregnancy with human milk feeding intention and mild to moderate depressive symptoms (Patient Health Questionnaire scores 5-14). Participants were randomized to either Sunnyside, a 6-week cognitive behavioral therapy–based web-based intervention, or Sunnyside Plus, which included additional education and support to promote human milk feeding. Assessments occurred at baseline, third trimester (end of antenatal treatment), 6 weeks postpartum (end of postpartum treatment), and 12 weeks postpartum. The primary focus of this randomized pilot trial was the feasibility and preliminary outcomes of mental health and human milk feeding. Results: A total of 22 tertiary-educated participants were randomized. The mean number of log-ins was 7.3 (SD 5.3) for Sunnyside and 13.8 (SD 10.5) for Sunnyside Plus. Scores of depression and anxiety measures remained below the clinical threshold for referral to treatment in both groups. All the participants initiated human milk feeding (18/18, 100%). Most participants reported at least some human milk feeding at both 6 and 12 weeks postpartum (6/7, 86%; 11/11, 100%, or 10/10, 100%, for Sunnyside and Sunnyside Plus, respectively). Conclusions: The results suggest that tertiary-educated Black mothers at risk for perinatal depression and who intended to human milk feed were receptive to and satisfied with a web-based cognitive behavioral therapy–based internet intervention, with and without human milk feeding education and support. Preliminary findings indicate that both Sunnyside and Sunnyside Plus interventions have the potential to affect symptoms of depression, anxiety, and human milk feeding outcomes. Trial Registration: ClinicalTrials.gov NCT04128202; https://www.clinicaltrials.gov/ct2/show/NCT04128202 %M 35503244 %R 10.2196/32226 %U https://formative.jmir.org/2022/5/e32226 %U https://doi.org/10.2196/32226 %U http://www.ncbi.nlm.nih.gov/pubmed/35503244 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e33363 %T Associations Between Prenatal Exposure to Serotonergic Medications and Biobehavioral Stress Regulation: Protocol for a Systematic Review and Meta-analysis %A Zusman,Enav Z %A Lavu,Alekhya %A Pawliuk,Colleen %A Pawluski,Jodi %A Hutchison,Sarah M %A Platt,Robert W %A Oberlander,Tim F %+ Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak St, Vancouver, BC, V6H 3V4, Canada, 1 (604) 875 3200, enav.zusman@bcchr.ca %K pregnancy %K serotonergic medications %K antidepressants %K stress regulation %K systematic review %K meta-analysis %D 2022 %7 28.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Up to 20% of mothers experience antenatal depression and approximately 30% of these women are treated with serotonergic psychotropic pharmacological therapy during pregnancy. Serotonergic antidepressants readily cross the placenta and the fetal blood-brain barrier, altering central synaptic serotonin signaling and potentially altering serotonin levels in the developing fetal brain. Objective: The aim of this study is to assess the impact of prenatal exposure to serotonergic antidepressants, accounting for maternal mood disturbances, on markers of stress regulation during childhood. Methods: We will follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and will search MEDLINE, Embase, CINAHL, PsycINFO, and ClinicalTrials.gov for full-length studies that assessed physiological (eg, cortisol level, heart rate variability, salivary amylase, pupillary size, C-reactive protein) indices of stress regulation in children of pregnant people who were treated with a serotonergic antidepressant at any point during pregnancy. We will assess the quality of observational studies using the Newcastle-Ottawa Scale and the quality of experimental studies using the Cochrane risk-of-bias tool. When possible, we will conduct a random-effects meta-analysis. If meta-analysis is not possible, we will conduct a narrative review. If a sufficient number of studies are found, we will perform subgroup analysis and assess outcomes measured by drug class, dose, trimester of exposure, and child’s age and gender. Results: We registered our review protocol with PROSPERO (International Prospective Register of Systematic Reviews; CRD42021275750), completed the literature search, and initiated title and abstract review in August 2021. We expect to finalize this review by April 2022. Conclusions: Findings should identify the impact of prenatal antidepressant effects on stress regulation and distinguish it from the impact of prenatal exposure to maternal mood disturbances. This review should inform decisions about serotonergic antidepressant use during pregnancy. Trial Registration: PROSPERO CRD42021275750; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=275750 International Registered Report Identifier (IRRID): PRR1-10.2196/33363 %M 35343913 %R 10.2196/33363 %U https://www.researchprotocols.org/2022/3/e33363 %U https://doi.org/10.2196/33363 %U http://www.ncbi.nlm.nih.gov/pubmed/35343913 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e28081 %T App-Based Ecological Momentary Assessment to Enhance Clinical Care for Postpartum Depression: Pilot Acceptability Study %A Krohn,Holly %A Guintivano,Jerry %A Frische,Rachel %A Steed,Jamie %A Rackers,Hannah %A Meltzer-Brody,Samantha %+ Department of Psychiatry, University of North Carolina at Chapel Hill, 333 S. Columbia Street, MacNider 304 CB 7160, Chapel Hill, NC, 27599, United States, 1 919 445 0218, holly_krohn@med.unc.edu %K postpartum care %K depression %K mobile health %K mHealth %K ecological momentary assessment (EMA) %K mobile apps %K personalized care %K mobile phone %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Wearable tracking devices and mobile health technology are increasingly used in an effort to enhance clinical care and the delivery of personalized medical treatment. Postpartum depression is the most frequently diagnosed complication of childbirth; however, significant gaps in screening and treatment remain. Objective: This study aims to investigate the clinical utility, predictive ability, and acceptability of using ecological momentary assessment to collect daily mood, sleep, and activity data through the use of an Apple Watch and mobile app among women with postpartum depression. Methods: This was a pilot study consisting of 3 in-person research visits over the course of a 6-week enrollment period. Questionnaires to assess depression, anxiety, and maternal functioning were periodically collected, along with daily self-reported symptoms and passively collected physiological data via an Apple Watch. Feedback was collected from study participants and the study clinician to determine the utility and acceptability of daily tracking. Logistic regression was used to determine whether mood scores in the 2 weeks before a visit predicted scores at follow-up. Compliance with daily assessments was also measured. Results: Of the 26 women enrolled, 23 (88%) completed the 6-week study period. On average, the participants completed 67% (34.4/51.5 days) of all active daily assessments and 74% (38/51.5 days) of all passive measures. Furthermore, all 23 participants completed the 3 required visits with the research team. Predictive correlations were found between self-reported mood and Edinburgh Postnatal Depression Scale score at follow-up, self-reported anxiety and EDPS, and sleep quality and Edinburgh Postnatal Depression Scale. Conclusions: Using ecological momentary assessment to track daily symptoms of postpartum depression using a wearable device was largely endorsed as acceptable and clinically useful by participants and the study clinician and could be an innovative solution to increase care access during the COVID-19 pandemic. %M 35319483 %R 10.2196/28081 %U https://formative.jmir.org/2022/3/e28081 %U https://doi.org/10.2196/28081 %U http://www.ncbi.nlm.nih.gov/pubmed/35319483 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e25821 %T Cost-effectiveness of Web-Based and Home-Based Postnatal Psychoeducational Interventions for First-time Mothers: Economic Evaluation Alongside Randomized Controlled Trial %A Zheng,Qishi %A Shi,Luming %A Zhu,Lixia %A Jiao,Nana %A Chong,Yap Seng %A Chan,Sally Wai-Chi %A Chan,Yiong Huak %A Luo,Nan %A Wang,Wenru %A He,Honggu %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 65167448, nurhhg@nus.edu.sg %K anxiety %K cost-effectiveness %K depression %K first-time mother %K home-based %K postnatal %K psychoeducational %K self-efficacy %K social support %K web-based %D 2022 %7 11.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The cost-effectiveness of interventions has attracted increasing interest among researchers. Although web-based and home-based psychoeducational interventions have been developed to improve first-time mothers’ postnatal health outcomes, very limited studies have reported their cost-effectiveness. Objective: The aim of this study was to evaluate the cost-effectiveness of web-based and home-based postnatal psychoeducational interventions for first-time mothers during the early postpartum period. Methods: A randomized controlled 3-group pretest and posttest design was adopted, and cost-effectiveness analysis from the health care’s perspective was conducted. A total of 204 primiparas were recruited from a public tertiary hospital in Singapore from October 2016 to August 2017 who were randomly allocated to the web-based intervention (n=68), home-based intervention (n=68), or control (n=68) groups. Outcomes of maternal parental self-efficacy, social support, postnatal depression, anxiety, and health care resource utilization were measured using valid and reliable instruments at baseline and at 1 month, 3 months, and 6 months after childbirth. The generalized linear regression models on effectiveness and cost were used to assess the incremental cost-effectiveness ratios of the web-based and home-based intervention programs compared to routine care. Projections of cumulative cost over 5 years incurred by the 3 programs at various coverage levels (ie, 10%, 50%, and 100%) were also estimated. Results: The web-based intervention program dominated the other 2 programs (home-based program and routine care) with the least cost (adjusted costs of SGD 376.50, SGD 457.60, and SGD 417.90 for web-based, home-based, and control group, respectively; SGD 1=USD 0.75) and the best improvements in self-efficacy, social support, and psychological well-being. When considering the implementation of study programs over the next 5 years by multiplying the average cost per first-time mother by the estimated average number of first-time mothers in Singapore during the 5-year projection period, the web-based program was the least costly program at all 3 coverage levels. Based on the 100% coverage, the reduced total cost reached nearly SGD 7.1 million and SGD 11.3 million when compared to control and home-based programs at the end of the fifth year, respectively. Conclusions: The web-based approach was promisingly cost-effective to deliver the postnatal psychoeducational intervention to first-time mothers and could be adopted by hospitals as postnatal care support. Trial Registration: ISRCTN registry ISRCTN45202278; https://www.isrctn.com/ISRCTN45202278 %M 35275078 %R 10.2196/25821 %U https://www.jmir.org/2022/3/e25821 %U https://doi.org/10.2196/25821 %U http://www.ncbi.nlm.nih.gov/pubmed/35275078 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e30724 %T mHealth Solutions for Perinatal Mental Health: Scoping Review and Appraisal Following the mHealth Index and Navigation Database Framework %A Spadaro,Benedetta %A Martin-Key,Nayra A %A Funnell,Erin %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K digital mental health %K perinatal mental health %K pregnancy %K MIND %K mobile phone %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The ever-increasing pressure on health care systems has resulted in the underrecognition of perinatal mental disorders. Digital mental health tools such as apps could provide an option for accessible perinatal mental health screening and assessment. However, there is a lack of information regarding the availability and features of perinatal app options. Objective: This study aims to evaluate the current state of diagnostic and screening apps for perinatal mental health available on the Google Play Store (Android) and Apple App Store (iOS) and to review their features following the mHealth Index and Navigation Database framework. Methods: Following a scoping review approach, the Apple App Store and Google Play Store were systematically searched to identify perinatal mental health assessment apps. A total of 14 apps that met the inclusion criteria were downloaded and reviewed in a standardized manner using the mHealth Index and Navigation Database framework. The framework comprised 107 questions, allowing for a comprehensive assessment of app origin, functionality, engagement features, security, and clinical use. Results: Most apps were developed by for-profit companies (n=10), followed by private individuals (n=2) and trusted health care companies (n=2). Out of the 14 apps, 3 were available only on Android devices, 4 were available only on iOS devices, and 7 were available on both platforms. Approximately one-third of the apps (n=5) had been updated within the last 180 days. A total of 12 apps offered the Edinburgh Postnatal Depression Scale in its original version or in rephrased versions. Engagement, input, and output features included reminder notifications, connections to therapists, and free writing features. A total of 6 apps offered psychoeducational information and references. Privacy policies were available for 11 of the 14 apps, with a median Flesch-Kincaid reading grade level of 12.3. One app claimed to be compliant with the Health Insurance Portability and Accountability Act standards and 2 apps claimed to be compliant with General Data Protection Regulation. Of the apps that could be accessed in full (n=10), all appeared to fulfill the claims stated in their description. Only 1 app referenced a relevant peer-reviewed study. All the apps provided a warning for use, highlighting that the mental health assessment result should not be interpreted as a diagnosis or as a substitute for medical care. Only 3 apps allowed users to export or email their mental health test results. Conclusions: These results indicate that there are opportunities to improve perinatal mental health assessment apps. To this end, we recommend focusing on the development and validation of more comprehensive assessment tools, ensuring data protection and safety features are adequate for the intended app use, and improving data sharing features between users and health care professionals for timely support. %M 35037894 %R 10.2196/30724 %U https://mhealth.jmir.org/2022/1/e30724 %U https://doi.org/10.2196/30724 %U http://www.ncbi.nlm.nih.gov/pubmed/35037894 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27033 %T Development of a Supportive Parenting App to Improve Parent and Infant Outcomes in the Perinatal Period: Development Study %A Shorey,Shefaly %A Tan,Thiam Chye %A , %A Mathews,Jancy %A Yu,Chun Yan %A Lim,Siew Hoon %A Shi,Luming %A Ng,Esperanza Debby %A Chan,Yiong Huak %A Law,Evelyn %A Chee,Cornelia %A Chong,Yap Seng %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66011294, nurssh@nus.edu.sg %K depression %K development %K education %K parent %K perinatal %K support %K telehealth %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The transition to parenthood can be challenging, and parents are vulnerable to psychological disorders during the perinatal period. This may have adverse long-term consequences on a child’s development. Given the rise in technology and parents’ preferences for mobile health apps, a supportive mobile health intervention is optimal. However, there is a lack of a theoretical framework and technology-based perinatal educational intervention for couples with healthy infants. Objective: The aim of this study is to describe the Supportive Parenting App (SPA) development procedure and highlight the challenges and lessons learned. Methods: The SPA development procedure was guided by the information systems research framework, which emphasizes a nonlinear, iterative, and user-centered process involving 3 research cycles—the relevance cycle, design cycle, and rigor cycle. Treatment fidelity was ensured, and team cohesiveness was maintained using strategies from the Tuckman model of team development. Results: In the relevance cycle, end-user requirements were identified through focus groups and interviews. In the rigor cycle, the user engagement pyramid and well-established theories (social cognitive theory proposed by Bandura and attachment theory proposed by Bowlby) were used to inform and justify the features of the artifact. In the design cycle, the admin portal was developed using Microsoft Visual Studio 2017, whereas the SPA, which ran on both iOS and Android, was developed using hybrid development tools. The SPA featured knowledge-based content, informational videos and audio clips, a discussion forum, chat groups, and a frequently asked questions and expert advice section. The intervention underwent iterative testing by a small group of new parents and research team members. Qualitative feedback was obtained for further app enhancements before official implementation. Testing revealed user and technological issues, such as web browser and app incompatibility, a lack of notifications for both administrators and users, and limited search engine capability. Conclusions: The information systems research framework documented the technical details of the SPA but did not take into consideration the interpersonal and real-life challenges. Ineffective communication between the health care research team and the app developers, limited resources, and the COVID-19 pandemic were the main challenges faced during content development. Quick adaptability, team cohesion, and hindsight budgeting are crucial for intervention development. Although the effectiveness of the SPA in improving parental and infant outcomes is currently unknown, this detailed intervention development study highlights the key aspects that need to be considered for future app development. %M 36260376 %R 10.2196/27033 %U https://www.jmir.org/2021/12/e27033 %U https://doi.org/10.2196/27033 %U http://www.ncbi.nlm.nih.gov/pubmed/36260376 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e26665 %T Evaluation of Repeated Web-Based Screening for Predicting Postpartum Depression: Prospective Cohort Study %A Haßdenteufel,Kathrin %A Lingenfelder,Katrin %A Schwarze,Cornelia E %A Feisst,Manuel %A Brusniak,Katharina %A Matthies,Lina Maria %A Goetz,Maren %A Wallwiener,Markus %A Wallwiener,Stephanie %+ Department of Obstetrics and Gynecology, Heidelberg University, Im Neuenheimer Feld 440, Heidelberg, D-69120, Germany, 49 62215637551, stephanie.wallwiener@med.uni-heidelberg.de %K postpartum depression %K Edinburgh Postnatal Depression Scale %K screening %K pregnancy %K algorithm %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Postpartum depression (PPD) is a severe mental disorder that often results in poor maternal-infant attachment and negatively impacts infant development. Universal screening has recently been recommended to identify women at risk, but the optimal screening time during pregnancy has not been defined so far. Thus, web-based technologies with widespread use among women of childbearing age create new opportunities to detect pregnancies with a high risk for adverse mental health outcomes at an early stage. Objective: The aim of this study was to stratify the risk for PPD and to determine the optimal screening time during pregnancy by using a web-based screening tool collecting electronic patient-reported outcomes (ePROs) as the basis for a screening algorithm. Methods: In total, 214 women were repeatedly tested for depressive symptoms 5 times during and 3 times after pregnancy by using the Edinburgh Postnatal Depression Scale (EPDS), accessible on a web-based pregnancy platform, developed by the authors of this study. For each prenatal assessment, the area under the curve (AUC), sensitivity, specificity, and predictive values for PPD were calculated. Multivariate logistic regression analyses were applied to identify further potential predictors, such as age, education, parity, relationship quality, and anxiety, to increase predictive accuracy. Results: Digitally collected data from 214 pregnant women were analyzed. The predictive accuracy of depressive symptoms 3 and 6 months postpartum was reasonable to good regarding the screening in the second (AUC=0.85) and third (AUC=0.75) trimester. The multivariate logistic regression analyses resulted in an excellent AUC of 0.93 at 3 months and a good AUC of 0.87 at 6 months postpartum. Conclusions: The best predictive accuracy for PPD has been shown for screening between the 24th and the 28th gestational week (GW) and seems to be beneficial for identifying women at risk. In combination with the aforementioned predictive factors, the discriminatory power improved, particularly at 3 months postpartum. Screening for depression during pregnancy, combined with the women’s personal risk profile, can be used as a starting point for developing a digital screening algorithm. Thereby, web-based assessment tools constitute feasible, efficient, and cost-effective approaches. Thus, they seem to be beneficial in detecting high-risk pregnancies in order to improve maternal and infant birth outcomes in the long term. %M 34890349 %R 10.2196/26665 %U https://mental.jmir.org/2021/12/e26665 %U https://doi.org/10.2196/26665 %U http://www.ncbi.nlm.nih.gov/pubmed/34890349 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e17185 %T Internet and Face-to-face Cognitive Behavioral Therapy for Postnatal Depression Compared With Treatment as Usual: Randomized Controlled Trial of MumMoodBooster %A Milgrom,Jeannette %A Danaher,Brian G %A Seeley,John R %A Holt,Christopher J %A Holt,Charlene %A Ericksen,Jennifer %A Tyler,Milagra S %A Gau,Jeff M %A Gemmill,Alan W %+ Parent-Infant Research Institute, Heidelberg Repatriation Hospital, 300 Waterdale Rd, Heidelberg Heights, 3081, Australia, 61 3 9496 4496, alan.gemmill@austin.org.au %K postnatal depression %K postpartum depression %K postnatal anxiety %K postpartum anxiety %K cognitive behavioral therapy %K internet intervention %K web-based intervention %K randomized controlled trial %K online intervention %K treatment %K mobile phone %D 2021 %7 8.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous research has confirmed that symptoms of postnatal depression (PND) can be ameliorated through internet-delivered psychological interventions. Advantages of internet-delivered treatment include anonymity, convenience, and catering to women who are unable to access face-to-face (FTF) treatments. To date, no research has examined the efficacy of such interventions compared directly with FTF treatments in women clinically diagnosed with PND. Objective: This study aims to compare the efficacy of one of the first web-based cognitive behavioral therapy (CBT) interventions (internet CBT+coach calls) for PND (MumMoodBooster [MMB]) with FTF-CBT in a randomized controlled trial (RCT). Methods: In this study, 116 postnatal women with a Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) diagnosis of major or minor depression were randomized to MMB (39/116, 33.6%), FTF-CBT (39/116, 33.6%), or a treatment-as-usual (TAU) control condition (38/116, 32.8%). Diagnostic status was determined at baseline and at 21-week follow-up using the Structured Clinical Interview for the DSM-IV. Severity of anxiety and depressive symptoms was evaluated using the Depression Anxiety Stress Scales and the revised Beck Depression Inventory at baseline, 12-week follow-up (after treatment), and 21-week follow-up. Results: Of the 116 participants, 107 (92.2%) had a diagnosis of major depression at baseline. Rates of remission from a major or minor depressive episode at 21 weeks in both the FTF-CBT and MMB groups were superior to that of the TAU group (56.6% and 47.7% less likely to be depressed, respectively) and they were not significantly different from each other. Although remission rates differed between TAU and FTF-CBT, growth models showed that, in terms of symptom reduction across time, the FTF-CBT treatment was not significantly better than TAU. By comparison, MMB was statistically superior to both TAU and FTF-CBT in reducing symptoms of depression, anxiety, and stress from baseline to the 21-week follow-up (large and moderate effect sizes). Thus, after 21 weeks, the average symptom scores for depression and anxiety of women receiving MMB were approximately half those of women in both the TAU and FTF-CBT groups. Conclusions: In this RCT, MMB was at least as effective as FTF-CBT in achieving remission from a diagnosed PND episode. MMB was superior to TAU and FTF-CBT in encouraging and maintaining reduction of symptom severity over the 21-week follow-up for depressed postnatal women. These findings replicate results of prior studies on MMB that showed clinically significant improvements in depressive symptoms, and they provide direct empirical support that internet-delivered treatment for depressed postnatal women is a viable alternative to FTF treatment. The generalizability of the results needs to be examined in future research, as RCTs of internet-based versus FTF treatments necessarily involve a subset of people who are willing to undertake either modality of treatment. Trial Registration: Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000881730; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364683&isReview=true %M 34889742 %R 10.2196/17185 %U https://www.jmir.org/2021/12/e17185 %U https://doi.org/10.2196/17185 %U http://www.ncbi.nlm.nih.gov/pubmed/34889742 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e29838 %T Machine Learning Methods for Predicting Postpartum Depression: Scoping Review %A Saqib,Kiran %A Khan,Amber Fozia %A Butt,Zahid Ahmad %+ School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 45107, zahid.butt@uwaterloo.ca %K machine learning %K postpartum depression %K big data %K mobile phone %D 2021 %7 24.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: Machine learning (ML) offers vigorous statistical and probabilistic techniques that can successfully predict certain clinical conditions using large volumes of data. A review of ML and big data research analytics in maternal depression is pertinent and timely, given the rapid technological developments in recent years. Objective: This study aims to synthesize the literature on ML and big data analytics for maternal mental health, particularly the prediction of postpartum depression (PPD). Methods: We used a scoping review methodology using the Arksey and O’Malley framework to rapidly map research activity in ML for predicting PPD. Two independent researchers searched PsycINFO, PubMed, IEEE Xplore, and the ACM Digital Library in September 2020 to identify relevant publications in the past 12 years. Data were extracted from the articles’ ML model, data type, and study results. Results: A total of 14 studies were identified. All studies reported the use of supervised learning techniques to predict PPD. Support vector machine and random forest were the most commonly used algorithms in addition to Naive Bayes, regression, artificial neural network, decision trees, and XGBoost (Extreme Gradient Boosting). There was considerable heterogeneity in the best-performing ML algorithm across the selected studies. The area under the receiver operating characteristic curve values reported for different algorithms were support vector machine (range 0.78-0.86), random forest method (0.88), XGBoost (0.80), and logistic regression (0.93). Conclusions: ML algorithms can analyze larger data sets and perform more advanced computations, which can significantly improve the detection of PPD at an early stage. Further clinical research collaborations are required to fine-tune ML algorithms for prediction and treatment. ML might become part of evidence-based practice in addition to clinical knowledge and existing research evidence. %M 34822337 %R 10.2196/29838 %U https://mental.jmir.org/2021/11/e29838 %U https://doi.org/10.2196/29838 %U http://www.ncbi.nlm.nih.gov/pubmed/34822337 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30995 %T Integrating SMS Text Messages Into a Preventive Intervention for Postpartum Depression Delivered via In-Home Visitation Programs: Feasibility and Acceptability Study %A Barrera,Alinne Z %A Hamil,Jaime %A Tandon,Darius %+ Department of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, United States, 1 6504333854, abarrera@paloaltou.edu %K perinatal mental health %K postpartum depression %K public health %K SMS %K technology %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Form Res %G English %X 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 %M 34792478 %R 10.2196/30995 %U https://formative.jmir.org/2021/11/e30995 %U https://doi.org/10.2196/30995 %U http://www.ncbi.nlm.nih.gov/pubmed/34792478 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e32544 %T Effectiveness of Telehealth Interventions for Women With Postpartum Depression: Systematic Review and Meta-analysis %A Zhao,Liuhong %A Chen,Jingfen %A Lan,Liuying %A Deng,Ni %A Liao,Yan %A Yue,Liqun %A Chen,Innie %A Wen,Shi Wu %A Xie,Ri-hua %+ Department of Nursing, The Seventh Affiliated Hospital, Southern Medical University, 28 Liguan Road, Lishui, Foshan, 528244, China, 86 189 2869 7126, xierihua928@hotmail.com %K telehealth %K postpartum depression %K anxiety %K meta-analysis %D 2021 %7 7.10.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Postpartum depression (PPD) is a prevalent mental health problem with serious adverse consequences for affected women and their infants. Clinical trials have found that telehealth interventions for women with PPD result in increased accessibility and improved treatment effectiveness. However, no comprehensive synthesis of evidence from clinical trials by systematic review has been conducted. Objective: The aim of this study is to evaluate the effectiveness of telehealth interventions in reducing depressive symptoms and anxiety in women with PPD. To enhance the homogeneity and interpretability of the findings, this systematic review focuses on PPD measured by the Edinburgh Postnatal Depression Scale (EPDS). Methods: PubMed, The Cochrane Library, CINAHL, PsycINFO, CNKI, and Wanfang were electronically searched to identify randomized controlled trials (RCTs) on the effectiveness of telehealth interventions for women with PPD from inception to February 28, 2021. Data extraction and quality assessment were performed independently by two researchers. The quality of included studies was assessed using the Cochrane risk-of-bias tool, and meta-analysis was performed using RevMan 5.4 software. Results: Following the search, 9 RCTs with a total of 1958 women with PPD were included. The EPDS (mean difference=–2.99, 95% CI –4.52 to –1.46; P<.001) and anxiety (standardized mean difference=–0.39, 95% CI –0.67 to –0.12; P=.005) scores were significantly lower in the telehealth group compared with the control group. Significant subgroup differences were found in depressive symptoms according to the severity of PPD, telehealth technology, specific therapy, and follow-up time (P<.001). Conclusions: Telehealth interventions could effectively reduce the symptoms of depression and anxiety in women with PPD. However, better designed and more rigorous large-scale RCTs targeting specific therapies are needed to further explore the potential of telehealth interventions for PPD. Trial Registration: PROSPERO CRD42021258541; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258541 %M 34617909 %R 10.2196/32544 %U https://mhealth.jmir.org/2021/10/e32544 %U https://doi.org/10.2196/32544 %U http://www.ncbi.nlm.nih.gov/pubmed/34617909 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26188 %T A Social Media Group Cognitive Behavioral Therapy Intervention to Prevent Depression in Perinatal Youth: Stakeholder Interviews and Intervention Design %A Gewali,Anupa %A Lopez,Alana %A Dachelet,Kristin %A Healy,Elise %A Jean-Baptiste,Marimirca %A Harridan,Holly %A Evans,Yolanda %A Unger,Jennifer A %A Bhat,Amritha %A Tandon,Darius %A Ronen,Keshet %+ Department of Global Health, University of Washington, 3980 15th Ave NE, Seattle, WA, , United States, 1 206 685 4363, keshet@uw.edu %K depression %K mental health %K perinatal %K pregnancy %K postpartum %K adolescent %K youth %K social media %K group %K mobile phone %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adolescents and young adults aged <25 years (youth) are at a higher risk of perinatal depression than older adults, and they experience elevated barriers to in-person care. Digital platforms such as social media offer an accessible avenue to deliver group cognitive behavioral therapy (CBT) to perinatal youth. Objective: We aim to develop the Interactive Maternal Group for Information and Emotional Support (IMAGINE) intervention, a facilitated social media group CBT intervention to prevent perinatal depression in youth in the United States, by adapting the Mothers and Babies (MB) course, an evidence-based in-person group CBT intervention. In this study, we report perspectives of youth and health care providers on perinatal youths’ mental health needs and document how they informed IMAGINE design. Methods: We conducted 21 semistructured in-depth individual interviews with 10 pregnant or postpartum youths aged 14-24 years and 6 health care workers. All interviews were recorded, transcribed, and analyzed using deductive and inductive approaches to characterize perceptions of challenges and facilitators of youth perinatal mental health. Using a human-centered design approach, stakeholder perspectives were incorporated into the IMAGINE design. We classified MB adaptations to develop IMAGINE according to the Framework for Modification and Adaptation, reporting the nature, timing, reason, and goal of the adaptations. Results: Youth and health care workers described stigma associated with young pregnancy and parenting, social isolation, and lack of material resources as significant challenges to youth mental wellness. They identified nonjudgmental support, peer companionship, and access to step-by-step guidance as facilitators of youth mental wellness. They endorsed the use of a social media group to prevent perinatal depression and recommended that IMAGINE facilitate peer support, deliver content asynchronously to accommodate varied schedules, use a confidential platform, and facilitate the discussion of topics beyond the MB curriculum, such as navigating support resources or asking medical questions. IMAGINE was adapted from MB to accommodate stakeholder recommendations and facilitate the transition to web-based delivery. Content was tailored to be multimodal (text, images, and video), and the language was shortened and simplified. All content was designed for asynchronous engagement, and redundancy was added to accommodate intermittent access. The structure was loosened to allow the intervention facilitator to respond in real time to topics of interest for youth. A social media platform was selected that allows multiple conversation channels and conceals group member identity. All adaptations sought to preserve the fidelity of the MB core components. Conclusions: Our findings highlight the effect of stigmatization of young pregnancy and social determinants of health on youth perinatal mental health. Stakeholders supported the use of a social media group to create a supportive community and improve access to evidence-based depression prevention. This study demonstrates how a validated intervention can be tailored to this unique group. %M 34524086 %R 10.2196/26188 %U https://mental.jmir.org/2021/9/e26188 %U https://doi.org/10.2196/26188 %U http://www.ncbi.nlm.nih.gov/pubmed/34524086 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e31072 %T Optimizing Social-Emotional-Communication Development in Infants of Mothers With Depression: Protocol for a Randomized Controlled Trial of a Mobile Intervention Targeting Depression and Responsive Parenting %A Baggett,Kathleen M %A Davis,Betsy %A Sheeber,Lisa %A Miller,Katy %A Leve,Craig %A Mosley,Elizabeth A %A Landry,Susan H %A Feil,Edward G %+ Georgia State University, 14 Marietta St NW, Atlanta, GA, 30303, United States, 1 404 413 1571, kbaggett@gsu.edu %K maternal depression %K parenting %K infant social-emotional and social-communication development %K mobile intervention %K remote coaching %K trial protocol %K mobile phone %D 2021 %7 18.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum depression interferes with maternal engagement in interventions that are effective in improving infant social-emotional and social-communication outcomes. There is an absence of integrated interventions with demonstrated effectiveness in both reducing maternal depression and promoting parent-mediated practices that optimize infant social-emotional and social-communication competencies. Interventions targeting maternal depression are often separate from parent-mediated interventions. To address the life course needs of depressed mothers and their infants, we need brief, accessible, and integrated interventions that target both maternal depression and specific parent practices shown to improve infant social-emotional and social-communication trajectories. Objective: The aim of this study is to evaluate the efficacy of a mobile internet intervention, Mom and Baby Net, with remote coaching to improve maternal mood and promote parent practices that optimize infant social-emotional and social-communication development. Methods: This is a two-arm, randomized controlled intent-to-treat trial. Primary outcomes include maternal depression symptoms and observed parent and infant behaviors. Outcomes are measured via direct observational assessments and standardized questionnaires. The sample is being recruited from the urban core of a large southern city in the United States. Study enrollment was initiated in 2017 and concluded in 2020. Participants are biological mothers with elevated depression symptoms, aged 18 years or older, and who have custody of an infant less than 12 months of age. Exclusion criteria at the time of screening include maternal homelessness or shelter residence, inpatient mental health or substance abuse treatment, or maternal or infant treatment of a major mental or physical illness that would hinder meaningful study participation. Results: The start date of this grant-funded randomized controlled trial (RCT) was September 1, 2016. Data collection is ongoing. Following the institutional review board (IRB)–approved pilot work, the RCT was approved by the IRB on November 17, 2017. Recruitment was initiated immediately following IRB approval. Between February 15, 2018, and March 11, 2021, we successfully recruited a sample of 184 women and their infants into the RCT. The sample is predominantly African American and socioeconomically disadvantaged. Conclusions: Data collection is scheduled to be concluded in March 2022. We anticipate that relative to the attention control condition, which is focused on education around maternal depression and infant developmental milestones with matching technology and coaching structure, mothers in the Mom and Baby Net intervention will experience greater reductions in depression and gains in sensitive and responsive parent practices and that their infants will demonstrate greater gains in social-emotional and social-communication behavior. Trial Registration: ClinicalTrials.gov NCT03464630; https://clinicaltrials.gov/ct2/show/NCT03464630 International Registered Report Identifier (IRRID): DERR1-10.2196/31072 %M 34406122 %R 10.2196/31072 %U https://www.researchprotocols.org/2021/8/e31072 %U https://doi.org/10.2196/31072 %U http://www.ncbi.nlm.nih.gov/pubmed/34406122 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e29770 %T Using Co-design to Explore How Midwives Can Support the Emerging Mother-Infant Relationship During the Early Postnatal Period: Protocol for a Mixed Methods Study %A Stoodley,Cathy %A McKellar,Lois %A Ziaian,Tahereh %A Steen,Mary %A Gwilt,Ian %A Fereday,Jenny %+ UniSA Clinical & Health Sciences, City East Campus, University of South Australia, Corner of North Terrace and, Frome Rd,, Adelaide, 5001, Australia, 61 430346633, cathy.stoodley@unisa.edu.au %K mother-infant relationship %K mother-infant relations %K mother-infant bonding %K infant development %K midwife %K early postnatal %K co-design %K mixed methods %D 2021 %7 10.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The postnatal period can be a challenging time for women, with mothers experiencing a range of emotions. As a woman transitions to motherhood, she adjusts to a new sense of self and forms a new relationship with her infant. Becoming a mother is a complex cognitive and social process that is unique for each woman and is influenced and shaped by culture. The emerging mother-infant relationship is a significant factor in maternal well-being and infant development, with the bond between the mother and her baby being critical to the development of secure attachment. It has been recognized that the strength of this relationship is the main predictor of how well a child will do throughout life. There has been a global focus on the importance of the first 1000 days, with Australia identifying this as a national priority. Midwives are ideally placed to support mothers during the development of the mother-infant relationship, providing care through the early postnatal period, which has been identified as a sensitive period for the development of the mother-infant relationship. Objective: The aim of this study is to explore how midwives can support the emerging mother-infant relationship in the context of cultural diversity and develop an appropriate co-designed intervention in the early postnatal period. Methods: This study will use a mixed method approach, specifically the exploratory sequential design (intervention development variant). This study will be undertaken in 3 phases: 1 qualitative phase, which is followed by 2 quantitative phases. Phase 1 will include a scoping review to explore interventions that have influenced the development of the mother-infant relationship, and then, interviews will be undertaken with women exploring their early experiences of motherhood, followed by 3 co-design workshops. The workshops will engage with multilevel stakeholder representatives where, through partnership and participation, they will propose and develop an intervention to support the emerging mother-infant relationship. Phase 2 will develop and pilot 2 purpose-designed evaluation surveys to evaluate the co-designed intervention from the perspective of both mothers and midwives. Phase 3 will implement and evaluate the co-designed intervention using pre- and postmeasures and feedback from the purpose-designed surveys. Results: Phase 1 has commenced and is expected to be completed by August 2021. Phase 2 is expected to be completed by September 2021, with phase 3 commencing in October 2021. The study will be completed by March 2023. Conclusions: The results of this study will be shared with a variety of audiences and will contribute to the body of knowledge on the mother-infant relationship, potentially improving the understanding of this relationship for women and midwives. This may result in improved strategies for care, with mothers benefiting from enhanced experience and satisfaction during the early postnatal period. %M 34110301 %R 10.2196/29770 %U https://www.researchprotocols.org/2021/6/e29770 %U https://doi.org/10.2196/29770 %U http://www.ncbi.nlm.nih.gov/pubmed/34110301 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27132 %T Proof-of-Concept Support for the Development and Implementation of a Digital Assessment for Perinatal Mental Health: Mixed Methods Study %A Martin-Key,Nayra Anna %A Spadaro,Benedetta %A Schei,Thea Sofie %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K COM-B %K COVID-19 %K digital mental health %K maternal mental health %K paternal mental health %K perinatal mental health %K mental health %K support %K development %K implementation %K assessment %K mother %K women %D 2021 %7 4.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Perinatal mental health symptoms commonly remain underdiagnosed and undertreated in maternity care settings in the United Kingdom, with outbreaks of disease, like the COVID-19 pandemic, further disrupting access to adequate mental health support. Digital technologies may offer an innovative way to support the mental health needs of women and their families throughout the perinatal period, as well as assist midwives in the recognition of perinatal mental health concerns. However, little is known about the acceptability and perceived benefits and barriers to using such technologies. Objective: The aim of this study was to conduct a mixed methods evaluation of the current state of perinatal mental health care provision in the United Kingdom, as well as users’ (women and partners) and midwives’ interest in using a digital mental health assessment throughout the perinatal period. Methods: Women, partners, and midwives were recruited to participate in the study, which entailed completing an online survey. Quantitative data were explored using descriptive statistics. Open-ended response data were first investigated using thematic analysis. Resultant themes were then mapped onto the components of the Capability, Opportunity, and Motivation Behavior model and summarized using descriptive statistics. Results: A total of 829 women, 103 partners, and 90 midwives participated in the study. The provision of adequate perinatal mental health care support was limited, with experiences varying significantly across respondents. There was a strong interest in using a digital mental health assessment to screen, diagnose, and triage perinatal mental health concerns, particularly among women and midwives. The majority of respondents (n=781, 76.42%) expressed that they would feel comfortable or very comfortable using or recommending a digital mental health assessment. The majority of women and partners showed a preference for in-person consultations (n=417, 44.74%), followed by a blended care approach (ie, both in-person and online consultations) (n=362, 38.84%), with fewer participants preferring online-only consultations (n=120, 12.88%). Identified benefits and barriers mainly related to physical opportunity (eg, accessibility), psychological capability (eg, cognitive skills), and automatic motivation (eg, emotions). Conclusions: This study provides proof-of-concept support for the development and implementation of a digital mental health assessment to inform clinical decision making in the assessment of perinatal mental health concerns in the United Kingdom. %M 34033582 %R 10.2196/27132 %U https://www.jmir.org/2021/6/e27132 %U https://doi.org/10.2196/27132 %U http://www.ncbi.nlm.nih.gov/pubmed/34033582 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25047 %T Effectiveness of an Integrated Care Package for Refugee Mothers and Children: Protocol for a Cluster Randomized Controlled Trial %A Al Azdi,Zunayed %A Islam,Khaleda %A Khan,Muhammad Amir %A Khan,Nida %A Ejaz,Amna %A Khan,Muhammad Ahmar %A Warraitch,Azza %A Jahan,Ishrat %A Huque,Rumana %+ ARK Foundation, Suite C-4, House No. 6, Road No. 109, Gulshan-2, Dhaka, 1212, Bangladesh, 880 1711455670, azdi1627@gmail.com %K mental health %K refugee health %K early childhood development %K Rohingya %K Bangladesh %K community health care %K community health worker %D 2021 %7 4.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Thousands of Rohingya refugee mothers at the world’s largest refugee camp located in Bangladesh are at risk of poor mental health. Accordingly, their children are also vulnerable to delayed cognitive and physical development. Objective: The aim of this study is to evaluate the effectiveness of an integrated care package in reducing the prevalence of developmental delays among children aged 1 year and improving their mothers’ mental health status. Methods: This is a parallel, two-arm, single-blind, cluster randomized controlled trial (cRCT). A total of 704 mother-child dyads residing at the Kutupalong refugee camp in Cox’s Bazar, Bangladesh, will be recruited from 22 clusters with 32 mother-child dyads per cluster. In the intervention arm, an integrated early childhood development and maternal mental health package will be delivered every quarter to mothers of newborns by trained community health workers until the child is 1 year old. Our primary outcome is a reduction in the prevalence of two or more childhood developmental delays of infants aged 1 year compared to the usual treatment. The secondary outcomes include reduced stunting among children and the prevalence of maternal depression. We will also assess the cost-effectiveness of the integrated intervention, and will further explore the intervention’s acceptability and feasibility. Results: At the time of submission, the study was at the stage of endpoint assessment. The data analysis started in December 2020, and the results are expected to be published after the first quarter of 2021. Conclusions: This study will address the burden of childhood developmental delays and poor maternal mental health in a low-resource setting. If proven effective, the delivery of the intervention through community health workers will ensure the proposed intervention’s sustainability. Trial Registration: ISRCTN Registry ISRCTN10892553; https://www.isrctn.com/ISRCTN10892553 International Registered Report Identifier (IRRID): DERR1-10.2196/25047 %M 33944793 %R 10.2196/25047 %U https://www.researchprotocols.org/2021/5/e25047 %U https://doi.org/10.2196/25047 %U http://www.ncbi.nlm.nih.gov/pubmed/33944793 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e25407 %T Protocol for the Pregnancy During the COVID-19 Pandemic (PdP) Study: A Longitudinal Cohort Study of Mental Health Among Pregnant Canadians During the COVID-19 Pandemic and Developmental Outcomes in Their Children %A Giesbrecht,Gerald F %A Bagshawe,Mercedes %A van Sloten,Melinda %A MacKinnon,Anna L %A Dhillon,Ashley %A van de Wouw,Marcel %A Vaghef-Mehrabany,Elnaz %A Rojas,Laura %A Cattani,Danielle %A Lebel,Catherine %A Tomfohr-Madsen,Lianne %+ Department of Pediatrics, University of Calgary, 2500 University Drive, Calgary, AB, T2N 1N4, Canada, 1 403 441 8469, ggiesbre@ucalgary.ca %K pregnancy %K anxiety %K depression %K stress %K social support %K resilience %K COVID-19 %K infant development %K pandemic %D 2021 %7 28.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic and countermeasures implemented by governments around the world have led to dramatically increased symptoms of depression and anxiety. Pregnant individuals may be particularly vulnerable to the negative psychological effects of COVID-19 public health measures because they represent a demographic that is most affected by disasters and because pregnancy itself entails significant life changes that require major psychosocial and emotional adjustments. Objective: The PdP study was designed to investigate the associations among exposure to objective hardship caused by the pandemic, perceived stress and psychological distress in pregnant individuals, and developmental outcomes in their offspring. Methods: The PdP study comprises a prospective longitudinal cohort of individuals who were pregnant at enrollment, with repeated follow-ups during pregnancy and the postpartum period. Participants were eligible if they were pregnant, ≥17 years old, at ≤35 weeks of gestation at study enrollment, living in Canada, and able to read and write in English or French. At enrollment, participants completed an initial survey that assessed demographic and socioeconomic characteristics, previous pregnancies and births, prepregnancy health, health conditions during pregnancy, medications, psychological distress, social support, and hardships experienced because of the COVID-19 pandemic (eg, lost employment or a loved one dying). For the first three months following the initial survey, participants received a monthly email link to complete a follow-up survey that asked about their experiences since the previous survey. After three months, follow-up surveys were sent every other month to reduce participant burden. For each of these surveys, participants were first asked if they were still pregnant and then routed either to the next prenatal survey or to the delivery survey. In the postpartum period, surveys were sent at 3, 6, and 12 months of infant age to assess maternal stress, psychological distress, and infant development. Results: Participant recruitment via social media (Facebook and Instagram) began on April 5, 2020, and is ongoing. As of April 2021, more than 11,000 individuals have started the initial survey. Follow-up data collection is ongoing. Conclusions: This longitudinal investigation seeks to elucidate the associations among hardships, maternal psychological distress, child development during the COVID-19 pandemic, and risk and resilience factors that amplify or ameliorate these associations. The findings of this study are intended to generate knowledge about the psychological consequences of pandemics on pregnant individuals and point toward prevention and intervention targets. International Registered Report Identifier (IRRID): DERR1-10.2196/25407 %M 33848971 %R 10.2196/25407 %U https://www.researchprotocols.org/2021/4/e25407 %U https://doi.org/10.2196/25407 %U http://www.ncbi.nlm.nih.gov/pubmed/33848971 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e16280 %T Leveraging Digital Technology in Conducting Longitudinal Research on Mental Health in Pregnancy: Longitudinal Panel Survey Study %A McGee,Beth %A Leonte,Marie %A Wildenhaus,Kevin %A Wilcox,Marsha %A Reps,Jenna %A LaCross,Lauren %+ BabyCenter, LLC, 163 Freelon St, San Francisco, CA, 94107, United States, 1 415 237 9990, bethannmcgee@gmail.com %K digital %K longitudinal %K pregnancy %K postpartum %K perinatal %K panel %K study design %K mental health %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Collecting longitudinal data during and shortly after pregnancy is difficult, as pregnant women often avoid studies with repeated surveys. In contrast, pregnant women interact with certain websites at multiple stages throughout pregnancy and the postpartum period. This digital connection presents the opportunity to use a website as a way to recruit and enroll pregnant women into a panel study and collect valuable longitudinal data for research. These data can then be used to learn new scientific insights and improve health care. Objective: The objective of this paper is to describe the approaches applied and lessons learned from designing and conducting an online panel for health care research, specifically perinatal mood disorders. Our panel design and approach aimed to recruit a large sample (N=1200) of pregnant women representative of the US population and to minimize attrition over time. Methods: We designed an online panel to enroll participants from the pregnancy and parenting website BabyCenter. We enrolled women into the panel from weeks 4 to 10 of pregnancy (Panel 1) or from weeks 28 to 33 of pregnancy (Panel 2) and administered repeated psychometric assessments from enrollment through 3 months postpartum. We employed a combination of adaptive digital strategies to recruit, communicate with, and build trust with participants to minimize attrition over time. We were transparent at baseline about expectations, used monetary and information-based incentives, and sent personalized reminders to reduce attrition. The approach was participant-centric and leveraged many aspects of flexibility that digital methods afford. Results: We recruited 1179 pregnant women—our target was 1200—during a 26-day period between August 25 and September 19, 2016. Our strategy to recruit participants using adaptive sampling tactics resulted in a large panel that was similar to the US population of pregnant women. Attrition was on par with existing longitudinal observational studies in pregnant populations, and 79.2% (934/1179) of our panel completed another survey after enrollment. There were 736 out of 1179 (62.4%) women who completed at least one assessment in both the prenatal and postnatal periods, and 709 out of 1179 (60.1%) women who completed the final assessment. To validate the data, we compared participation rates and factors of perinatal mood disorders ascertained from this study with prior research, suggesting reliability of our approach. Conclusions: A suitably designed online panel created in partnership with a digital media source that reaches the target audience is a means to leverage a conveniently sized and viable sample for scientific research. Our key lessons learned are as follows: sampling tactics may need to be adjusted to enroll a representative sample, attrition can be reduced by adapting to participants’ needs, and study engagement can be boosted by personalizing interactions with the flexibility afforded by digital technologies. %M 33904826 %R 10.2196/16280 %U https://pediatrics.jmir.org/2021/2/e16280 %U https://doi.org/10.2196/16280 %U http://www.ncbi.nlm.nih.gov/pubmed/33904826 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e27382 %T Development and Implementation of a Mobile Tool for High-Risk Pregnant Women to Deliver Effective Caregiving for Neonatal Abstinence Syndrome: Protocol for a Mixed Methods Study %A Burduli,Ekaterina %A Jones,Hendrée E %A Brooks,Olivia %A Barbosa-Leiker,Celestina %A Johnson,Ron Kim %A Roll,John %A McPherson,Sterling Marshall %+ College of Nursing, Washington State University, 412 E Spokane Falls Blvd, Spokane, WA, 99202, United States, 1 509 324 7368, eburduli@wsu.edu %K neonatal abstinence syndrome %K opioid use disorder %K mHealth %K maternal child outcomes %D 2021 %7 15.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The United States continues to experience an alarming rise in opioid use that includes women who become pregnant and related neonatal abstinence syndrome (NAS) in newborns. Most newborns experiencing NAS require nonpharmacological care, which entails, most importantly, maternal involvement with the newborn. To facilitate positive maternal-newborn interactions, mothers need to learn effective caregiving NAS strategies when they are pregnant; however, an enormous gap exists in the early education of mothers on the symptoms and progression of NAS, partly because no education, training, or other interventions exist to prepare future mothers for the challenges of caring for their newborns at risk for NAS. Objective: In this paper, we describe a mixed methods, multistage study to adapt an existing mobile NAS tool for high-risk pregnant women and assess its usability, acceptability, and feasibility in a small randomized controlled trial. Methods: Stage 1 will include 20 semistructured interviews with a panel of neonatology experts, NAS care providers, and mothers with experience caring for NAS-affected newborns to gather their recommendations on the management of NAS and explore their perspectives on the care of these newborns. The findings will guide the adaptation of existing mobile NAS tools for high-risk pregnant women. In stage 2, we will test the usability, acceptability, and feasibility of the adapted mobile tool via surveys with 10 pregnant women receiving opioid agonist therapy (OAT). Finally, in stage 3, we will randomize 30 high-risk pregnant women receiving OAT to either receive the adapted mobile NAS caregiving tool or usual care. We will compare these women on primary outcomes—maternal drug relapse and OAT continuation—and secondary outcomes—maternal-newborn bonding; length of newborn hospital stays; readmission rates; breastfeeding initiation and duration; and postpartum depression and anxiety at 4, 8, and 12 weeks postpartum. Results: This project was funded in July 2020 and approved by the institutional review board in April 2020. Data collection for stage 1 began in December 2020, and as of January 2021, we completed 18 semistructured interviews (10 with NAS providers and 8 with perinatal women receiving OAT). Common themes from all interviews will be analyzed in spring 2021 to inform the adaptation of the NAS caregiving tool. The results from stage 1 are expected to be published in summer 2021. Stage 2 data collection will commence in fall 2021. Conclusions: The findings of this study have the potential to improve NAS care and maternal-newborn outcomes and lead to commercialized product development. If effective, our new tool will be well suited to tailoring for other high-risk perinatal women with substance use disorders. Trial Registration: ClinicalTrials.gov NCT04783558; https://clinicaltrials.gov/ct2/show/NCT04783558 International Registered Report Identifier (IRRID): DERR1-10.2196/27382 %M 33856360 %R 10.2196/27382 %U https://www.researchprotocols.org/2021/4/e27382 %U https://doi.org/10.2196/27382 %U http://www.ncbi.nlm.nih.gov/pubmed/33856360 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e28089 %T Autonomic Nervous System Maturation and Emotional Coordination in Interactions of Preterm and Full-Term Infants With Their Parents: Protocol for a Multimethod Study %A Koumarela,Christina %A Kokkinaki,Theano %A Giannakakis,Giorgos %A Koutra,Katerina %A Hatzidaki,Eleftheria %+ Laboratory of Applied Psychology, Department of Psychology, University of Crete, Gallos, Rethymnon, 74 100, Greece, 30 2831077536, kokkinaki@uoc.gr %K preterm infants %K heart rate variability %K emotional coordination %K developmental outcomes %D 2021 %7 12.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is limited knowledge on the physiological and behavioral pathways that may affect the developmental outcomes of preterm infants and particularly on the link between autonomic nervous system maturation and early social human behavior. Thus, this study attempts to investigate the way heart rate variability (HRV) parameters are related to emotional coordination in interactions of preterm and full-term infants with their parents in the first year of life and the possible correlation with the developmental outcomes of infants at 18 months. Objective: The first objective is to investigate the relationship between emotional coordination and HRV in dyadic full-term infant–parent (group 1) and preterm infant–parent (group 2) interactions during the first postpartum year. The second objective is to examine the relationship of emotional coordination and HRV in groups 1 and 2 in the first postpartum year with the developmental outcomes of infants at 18 months. The third objective is to investigate the effect of maternal and paternal postnatal depression on the relation between emotional coordination and HRV in the two groups and on developmental outcomes at 18 months. The fourth objective is to examine the effect of family cohesion and coping on the relation between emotional coordination and HRV in the two groups and on developmental outcomes at 18 months. Methods: This is an observational, naturalistic, and longitudinal study applying a mixed method design that includes the following: (1) video recordings of mother-infant and father-infant interactions at the hospital, in the neonatal period, and at home at 2, 4, 6, 9, and 12 months of the infants’ life; (2) self-report questionnaires of parents on depressive symptoms, family cohesion, and dyadic coping of stress; (3) infants’ HRV parameters in the neonatal period and at each of the above age points during and after infant-parent video recordings; and (4) assessment of toddlers’ social and cognitive development at 18 months through an observational instrument. Results: The study protocol has been approved by the Research Ethics Committee of the University of Crete (number/date: 170/September 18, 2020). This work is supported by the Special Account for Research Funds of the University of Crete (grant number: 10792-668/08.02.2021). All mothers (with their partners) of full-term and preterm infants who give birth between March 2021 and January 2022 at the General University Hospital of Crete (northern Crete, Greece) will be invited to participate. The researcher will invite the parents of infants to participate in the study 1 to 2 days after birth. Data collection is expected to be completed by March 2023, and the first results will be published by the end of 2023. Conclusions: Investigating the regulatory role of HRV and social reciprocity in preterm infants may have implications for both medicine and psychology. International Registered Report Identifier (IRRID): PRR1-10.2196/28089 %M 33843606 %R 10.2196/28089 %U https://www.researchprotocols.org/2021/4/e28089 %U https://doi.org/10.2196/28089 %U http://www.ncbi.nlm.nih.gov/pubmed/33843606 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e18517 %T Attitudes and Engagement of Pregnant and Postnatal Women With a Web-Based Emotional Health Tool (Mummatters): Cross-sectional Study %A Reilly,Nicole %A Austin,Marie-Paule %+ Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Building 234 (iC Enterprise 1), Innovation Campus, Wollongong, 2522, Australia, 61 0242218045, nreilly@uow.edu.au %K pregnancy %K postpartum %K self-assessment %K depression %K risk %D 2021 %7 26.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mummatters is a web-based health tool that allows women to self-assess the symptoms of depression and the presence of psychosocial risk factors throughout pregnancy and the postnatal period. It aims to increase women’s awareness of their own symptoms or risk factors and their knowledge of the available support options, to encourage engagement with these support options (as appropriate), and to facilitate communication about emotional health issues between women and their health care providers. Objective: The aim of this study is to report the uptake of mummatters; the sociodemographic and psychosocial risk profiles of a subsample of users; and the acceptability, credibility, perceived effect, and motivational appeal of the tool. The help-seeking behaviors of the subsample of users and barriers to help seeking were also examined. Methods: Mummatters was launched in November 2016. Women who completed the mummatters baseline assessment were invited to complete a web-based follow-up survey 1 month later. Results: A total of 2817 women downloaded and used mummatters between November 13, 2016, and May 22, 2018, and 140 women participated in the follow-up study. Approximately half of these women (51%; 72/140) were Whooley positive (possible depression), and 43% (60/140) had an elevated psychosocial risk score on the Antenatal Risk Questionnaire. Mummatters was rated favorably by pregnant and postnatal women in terms of its acceptability (94%-99%), credibility (93%-97%), appeal (78%-91%), and potential to affect a range of health behaviors specific to supporting emotional wellness during the perinatal period (78%-93%). Whooley-positive women were more likely to speak with their families than with a health care provider about their emotional health. Normalizing symptoms and stigma were key barriers to seeking help. Conclusions: Although mummatters was rated positively by consumers, only 53% (19/36) to 61% (22/36) of women with possible depression reported speaking to their health care providers about their emotional health. There was a trend for more prominent barriers to seeking help among postnatal women than among pregnant women. Future studies that investigate whether social barriers to seeking help are greater once a woman has an infant are warranted. Such barriers potentially place these women at greater risk of remaining untreated, as the demands on them are greater. %M 33769302 %R 10.2196/18517 %U https://www.jmir.org/2021/3/e18517 %U https://doi.org/10.2196/18517 %U http://www.ncbi.nlm.nih.gov/pubmed/33769302 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e27138 %T Effectiveness of a Postpartum Text Message Program (Essential Coaching for Every Mother) on Maternal Psychosocial Outcomes: Protocol for a Randomized Controlled Trial %A Dol,Justine %A Aston,Megan %A McMillan,Douglas %A Tomblin Murphy,Gail %A Campbell-Yeo,Marsha %+ Faculty of Health, Dalhousie University, 6299 South St, Halifax, NS, B3H 4R2, Canada, 1 902 470 2640, Justine.dol@dal.ca %K text message %K mobile health %K postpartum education %K self-efficacy %K social support %K postpartum anxiety %K postpartum depression %D 2021 %7 25.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Women experience changes both physically and psychologically during their transition to motherhood. The postnatal period is a critical time for women to develop maternal self-efficacy. Mobile health interventions may offer a way to reach women during this critical period to offer support and information. Essential Coaching for Every Mother is a text message program that seeks to educate and support women during the first 6 weeks postpartum. Objective: The primary effectiveness objective is to compare the effectiveness of the Essential Coaching for Every Mother program on maternal psychosocial outcomes (self-efficacy, social support, postpartum depression, and postpartum anxiety) immediately after the intervention and 6 months postpartum, collectively as well as stratified by parity. The primary implementation objective is to evaluate the implementation extent and quality of the Essential Coaching for Every Mother program. Methods: This will be a hybrid type 1 effectiveness-implementation randomized controlled trial. A total of 140 mothers-to-be or new mothers from Nova Scotia will be recruited and randomized to the intervention or control arm, stratified by parity. The intervention arm will receive the Essential Coaching for Every Mother program, which consists of 53 messages sent twice a day for the first 2 weeks and daily for weeks 3 through 6. The control group will receive usual care. Messages are personalized based on the infant’s age and the woman’s self-selected preference for breastfeeding or formula feeding and tailored with the infant’s name and gender. Women can enroll in the program if they are ≥37 weeks pregnant or within 10 days postpartum, with the first message designed to be sent on the second evening after birth. The actual number of messages received will vary based on the timing of enrollment and the infant’s date of birth. Participants will complete questionnaires assessing self-efficacy, social support, and postpartum depression and anxiety at baseline (enrollment after birth) and 6 weeks (postintervention) and 6 months postpartum. Implementation data will be collected throughout the trial, and evaluation feedback will be collected at 6 weeks from women who received the intervention. Results: Recruitment for this study started on January 5, 2021, and is currently ongoing, with an anticipated date of recruitment completion of January 2022. Conclusions: This study will assess the effectiveness of a postpartum text message program to improve maternal self-efficacy and social support while decreasing postpartum depression and anxiety. It will also shed light on the implementation effectiveness of the program. Trial Registration: ClinicalTrials.gov NCT04730570; https://clinicaltrials.gov/ct2/show/NCT04730570 International Registered Report Identifier (IRRID): DERR1-10.2196/27138 %M 33764309 %R 10.2196/27138 %U https://www.researchprotocols.org/2021/3/e27138 %U https://doi.org/10.2196/27138 %U http://www.ncbi.nlm.nih.gov/pubmed/33764309 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e24162 %T Intentions to Seek Mental Health Services During the COVID-19 Pandemic Among Chinese Pregnant Women With Probable Depression or Anxiety: Cross-sectional, Web-Based Survey Study %A Wang,Qian %A Song,Bo %A Di,Jiangli %A Yang,Xue %A Wu,Anise %A Lau,Joseph %A Xin,Meiqi %A Wang,Linhong %A Mo,Phoenix Kit-Han %+ Center for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, JC School of Public Health and Primary Care, Room 508, 30-32 Ngan Shing St, Hong Kong, Hong Kong, 852 22528765, phoenix.mo@cuhk.edu.hk %K pregnant women %K COVID-19 %K depression %K anxiety %K help-seeking %K mental health services %K social support %K trust %K intention %K mental health %K pregnancy %K survey %D 2021 %7 11.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health problems are prevalent among pregnant women, and it is expected that their mental health will worsen during the COVID-19 pandemic. Furthermore, the underutilization of mental health services among pregnant women has been widely documented. Objective: We aimed to identify factors that are associated with pregnant women’s intentions to seek mental health services. We specifically assessed pregnant women who were at risk of mental health problems in mainland China. Methods: A web-based survey was conducted from February to March, 2020 among 19,515 pregnant women who were recruited from maternal health care centers across various regions of China. A subsample of 6248 pregnant women with probable depression (ie, those with a score of ≥10 on the 9-item Patient Health Questionnaire) or anxiety (ie, those with a score of ≥5 on the 7-item General Anxiety Disorder Scale) was included in our analysis. Results: More than half (3292/6248, 52.7%) of the participants reported that they did not need mental health services. Furthermore, 28.3% (1770/6248) of participants felt that they needed mental health services, but had no intentions of seeking help, and only 19% (1186/6248) felt that they needed mental health services and had intentions of seek help. The results from our multivariate logistic regression analysis showed that age, education level, and gestational age were factors of not seeking help. However, COVID-19–related lockdowns in participants’ cities of residence, social support during the COVID-19 pandemic, and trust in health care providers were protective factors of participants’ intentions to seek help from mental health services. Conclusions: Interventions that promote seeking help for mental health problems among pregnant women should also promote social support from health care providers and trust between pregnant women and their care providers. %M 33570500 %R 10.2196/24162 %U http://mental.jmir.org/2021/2/e24162/ %U https://doi.org/10.2196/24162 %U http://www.ncbi.nlm.nih.gov/pubmed/33570500 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e23410 %T Effectiveness of Smartphone-Based Mindfulness Training on Maternal Perinatal Depression: Randomized Controlled Trial %A Sun,Yaoyao %A Li,Yanyan %A Wang,Juan %A Chen,Qingyi %A Bazzano,Alessandra N %A Cao,Fenglin %+ School of Nursing and Rehabilitation, Shandong University, 44 Wenhua Xi Road, Jinan, 250012, China, 86 053188382291, caofenglin2008@126.com %K mindfulness %K pregnancy %K perinatal care %K depression %K mHealth %K mobile health %K psychosocial intervention %D 2021 %7 27.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite potential for benefit, mindfulness remains an emergent area in perinatal mental health care, and evidence of smartphone-based mindfulness training for perinatal depression is especially limited. Objective: The objective of this study was to evaluate the effectiveness of a smartphone-based mindfulness training intervention during pregnancy on perinatal depression and other mental health problems with a randomized controlled design. Methods: Pregnant adult women who were potentially at risk of perinatal depression were recruited from an obstetrics clinic and randomized to a self-guided 8-week smartphone-based mindfulness training during pregnancy group or attention control group. Mental health indicators were surveyed over five time points through the postpartum period by online self-assessment. The assessor who collected the follow-up data was blind to the assignment. The primary outcome was depression as measured by symptoms, and secondary outcomes were anxiety, stress, affect, sleep, fatigue, memory, and fear. Results: A total of 168 participants were randomly allocated to the mindfulness training (n=84) or attention control (n=84) group. The overall dropout rate was 34.5%, and 52.4% of the participants completed the intervention. Mindfulness training participants reported significant improvement of depression (group × time interaction χ24=16.2, P=.003) and secondary outcomes (χ24=13.1, P=.01 for anxiety; χ24=8.4, P=.04 for positive affect) compared to attention control group participants. Medium between-group effect sizes were found on depression and positive affect at postintervention, and on anxiety in late pregnancy (Cohen d=0.47, –0.49, and 0.46, respectively). Mindfulness training participants reported a decreased risk of positive depressive symptom (Edinburgh Postnatal Depression Scale [EPDS] score>9) compared to attention control participants postintervention (odds ratio [OR] 0.391, 95% CI 0.164-0.930) and significantly higher depression symptom remission with different EPDS reduction scores from preintervention to postintervention (OR 3.471-27.986). Parity did not show a significant moderating effect; however, for nulliparous women, mindfulness training participants had significantly improved depression symptoms compared to nulliparous attention control group participants (group × time interaction χ24=18.1, P=.001). Conclusions: Smartphone-based mindfulness training is an effective intervention in improving maternal perinatal depression for those who are potentially at risk of perinatal depression in early pregnancy. Nulliparous women are a promising subgroup who may benefit more from mindfulness training. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900028521; http://www.chictr.org.cn/showproj.aspx?proj=33474 %M 33502326 %R 10.2196/23410 %U http://www.jmir.org/2021/1/e23410/ %U https://doi.org/10.2196/23410 %U http://www.ncbi.nlm.nih.gov/pubmed/33502326 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e20314 %T Mobile Phone Use and Acceptability for the Delivery of Mental Health Information Among Perinatal Adolescents in Nigeria: Survey Study %A Kola,Lola %A Abiona,Dolapo %A Adefolarin,Adeyinka Olufolake %A Ben-Zeev,Dror %+ University of Ibadan, Department of Psychiatry, College of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Ibadan, , Nigeria, 234 8057943775, lola_kola2004@yahoo.com %K mHealth %K perinatal adolescent %K perinatal depression %K community %K low income %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: There are several barriers that may hamper adolescent mothers’ utilization of available health interventions for perinatal depression. Innovative treatment approaches are needed to increase adolescent mothers’ access to mental health care for improved maternal and child health outcomes. Mobile phones have the potential to serve as important conduits to mental health care in Africa. However, mobile phone use patterns and needs among young mothers in Nigeria are not well documented. Objective: This study sought to determine the prevalence of mobile phone use among perinatal adolescents and report patterns of use, as well as to assess the openness of young mothers to mobile health (mHealth) mental health interventions. Methods: We surveyed 260 adolescent mothers (ages 16-19 years) in their perinatal or postnatal periods of pregnancies in 33 primary health care clinics in Ibadan, Oyo State, Nigeria in 2020. Respondents were included if they were pregnant with a gestation age of greater than or equal to 4 weeks, or had babies (which they had birthed) that were younger than 12 months. Results: The total study sample consisted of 260 adolescent mothers with a mean age of 18.4 (SD 0.88) years. The majority of the respondents (233/260, 89.6%) owned mobile phones (eg, keypad, keypad and internet, smartphones); 22 (8.5%) of the 260 mothers had access to phones that belonged to relatives who lived in the same household, while 5 (1.9%) had access only to public paid phones. Only 23% (54/233) of phone owners (which is 20.5% of the total study population) had smartphones. On average, respondents reported first using mobile phones at 15.5 (SD 2.06) years old. The majority of respondents (222/260, 85.4%) reported using their phones for an average of 45 minutes daily for calls to family members. Facebook was the social media platform that was most often used among respondents who had phones with internet access (122/146 minutes per day, 83.4%). The majority of the sample responded as being “interested” and “very interested” in the use of mobile phones for preventive interventions (250/260, 96.2%) and treatment (243/260, 93.5%) information on mental illness such as depression and “hearing voices.” Half of the respondents (126/233, 50.4%) preferred to receive such information in the form of text messages. Conclusions: Findings from this study suggest that the vast majority of perinatal adolescents in Nigeria own and use mobile phones and that they are interested in leveraging these devices for prevention, treatment, and informational campaigns focused on mental health. The use of smartphones in this population is relatively low, and health intervention through text messages were favored by the women. %M 33496678 %R 10.2196/20314 %U http://mental.jmir.org/2021/1/e20314/ %U https://doi.org/10.2196/20314 %U http://www.ncbi.nlm.nih.gov/pubmed/33496678 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24495 %T Social, Cognitive, and eHealth Mechanisms of COVID-19–Related Lockdown and Mandatory Quarantine That Potentially Affect the Mental Health of Pregnant Women in China: Cross-Sectional Survey Study %A Yang,Xue %A Song,Bo %A Wu,Anise %A Mo,Phoenix K H %A Di,Jiangli %A Wang,Qian %A Lau,Joseph T F %A Wang,Linhong %+ National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No 12 Dahuisi Road, Haidan District, Beijing, 100081, China, 86 01062170871, qianawang@chinawch.org.cn %K eHealth %K lockdown %K quarantine %K depression %K anxiety %K pregnant women %D 2021 %7 22.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although lockdown and mandatory quarantine measures have played crucial roles in the sharp decrease of the number of newly confirmed/suspected COVID-19 cases, concerns have been raised over the threat that these measures pose to mental health, especially the mental health of vulnerable groups, including pregnant women. Few empirical studies have assessed whether and how these control measures may affect mental health, and no study has investigated the prevalence and impacts of the use of eHealth resources among pregnant women during the COVID-19 outbreak. Objective: This study investigated (1) the effects of lockdown and mandatory quarantine on mental health problems (ie, anxiety and depressive symptoms), (2) the potential mediation effects of perceived social support and maladaptive cognition, and (3) the moderation effects of eHealth-related factors (ie, using social media to obtain health information and using prenatal care services during the COVID-19 pandemic) on pregnant women in China. Methods: An online cross-sectional survey was conducted among 19,515 pregnant women from all 34 Chinese provincial-level administrative regions from February 25 to March 10, 2020. Results: Of the 19,515 participants, 12,209 (62.6%) were subjected to lockdown in their areas of residence, 737 (3.8%) were subjected to mandatory quarantine, 8712 (44.6%) had probable mild to severe depression, 5696 (29.2%) had probable mild to severe anxiety, and 1442 (7.4%) had suicidal ideations. Only 640 (3.3%) participants reported that they used online prenatal care services during the outbreak. Significant sociodemographic/maternal factors of anxiety/depressive symptoms included age, education, occupation, the area of residence, gestational duration, the number of children born, complication during pregnancy, the means of using prenatal care services, and social media use for obtaining health information. Multiple indicators multiple causes modeling (χ214=495.21; P<.05; comparative fit index=.99; nonnormed fit index=.98; root mean square error of approximation=.04, 90% CI 0.038-0.045) showed that quarantine was directly and indirectly strongly associated with poor mental health through decreased perceived social support and increased maladaptive cognition (B=.04; β=.02, 95% CI 0.01-0.02; P=.001), while lockdown was indirectly associated with mental health through increased social support and maladaptive cognition among pregnant women (B=.03; β=.03, 95% CI 0.02-0.03; P=.001). Multigroup analyses revealed that the use of social media for obtaining health information and the means of using prenatal care services were significant moderators of the model paths. Conclusions: Our findings provide epidemiological evidence for the importance of integrating mental health care and eHealth into the planning and implementation of control measure policies. The observed social and cognitive mechanisms and moderators in this study are modifiable, and they can inform the design of evidence-based mental health promotion among pregnant women. %M 33302251 %R 10.2196/24495 %U http://www.jmir.org/2021/1/e24495/ %U https://doi.org/10.2196/24495 %U http://www.ncbi.nlm.nih.gov/pubmed/33302251 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e18722 %T Maternal Mental Health Status and Approaches for Accessing Antenatal Care Information During the COVID-19 Epidemic in China: Cross-Sectional Study %A Jiang,Hong %A Jin,Longmei %A Qian,Xu %A Xiong,Xu %A La,Xuena %A Chen,Weiyi %A Yang,Xiaoguang %A Yang,Fengyun %A Zhang,Xinwen %A Abudukelimu,Nazhakaiti %A Li,Xingying %A Xie,Zhenyu %A Zhu,Xiaoling %A Zhang,Xiaohua %A Zhang,Lifeng %A Wang,Li %A Li,Lingling %A Li,Mu %+ School of Public Health, Fudan University, Mailbox 175, 138 Yixueyuan Road, Shanghai, 200032, China, 86 2154237267, h_jiang@fudan.edu.cn %K COVID-19 %K mental health %K perceived stress %K anxiety %K depression %K antenatal care information %K social media platform %K pregnancy %K women %D 2021 %7 18.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: China was the first country in the world to experience a large-scale COVID-19 outbreak. The rapid spread of the disease and enforcement of public health measures has caused distress among vulnerable populations such as pregnant women. With a limited understanding of the novel, emerging infectious disease, pregnant women have sought ways to access timely and trusted health care information. The mental health status of pregnant women during this public health emergency, as well as how they responded to the situation and where and how they obtained antenatal care information, remain to be understood. Objective: This study aimed to evaluate the mental health status of pregnant women during the COVID-19 epidemic in China by measuring their perceived stress, anxiety, and depression levels; explore the approaches used by them to access antenatal health care information; and determine their associations with maternal mental health status. Methods: We conducted a web-based, cross-sectional survey to assess the mental health status of Chinese pregnant women by using the validated, Chinese version of Perceived Stress Scale, Self-Rating Anxiety Scale, and Edinburgh Depression Scale. We also collected information on the various approaches these women used to access antenatal care information during the early stage of the COVID-19 epidemic, from February 5 to 28, 2020. Results: A total of 1873 pregnant women from 22 provinces or regions of China participated in the survey. The prevalence of perceived stress, anxiety, and depression among these participants was 89.1% (1668/1873; 95% CI 87.6%, 90.4%), 18.1% (339/1873; 95% CI 16.4%, 19.9%), and 45.9% (859/1873; 95% CI 43.6%, 48.1%), respectively. Hospitals’ official accounts on the Chinese social media platforms WeChat and Weibo were the most popular channels among these pregnant women to obtain antenatal care information during the COVID-19 outbreak. Access to antenatal care information via the hospitals’ official social media accounts was found to be associated with a significantly lower risk of perceived stress (adjusted odds ratio [aOR] 0.46, 95% CI 0.30-0.72; P=.001), anxiety (aOR 0.53, 95% CI 0.41-0.68; P<.001), and depression (aOR 0.73, 95% CI 0.59-0.91; P=.005). Access to health care information via hospital hotlines or SMS was found to be significantly associated with a lower risk of anxiety only (OR 0.77, 95% CI 0.60-0.98; P=.04). Conclusions: During the COVID-19 outbreak in China, pregnant women experienced high levels of perceived stress, anxiety, and depression. During such public health emergencies, mental health care services should be strengthened to reassure and support pregnant women. Specific information targeted at pregnant women, including information on how to cope in an emergency or major disease outbreak, developed and disseminated by health care institutions via social media platforms could be an effective way to mitigate mental health challenges and ensure epidemic preparedness and response in the future. %M 33347423 %R 10.2196/18722 %U http://www.jmir.org/2021/1/e18722/ %U https://doi.org/10.2196/18722 %U http://www.ncbi.nlm.nih.gov/pubmed/33347423 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e24045 %T Clinical Advice by Voice Assistants on Postpartum Depression: Cross-Sectional Investigation Using Apple Siri, Amazon Alexa, Google Assistant, and Microsoft Cortana %A Yang,Samuel %A Lee,Jennifer %A Sezgin,Emre %A Bridge,Jeffrey %A Lin,Simon %+ The Ohio State University University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, United States, 1 614 355 3703, samuel.yang@nationwidechildrens.org %K voice assistant %K virtual assistant %K conversational agent %K postpartum depression %K mobile health %K mental health %D 2021 %7 11.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A voice assistant (VA) is inanimate audio-interfaced software augmented with artificial intelligence, capable of 2-way dialogue, and increasingly used to access health care advice. Postpartum depression (PPD) is a common perinatal mood disorder with an annual estimated cost of $14.2 billion. Only a small percentage of PPD patients seek care due to lack of screening and insufficient knowledge of the disease, and this is, therefore, a prime candidate for a VA-based digital health intervention. Objective: In order to understand the capability of VAs, our aim was to assess VA responses to PPD questions in terms of accuracy, verbal response, and clinically appropriate advice given. Methods: This cross-sectional study examined four VAs (Apple Siri, Amazon Alexa, Google Assistant, and Microsoft Cortana) installed on two mobile devices in early 2020. We posed 14 questions to each VA that were retrieved from the American College of Obstetricians and Gynecologists (ACOG) patient-focused Frequently Asked Questions (FAQ) on PPD. We scored the VA responses according to accuracy of speech recognition, presence of a verbal response, and clinically appropriate advice in accordance with ACOG FAQ, which were assessed by two board-certified physicians. Results: Accurate recognition of the query ranged from 79% to 100%. Verbal response ranged from 36% to 79%. If no verbal response was given, queries were treated like a web search between 33% and 89% of the time. Clinically appropriate advice given by VA ranged from 14% to 29%. We compared the category proportions using the Fisher exact test. No single VA statistically outperformed other VAs in the three performance categories. Additional observations showed that two VAs (Google Assistant and Microsoft Cortana) included advertisements in their responses. Conclusions: While the best performing VA gave clinically appropriate advice to 29% of the PPD questions, all four VAs taken together achieved 64% clinically appropriate advice. All four VAs performed well in accurately recognizing a PPD query, but no VA achieved even a 30% threshold for providing clinically appropriate PPD information. Technology companies and clinical organizations should partner to improve guidance, screen patients for mental health disorders, and educate patients on potential treatment. %M 33427680 %R 10.2196/24045 %U http://mhealth.jmir.org/2021/1/e24045/ %U https://doi.org/10.2196/24045 %U http://www.ncbi.nlm.nih.gov/pubmed/33427680 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e18934 %T Digital Health Needs of Women With Postpartum Depression: Focus Group Study %A Lackie,Madison E %A Parrilla,Julia S %A Lavery,Brynn M %A Kennedy,Andrea L %A Ryan,Deirdre %A Shulman,Barbara %A Brotto,Lori A %+ Women's Health Research Institute, BC Women's Hospital + Health Centre, Box 42B, H214 - 4500 Oak St., Vancouver, BC, V6H 3N1, Canada, 1 604 875 3459, lori.brotto@vch.ca %K postpartum depression %K perinatal mental health %K eHealth %K women’s health %K reproductive health %K maternal health %K qualitative research %K focus groups %K user-centered design %K knowledge translation %K self-management %D 2021 %7 6.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although approximately 10% of new mothers in Canada develop postpartum depression (PPD), they face many barriers when accessing care. eHealth offers a unique opportunity to provide psychosocial skills and support to new mothers; however, patient populations are not consistently engaged in eHealth development processes. Thus, the diversity of women’s backgrounds and needs are often not reflected in existing tools. Objective: This study aims to engage women from a variety of backgrounds and locations around British Columbia (BC) who have previously experienced PPD to determine the unmet psychoeducational needs of women with PPD and how a web-enabled platform used to deliver psychosocial skills and education to assist in the management of PPD could fulfill those needs. Methods: Focus groups were conducted in 7 cities across BC with a total of 31 women (mean age 34.5 years, SD 4.9), with each group ranging from 2-7 participants. Focus groups were cofacilitated by the study coordinator and a local service provider in each community using a semistructured guide to discuss participants’ needs, ideas, and opinions as they relate to the use of technology in PPD management. Transcripts were approached inductively using thematic analysis to identify themes and qualitative description to frame what was observed in the data. Results: A total of 5 themes were identified: bridging gaps to meet needs; providing validation to combat stigma; nurturing capacity to cope, manage, and/or reach wellness; empowering people to take ownership over their mental health; and offering customization to ensure relevance. Each theme identified a need (eg, combatting stigma) and a way to address that need using a web-enabled intervention (eg, providing validation). At the intersection of these themes was the overarching value of promoting agency for women experiencing PPD. Conclusions: Ultimately, new mothers require accessible mental health care that promotes their agency in mental health care decision making. Our participants believed that a web-enabled intervention could help meet this need. These data will be used to guide the design of such an intervention, with the eventual implementation of this resource as a first-line management option for PPD. %M 33404506 %R 10.2196/18934 %U https://www.jmir.org/2021/1/e18934 %U https://doi.org/10.2196/18934 %U http://www.ncbi.nlm.nih.gov/pubmed/33404506 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23575 %T The Relationship Between Images Posted by New Mothers on WeChat Moments and Postpartum Depression: Cohort Study %A Zhang,Weina %A Liu,Lu %A Cheng,Qijin %A Chen,Yan %A Xu,Dong %A Gong,Wenjie %+ XiangYa School of Public Health, Central South University, 238 Shangmayuanling Lane, Xiangya Road, Kaifu District, Changsha, 410005, China, 86 13607445252, gongwenjie@csu.edu.cn %K social media %K WeChat %K WeChat Moments %K postpartum depression %D 2020 %7 30.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: As social media posts reflect users’ emotions, WeChat Moments, the most popular social media platform in China, may offer a glimpse into postpartum depression in the population. Objective: This study aimed to investigate the features of the images that mothers posted on WeChat Moments after childbirth and to explore the correlation between these features and the mothers' risk of postpartum depression. Methods: We collected the data of 419 mothers after delivery, including their demographics, factors associated with postpartum depression, and images posted on WeChat Moments. Postpartum depression was measured using the Edinburgh Postnatal Depression Scale. Descriptive analyses were performed to assess the following: content of the images, presence of people, the people’s facial expressions, and whether or not memes were posted on WeChat Moments. Logistic regression analyses were used to identify the image features associated with postpartum depression. Results: Compared with pictures of other people, we found that pictures of their children comprised the majority (3909/6887, 56.8%) of the pictures posted by the mothers on WeChat Moments. Among the posts showing facial expressions or memes, more positive than negative emotions were expressed. Women who posted selfies during the postpartum period were more likely to have postpartum depression (P=.003; odds ratio 2.27, 95% CI 1.33-3.87). Conclusions: The vast majority of mothers posted images conveying positive emotions during the postpartum period, but these images may have masked their depression. New mothers who have posted selfies may be at a higher risk of postpartum depression. Trial Registration: International Clinical Trials Registry Platform ChiCTR-ROC-16009255; http://www.chictr.org.cn/showproj.aspx?proj=15699 %M 33252343 %R 10.2196/23575 %U http://www.jmir.org/2020/11/e23575/ %U https://doi.org/10.2196/23575 %U http://www.ncbi.nlm.nih.gov/pubmed/33252343 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 11 %P e17405 %T A Mobile Health Mindfulness Intervention for Women With Moderate to Moderately Severe Postpartum Depressive Symptoms: Feasibility Study %A Avalos,Lyndsay A %A Aghaee,Sara %A Kurtovich,Elaine %A Quesenberry Jr,Charles %A Nkemere,Linda %A McGinnis,MegAnn K %A Kubo,Ai %+ Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA, 94612, United States, 1 510 891 3426, Lyndsay.A.Avalos@kp.org %K depression %K postpartum %K health services, mental %K eHealth %K mental health %K internet-based intervention %K mindfulness %K behavioral intervention %K mobile phone %D 2020 %7 12.11.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Approximately 20% of women suffer from postpartum depression (PPD). Due to barriers such as limited access to care, half of the women with PPD do not receive treatment. Therefore, it is critical to identify effective and scalable interventions. Traditional mindfulness programs have been effective in reducing depressive symptoms, however access remains a barrier. A self-paced mobile health (mHealth) mindfulness program may fit the lifestyle of busy mothers who are unable to attend in-person classes. However, little is known regarding the feasibility or efficacy of mHealth mindfulness interventions in postpartum women with depressive symptoms. Objective: This study aims to assess the feasibility, acceptability, and preliminary efficacy of an mHealth mindfulness intervention for postpartum women with moderate to moderately severe depressive symptoms. Methods: We conducted a single-arm feasibility trial of an mHealth mindfulness intervention within Kaiser Permanente Northern California (KPNC), a large integrated health care system. Participants were identified through clinician referral and electronic health records via KPNC's universal perinatal depression screening program and recruited by the study team. Inclusion criteria included the following: English-speaking, up to 6 months postpartum with a Patient Health Questionnaire (PHQ-8) score of 10 to 19, and no regular mindfulness/meditation practice. Participants were asked to use a mindfulness app, Headspace, 10 to 20 min/day for 6 weeks. Baseline and postintervention surveys captured data on patient-reported outcomes (depression and stress symptoms, sleep quality, and mindfulness). Semistructured interviews captured acceptability. Retention and adherence were used to assess feasibility. Results: Of the 115 women who were contacted and met the eligibility criteria or declined participation before eligibility assessment, 27 (23%) were enrolled. In addition, 70% (19/27) completed the study. The mean age of participants was 31 years (SD 5.2), 30% (8/27) were non-Hispanic White, and, on average, participants were 12.3 weeks postpartum (SD 5.7). Of the women who completed the study, 100% (19/19) used the Headspace app at least once, and nearly half (9/19, 47%) used the app on ≥50% of the days during the 6-week intervention period. Of the 16 participants who completed the postintervention interview, 69% (11/16) reported that they were very or extremely satisfied with the app. Interviews indicated that women appreciated the variety of meditations and felt that the program led to reduced anxiety and improved sleep. Significant improvements in pre- and postintervention scores were observed for depressive symptoms (PHQ-8: −3.8, P=.004), perceived stress (10-item Perceived Stress Scale: −6.0, P=.005), and sleep quality (Pittsburgh Sleep Quality Index: −2.1, P=.02, indicating less sleep disturbance). Improvements in mindfulness were also significant (Five Facet Mindfulness Questionnaire-Short Form: 10.9, P=.01). Conclusions: An mHealth mindfulness intervention for postpartum women with moderate to moderately severe depressive symptoms is feasible and acceptable. An efficacy trial is warranted. %M 33180028 %R 10.2196/17405 %U https://mental.jmir.org/2020/11/e17405 %U https://doi.org/10.2196/17405 %U http://www.ncbi.nlm.nih.gov/pubmed/33180028 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e17895 %T Expanding Access to Perinatal Depression Treatment in Kenya Through Automated Psychological Support: Development and Usability Study %A Green,Eric P %A Lai,Yihuan %A Pearson,Nicholas %A Rajasekharan,Sathyanath %A Rauws,Michiel %A Joerin,Angela %A Kwobah,Edith %A Musyimi,Christine %A Jones,Rachel M %A Bhat,Chaya %A Mulinge,Antonia %A Puffer,Eve S %+ Duke Global Health Institute, Box 90519, Durham, NC, 27708, United States, 1 9196817289, eric.green@duke.edu %K telemedicine %K mental health %K depression %K artificial intelligence %K Kenya %K text messaging %K mobile phone %D 2020 %7 5.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression during pregnancy and in the postpartum period is associated with poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings; however, there are significant barriers to scale-up. We address this gap by adapting Thinking Healthy for automated delivery via a mobile phone. This new intervention, Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users. Objective: This prepilot study aims to gather preliminary data on the Healthy Moms perinatal depression intervention to learn how to build and test a more robust service. Methods: We conducted a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya. We invited these women to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants were randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. We prompted participants to rate their mood via SMS text messaging every 3 days during the baseline and intervention periods, and we used these preliminary repeated measures data to fit a linear mixed-effects model of response to treatment. We also reviewed system logs and conducted in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. Results: We invited 647 women to learn more about Zuri: 86 completed our automated SMS screening and 41 enrolled in the study. Most of the enrolled women submitted at least 3 mood ratings (31/41, 76%) and sent at least 1 message to Zuri (27/41, 66%). A third of the sample engaged beyond registration (14/41, 34%). On average, women who engaged post registration started 3.4 (SD 3.2) Healthy Moms sessions and completed 3.1 (SD 2.9) of the sessions they started. Most interviewees who tried Zuri reported having a positive attitude toward the service and expressed trust in Zuri. They also attributed positive life changes to the intervention. We estimated that using this alpha version of Zuri may have led to a 7% improvement in mood. Conclusions: Zuri is feasible to deliver via SMS and was acceptable to this sample of pregnant women and new mothers. The results of this prepilot study will serve as a baseline for future studies in terms of recruitment, data collection, and outcomes. International Registered Report Identifier (IRRID): RR2-10.2196/11800 %M 33016883 %R 10.2196/17895 %U https://formative.jmir.org/2020/10/e17895 %U https://doi.org/10.2196/17895 %U http://www.ncbi.nlm.nih.gov/pubmed/33016883 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 8 %P e19271 %T Implementing Psychological Interventions Through Nonspecialist Providers and Telemedicine in High-Income Countries: Qualitative Study from a Multistakeholder Perspective %A Singla,Daisy Radha %A Lemberg-Pelly,Sasha %A Lawson,Andrea %A Zahedi,Nika %A Thomas-Jacques,Tyla %A Dennis,Cindy-Lee %+ Department of Psychiatry, University of Toronto, Room 914A, 600 University Ave, Toronto, ON, M5G1X5, Canada, 1 416 562 4438, daisy.singla@utoronto.ca %K nonspecialist providers %K task sharing %K perinatal mental health %K perinatal depression %K telemedicine %K psychological treatments %D 2020 %7 27.8.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Task sharing has been used worldwide to improve access to mental health care, where nonspecialist providers—individuals with no formal training in mental health—have been trained to effectively treat perinatal depressive and anxiety symptoms. Little formative research has been conducted to examine relevant barriers and facilitators of nonspecialist providers and the use of telemedicine in treatment service delivery. Objective: The primary objective of this study was to examine the main barriers and facilitators of nonspecialist provider–delivered psychological treatments for perinatal populations with common mental health disorders, such as depression and anxiety, from a multistakeholder perspective. Methods: This study took place in Toronto, Canada. In total, 33 in-depth interviews were conducted with multiple stakeholder groups (women with lived experience and their significant others, as well as health and mental health professionals). Qualitative data were quantified to estimate commonly endorsed themes within and across stakeholder groups. Results: Psychological treatments delivered by nonspecialist providers were considered acceptable by the vast majority of participants (30/33, 90%). Across all stakeholder groups, nurses (20/33, 61%) and midwives (14/33, 42%) were the most commonly endorsed cadre of nonspecialist providers. The majority of stakeholders (32/33, 97%) were amenable to nonspecialist providers delivering psychological treatment via telemedicine (27/33, 82%), although concerns were raised about the ability to establish a therapeutic alliance via telemedicine (16/33, 48%). Empathy was the most desired characteristic of a nonspecialist provider (61%). Patient and patient advocate stakeholders were more likely to emphasize stigma as an important barrier to accessing psychological treatments (7/12, 58%), compared to clinicians (2/9, 22%) and spouses (1/5, 20%). Clinician stakeholders were more likely to emphasize the importance of ensuring nonspecialist providers were trained to deliver psychological treatments (3/9, 33%), compared to other stakeholder groups. Conclusions: These results can inform the design, implementation, and integration of nonspecialist-delivered interventions via telemedicine for women with perinatal depressive and anxiety symptoms in high-income country contexts. %M 32852281 %R 10.2196/19271 %U http://mental.jmir.org/2020/8/e19271/ %U https://doi.org/10.2196/19271 %U http://www.ncbi.nlm.nih.gov/pubmed/32852281 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17593 %T Effects of a Brief Electronic Mindfulness-Based Intervention on Relieving Prenatal Depression and Anxiety in Hospitalized High-Risk Pregnant Women: Exploratory Pilot Study %A Goetz,Maren %A Schiele,Claudia %A Müller,Mitho %A Matthies,Lina M %A Deutsch,Thomas M %A Spano,Claudio %A Graf,Johanna %A Zipfel,Stephan %A Bauer,Armin %A Brucker,Sara Y %A Wallwiener,Markus %A Wallwiener,Stephanie %+ Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 6221 5636956, stephanie.wallwiener@googlemail.com %K pregnancy %K high-risk pregnancy %K hospitalization %K preterm labor %K anxiety %K depression %K psychological stress %K mindfulness %K stress reduction %K mobile app %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Peripartum depression and anxiety disorders are highly prevalent and are correlated with adverse maternal and neonatal outcomes. Antenatal care in Germany does not yet include structured screening and effective low-threshold treatment options for women facing peripartum depression and anxiety disorders. Mindfulness-based interventions (MBIs) are increasingly becoming a focus of interest for the management of such patients. Studies have shown a decrease in pregnancy-related stress and anxiety in expectant mothers following mindfulness programs. Objective: The aim of this study was to explore the clinical effectiveness of a 1-week electronic course of mindfulness on prenatal depression and anxiety in hospitalized, high-risk pregnant women. We hypothesized that participating in a 1-week electronic MBI (eMBI) could alleviate symptoms of depression and anxiety during the hospital stay. Methods: A prospective pilot study with an explorative study design was conducted from January to May 2019 in a sample of 68 women hospitalized due to high-risk pregnancies. After enrolling into the study, the participants were given access to an eMBI app on how to deal with stress, anxiety, and symptoms of depression. Psychometric parameters were assessed via electronic questionnaires comprising the Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI-S), and abridged version of the Pregnancy-Related Anxiety Questionnaire (PRAQ-R). Results: We observed a high prevalence of peripartum depression and anxiety among hospitalized high-risk pregnant women: 39% (26/67) of the study participants in the first assessment and 41% (16/39) of the participants in the second assessment achieved EPDS scores above the cutoff value for minor/major depression. The number of participants with anxiety levels above the cutoff value (66% [45/68] of the participants in the first assessment and 67% [26/39] of the participants in the second assessment) was significantly more than that of the participants with anxiety levels below the cutoff value, as measured with the STAI-S. After completing the 1-week electronic course on mindfulness, the participants showed a significant reduction in the mean state anxiety levels (P<.03). Regarding pregnancy-related anxiety, participants who completed more than 50% of the 1-week course showed lower scores in PRAQ-R in the second assessment (P<.05). No significant changes in the EPDS scores were found after completing the intervention. Conclusions: Peripartum anxiety and depression represent a relevant health issue in hospitalized pregnant patients. Short-term eMBIs could have the potential to reduce anxiety levels and pregnancy-related anxiety. However, we observed that compliance to eMBI seems to be related to lower symptoms of pregnancy-related stress among high-risk patients. eMBIs represent accessible mental health resources at reduced costs and can be adapted for hospitalized patients during pregnancy. %M 32780023 %R 10.2196/17593 %U https://www.jmir.org/2020/8/e17593 %U https://doi.org/10.2196/17593 %U http://www.ncbi.nlm.nih.gov/pubmed/32780023 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e17179 %T Assessing Feasibility of an Early Childhood Intervention Using Mobile Phones Among Low-Income Mothers of Newborns: Qualitative Interview Study %A Zhang,Donglan %A Jin,Lan %A Liang,Di %A Geng,Ruijin %A Liu,Yun %A Ling,Yu %A Jiang,Fan %A Zhang,Yunting %+ Child Health Advocacy Institute, National Children’s Medical Center, Shanghai Children’s Medical Center, 1678 Dongfang Road, Pudong, Shanghai, China, 86 21 3862606, zhangyunting@scmc.com.cn %K mobile health %K interview %K health belief model %K early child development %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Many children aged younger than 5 years living in low- and middle-income countries are at risk for poor development. Early child development (ECD) programs are cost-effective strategies to reduce poverty, crime, school dropouts, and socioeconomic inequality. With the spread of low-cost mobile phones and internet access in low- and middle-income countries, new service delivery models such as mobile phone–aided interventions have a great potential to improve early childhood development. Objective: This study aimed to identify the beliefs on importance of ECD, feasibility of a proposed intervention using mobile phones and factors that may affect the usability of the intervention among mothers of newborns in a poverty-stricken area in southwestern China. Methods: We conducted an in-depth, semistructured interview study of 25 low-income mothers of newborns recruited from two county hospitals in Yunnan Province. We applied the health belief model and cultural competence theories to identify the facilitators, barriers, and preferences among the target population for parenting knowledge. Results: The results showed that the participants had low health literacy and high perceived needs for learning ECD knowledge. At the same time, they experienced several barriers to learning parenting information and following evidence-based instructions including having limited time, limited financial resources, and different opinions on childcare among family members. Many participants preferred to receive personalized messages tailored to their specific needs and preferred videos or graphics to text only in the messages. Many favored a separate module to support postpartum mental health. Conclusions: The study assessed the acceptability of an early childhood intervention using mobile phones to meet the needs of the target population based on their beliefs, traits, and preferences and provided suggestions to refine the intervention to improve its usability. %M 32463374 %R 10.2196/17179 %U http://formative.jmir.org/2020/5/e17179/ %U https://doi.org/10.2196/17179 %U http://www.ncbi.nlm.nih.gov/pubmed/32463374 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 4 %P e15516 %T Machine Learning Models for the Prediction of Postpartum Depression: Application and Comparison Based on a Cohort Study %A Zhang,Weina %A Liu,Han %A Silenzio,Vincent Michael Bernard %A Qiu,Peiyuan %A Gong,Wenjie %+ XiangYa School of Public Health, Central South University, 238 Shangmayuanling Lane Xiangya Road, Kaifu District, Changsha, 410005, China, 86 13607445252, gongwenjie@csu.edu.cn %K depression %K postpartum %K machine learning %K support vector machine %K random forest %K prediction model %D 2020 %7 30.4.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Postpartum depression (PPD) is a serious public health problem. Building a predictive model for PPD using data during pregnancy can facilitate earlier identification and intervention. Objective: The aims of this study are to compare the effects of four different machine learning models using data during pregnancy to predict PPD and explore which factors in the model are the most important for PPD prediction. Methods: Information on the pregnancy period from a cohort of 508 women, including demographics, social environmental factors, and mental health, was used as predictors in the models. The Edinburgh Postnatal Depression Scale score within 42 days after delivery was used as the outcome indicator. Using two feature selection methods (expert consultation and random forest-based filter feature selection [FFS-RF]) and two algorithms (support vector machine [SVM] and random forest [RF]), we developed four different machine learning PPD prediction models and compared their prediction effects. Results: There was no significant difference in the effectiveness of the two feature selection methods in terms of model prediction performance, but 10 fewer factors were selected with the FFS-RF than with the expert consultation method. The model based on SVM and FFS-RF had the best prediction effects (sensitivity=0.69, area under the curve=0.78). In the feature importance ranking output by the RF algorithm, psychological elasticity, depression during the third trimester, and income level were the most important predictors. Conclusions: In contrast to the expert consultation method, FFS-RF was important in dimension reduction. When the sample size is small, the SVM algorithm is suitable for predicting PPD. In the prevention of PPD, more attention should be paid to the psychological resilience of mothers. %M 32352387 %R 10.2196/15516 %U http://medinform.jmir.org/2020/4/e15516/ %U https://doi.org/10.2196/15516 %U http://www.ncbi.nlm.nih.gov/pubmed/32352387 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e17011 %T Mobile Health for Perinatal Depression and Anxiety: Scoping Review %A Hussain-Shamsy,Neesha %A Shah,Amika %A Vigod,Simone N %A Zaheer,Juveria %A Seto,Emily %+ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 416 978 4326, neesha.hussainshamsy@mail.utoronto.ca %K mental health %K depression %K anxiety %K pregnancy %K postpartum %K smartphone %K mobile phone %K text message %K mHealth %D 2020 %7 13.4.2020 %9 Review %J J Med Internet Res %G English %X Background: The perinatal period is a vulnerable time during which depression and anxiety commonly occur. If left untreated or undertreated, there may be significant adverse effects; therefore, access to rapid, effective treatment is essential. Treatments for mild-to-moderate symptoms according to a stepped-care approach involve psychoeducation, peer support, and psychological therapy, all of which have been shown to be efficaciously delivered through digital means. Women experience significant barriers to care because of system- and individual-level factors, such as cost, accessibility, and availability of childcare. The use of mobile phones is widespread in this population, and the delivery of mental health services via mobile phones has been suggested as a means of reducing barriers. Objective: This study aimed to understand the extent, range, and nature of mobile health (mHealth) tools for prevention, screening, and treatment of perinatal depression and anxiety in order to identify gaps and inform opportunities for future work. Methods: Using a scoping review framework, 4 databases were searched for terms related to mobile phones, perinatal period, and either depression or anxiety. A total of 477 unique records were retrieved, 81 of which were reviewed by full text. Peer-reviewed publications were included if they described the population as women pregnant or up to 1 year postpartum and a tool explicitly delivered via a mobile phone for preventing, screening, or treating depression or anxiety. Studies published in 2007 or earlier, not in English, or as case reports were excluded. Results: A total of 26 publications describing 22 unique studies were included (77% published after 2017). mHealth apps were slightly more common than texting-based interventions (12/22, 54% vs 10/22, 45%). Most tools were for either depression (12/22, 54%) or anxiety and depression (9/22, 41%); 1 tool was for anxiety only (1/22, 4%). Interventions starting in pregnancy and continuing into the postpartum period were rare (2/22, 9%). Tools were for prevention (10/22, 45%), screening (6/22, 27%), and treatment (6/22, 27%). Interventions delivered included psychoeducation (16/22, 73%), peer support (4/22, 18%), and psychological therapy (4/22, 18%). Cost was measured in 14% (3/22) studies. Conclusions: Future work in this growing area should incorporate active psychological treatment, address continuity of care across the perinatal period, and consider clinical sustainability to realize the potential of mHealth. %M 32281939 %R 10.2196/17011 %U http://www.jmir.org/2020/4/e17011/ %U https://doi.org/10.2196/17011 %U http://www.ncbi.nlm.nih.gov/pubmed/32281939 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e15172 %T The Effectiveness of a Guided Internet-Based Tool for the Treatment of Depression and Anxiety in Pregnancy (MamaKits Online): Randomized Controlled Trial %A Heller,Hanna M %A Hoogendoorn,Adriaan W %A Honig,Adriaan %A Broekman,Birit F P %A van Straten,Annemieke %+ Department of Psychiatry, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, 1081 HV, Netherlands, 31 204440196, hm.heller@amsterdamumc.nl %K pregnancy %K depression %K anxiety %K internet %K pregnancy outcome %K treatment %D 2020 %7 23.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Pregnant women with symptoms of depression or anxiety often do not receive adequate treatment. In view of the high incidence of these symptoms in pregnancy and their impact on pregnancy outcomes, getting treatment is of the utmost importance. A guided internet self-help intervention may help to provide more women with appropriate treatment. Objective: This study aimed to examine the effectiveness of a guided internet intervention (MamaKits online) for pregnant women with moderate to severe symptoms of anxiety or depression. Assessments took place before randomization (T0), post intervention (T1), at 36 weeks of pregnancy (T2), and 6 weeks postpartum (T3). We also explored effects on perinatal child outcomes 6 weeks postpartum. Methods: This randomized controlled trial included pregnant women (<30 weeks) with depressive symptoms above threshold (ie, Center for Epidemiological Studies Depression scale [CES-D] >16) or anxiety above threshold (ie, Hospital Anxiety and Depression Scale-Anxiety subscale [HADS-A] >8) or both of them. Participants were recruited via general media and flyers in prenatal care waiting rooms or via obstetricians and midwives. After initial assessment, women were randomized to (1) MamaKits online in addition to treatment as usual or (2) treatment as usual (control condition). MamaKits online is a 5-week guided internet intervention based on problem solving treatment. Guidance was was provided by trained students pursuing a Master's in Psychology. Outcomes were based on a Web-based self-report. Women in the control condition were allowed to receive the intervention after the last assessment (6 weeks postpartum). Results: Of the 159 included women, 79 were randomized to MamaKits online, 47% (79/37) of whom completed the intervention. Both groups showed a substantial decrease in affective symptoms on the CES-D, HADS-A, and Edinburgh Postnatal Depression Scale over time. In the intervention group, affective symptoms decreased more than that in the control group, but between-group effect sizes were small to medium (Cohen d at T3=0.45, 0.21, and 0.23 for the 3 questionnaires, respectively) and statistically not significant. Negative perinatal child outcomes did not differ between the 2 groups (χ21=0.1; P=.78). Completer analysis revealed no differences in outcome between the treatment completers and the control group. The trial was terminated early for reasons of futility based on the results of an interim analysis, which we performed because of inclusion problems. Conclusions: Our study did show a significant reduction in affective symptoms in both groups, but the differences in reduction of affective symptoms between the intervention and control groups were not significant. There were also no differences in perinatal child outcomes. Future research should examine for which women these interventions might be effective or if changes in the internet intervention might make the intervention more effective. Trial Registration: Netherlands Trial Register NL4162; https://tinyurl.com/sdckjek %M 32202505 %R 10.2196/15172 %U http://www.jmir.org/2020/3/e15172/ %U https://doi.org/10.2196/15172 %U http://www.ncbi.nlm.nih.gov/pubmed/32202505 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 8 %P e14734 %T Wearable Digital Sensors to Identify Risks of Postpartum Depression and Personalize Psychological Treatment for Adolescent Mothers: Protocol for a Mixed Methods Exploratory Study in Rural Nepal %A Poudyal,Anubhuti %A van Heerden,Alastair %A Hagaman,Ashley %A Maharjan,Sujen Man %A Byanjankar,Prabin %A Subba,Prasansa %A Kohrt,Brandon A %+ Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2120 L Street, Suite 600, Washington, DC, 20037, United States, 1 (202) 741 2888, bkohrt@gwu.edu %K developing countries %K feasibility studies %K mobile health %K mother-child interaction %K postpartum depression %K psychotherapy %D 2019 %7 11.09.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a high prevalence of untreated postpartum depression among adolescent mothers with the greatest gap in services in low- and middle-income countries. Recent studies have demonstrated the potential of nonspecialists to provide mental health services for postpartum depression in these low-resource settings. However, there is inconsistency in short-term and long-term benefits from the interventions. Passive sensing data generated from wearable digital devices can be used to more accurately distinguish which mothers will benefit from psychological services. In addition, wearable digital sensors can be used to passively collect data to personalize care for mothers. Therefore, wearable passive sensing technology has the potential to improve outcomes from psychological treatments for postpartum depression. Objective: This study will explore the use of wearable digital sensors for two objectives: First, we will pilot test using wearable sensors to generate passive sensing data that distinguish adolescent mothers with depression from those without depression. Second, we will explore how nonspecialists can integrate data from passive sensing technologies to better personalize psychological treatment. Methods: This study will be conducted in rural Nepal with participatory involvement of adolescent mothers and health care stakeholders through a community advisory board. The first study objective will be addressed by comparing behavioral patterns of adolescent mothers without depression (n=20) and with depression (n=20). The behavioral patterns will be generated by wearable digital devices collecting data in 4 domains: (1) the physical activity of mothers using accelerometer data on mobile phones, (2) the geographic range and routine of mothers using GPS (Global Positioning System) data collected from mobile phones, (3) the time and routine of adolescent mothers with their infants using proximity data collected from Bluetooth beacons, and (4) the verbal stimulation and auditory environment for mothers and infants using episodic audio recordings on mobile phones. For the second objective, the same 4 domains of data will be collected and shared with nonspecialists who are delivering an evidence-based behavioral activation intervention to the depressed adolescent mothers. Over 5 weeks of the intervention, we will document how passive sensing data are used by nonspecialists to personalize the intervention. In addition, qualitative data on feasibility and acceptability of passive data collection will be collected for both objectives. Results: To date, a community advisory board comprising young women and health workers engaged with adolescent mothers has been established. The study is open for recruitment, and data collection is anticipated to be completed in November 2019. Conclusions: Integration of passive sensing data in public health and clinical programs for mothers at risk of perinatal mental health problems has the potential to more accurately identify who will benefit from services and increase the effectiveness by personalizing psychological interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/14734 %M 31512581 %R 10.2196/14734 %U http://www.researchprotocols.org/2019/8/e14734/ %U https://doi.org/10.2196/14734 %U http://www.ncbi.nlm.nih.gov/pubmed/31512581 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e12915 %T Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 2): Qualitative Study %A Shorey,Shefaly %A Ng,Esperanza Debby %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, MD 11, Level 2, 10 Medical Drive, Singapore, 117597, Singapore, 65 6601 1294, nurssh@nus.edu.sg %K depression %K mothers %K postpartum %K qualitative %K social support %K telecommunication %K digital health %K peer support %K peer-to-peer support %K online support groups %K internet %D 2019 %7 29.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Social support is known to reduce risks of postnatal depression (PND) and improve maternal emotional well-being. However, the Asian cultural context is often neglected when appraising maternal needs and mothers’ preferences for social support. While many preventive efforts have experimented with technology, professionals, and paraprofessionals in providing social support to mothers in need, most studies determined the effectiveness of their interventions through quantitative measurements of maternal outcomes. Experiences and feedback from both participants and administrators are rarely discussed, especially in an Asian setting. Objective: The goal of the research was to evaluate the postnatal experiences of Asian mothers at risk of PND and the perceptions of peer volunteers regarding a technology-based peer-support intervention program (PIP). Methods: A qualitative semistructured interview was conducted with 20 Asian mothers at risk of depression (10 from the control group and 10 from the intervention group) and 19 peer volunteers from a randomized controlled trial. The PIP included weekly correspondence between peer volunteers and mothers through any telecommunication means over 4 weeks. All interviews were approximately 30 to 60 minutes long, audiotaped, transcribed verbatim, and analyzed using thematic analysis. Study findings were reported according to the Consolidated Standards of Reporting Trials checklist. Results: Two overarching themes comprising five subthemes were generated: postnatal experience (a bouncy ride, a way forward) and evaluation of the PIP (valuable, flexible, and supportive program; building blocks of a good relationship; and lessons learned and the road ahead). Mothers from both the control and interventions groups were generally satisfied with hospital care and the support received from family. They also shared similar breastfeeding challenges and needs for more informed decisions and follow-up support from the hospital. However, mothers who received the PIP tended to have more positive outlooks of their birth experiences. Overall, peer volunteers and mothers involved in the PIP found the PIP useful and expressed satisfaction with the program’s flexibility. They also shared their personal takeaways, the qualities of their friendships, and the need for extended correspondence time and recommended outreach to non–at-risk mothers. Conclusions: The positive endorsement of the PIP by peer volunteers and mothers suggests the success of the PIP in maintaining positive maternal emotional well-being during the postpartum period. With the help of technology, hospitals can easily provide additional peer support to at-risk mothers in addition to existing standard care offered to these mothers. Trial Registration: ISRCTN Registry ISRCTN14864807; http://www.isrctn.com/ISRCTN14864807 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9416 %M 31469080 %R 10.2196/12915 %U http://www.jmir.org/2019/8/e12915/ %U https://doi.org/10.2196/12915 %U http://www.ncbi.nlm.nih.gov/pubmed/31469080 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e12410 %T Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 1): Randomized Controlled Trial %A Shorey,Shefaly %A Chee,Cornelia Yin Ing %A Ng,Esperanza Debby %A Lau,Ying %A Dennis,Cindy-Lee %A Chan,Yiong Huak %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School Of Medicine, National University of Singapore, Clinical Research Centre, MD 11, Level 2, 10 Medical Drive, Singapore, 117597, Singapore, 65 6601 1294, nurssh@nus.edu.sg %K anxiety %K loneliness %K postpartum depression %K social support %K technology %K digital health %K peer support %K peer-to-peer support %K online support groups %K internet %D 2019 %7 29.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The frenzy of postbirth events often takes a toll on mothers’ mental well-being, leaving them susceptible to postpartum psychological disorders such as postnatal depression (PND). Social support has been found to be effective in restoring the emotional well-being of new mothers. Therefore, mothers need to be supported during the crucial postpartum period to buffer the negative after effects of childbirth and to promote healthier maternal well-being. Objective: This study aimed to evaluate the effectiveness of a technology-based peer-support intervention program (PIP) on maternal outcomes during the early postpartum period. Methods: A randomized, parallel-armed controlled trial was conducted. The study recruited 138 mothers (69 in intervention group, 69 in control group) at risk of PND from a tertiary hospital in Singapore. To support these mothers, 20 peer volunteers were recruited by word of mouth and trained by a psychiatrist in social support skills before the intervention commenced. The 4-week–long intervention included a weekly follow-up with a peer volunteer through phone calls or text messages. The intervention group received peer support in addition to the standard care offered by the hospital. The control group only received postnatal standard care. Maternal outcomes (PND, postnatal anxiety [PNA], loneliness, and perceived social support) were measured with reliable and valid instruments. Data were collected immediately postpartum, at 1 month postpartum and at 3 months postpartum. The general linear model was used to compare the groups for postpartum percentage changes in the outcome variables at first and third months, and the linear mixed model was used to compare the trend over the study period. Results: There was a statistically significant difference in Edinburgh Postnatal Depression Scale scores (d=–2.11; 95% CI −4.0 to −0.3; P=.03) between the intervention and control groups at 3 months postpartum after adjusting for covariates. The intervention group had a significant change over time compared with the control group. Conclusions: The technology-based PIP was found to be effective in reducing the risk of PND among new mothers and showed a generally positive trend in reducing PNA and loneliness and increasing perceived social support. This study highlights the importance of training paraprofessionals to provide needed support for new mothers postpartum. A further long-term evaluation of the PIP on maternal and family outcomes and its cost-effectiveness is needed to inform clinical practices. Trial Registration: ISRCTN Registry ISRCTN14864807; https://www.isrctn.com/ISRCTN14864807 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9416 %M 31469084 %R 10.2196/12410 %U http://www.jmir.org/2019/8/e12410/ %U https://doi.org/10.2196/12410 %U http://www.ncbi.nlm.nih.gov/pubmed/31469084 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 8 %P e13271 %T Improving Mental Health in Pregnancy for Refugee Women: Protocol for the Implementation and Evaluation of a Screening Program in Melbourne, Australia %A Boyle,Jacqueline Anne %A Willey,Suzanne %A Blackmore,Rebecca %A East,Christine %A McBride,Jacqueline %A Gray,Kylie %A Melvin,Glenn %A Fradkin,Rebecca %A Ball,Natahl %A Highet,Nicole %A Gibson-Helm,Melanie %+ Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Gve, Clayton, Melbourne, 3168, Australia, 61 (613) 85722670, jacqueline.boyle@monash.edu %K mental health %K refugees %K transients and migrants %K pregnancy %K prenatal care %K mass screening %D 2019 %7 19.08.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Identifying mental health disorders in migrant and refugee women during pregnancy provides an opportunity for interventions that may benefit women and their families. Evidence suggests that perinatal mental health disorders impact mother-infant attachment at critical times, which can affect child development. Postnatal depression resulting in suicide is one of the leading causes of maternal mortality postpartum. Routine screening of perinatal mental health is recommended to improve the identification of depression and anxiety and to facilitate early management. However, screening is poorly implemented into routine practice. This study is the first to investigate routine screening for perinatal mental health in a maternity setting designed for refugee women. This study will determine whether symptoms of depression and anxiety are more likely to be detected by the screening program compared with routine care and will evaluate the screening program’s feasibility and acceptability to women and health care providers (HCPs). Objective: The objectives of this study are (1) to assess if refugee women are more likely to screen risk-positive for depression and anxiety than nonrefugee women, using the Edinburgh Postnatal Depression Scale (EPDS); (2) to assess if screening in pregnancy using the EPDS enables better detection of symptoms of depression and anxiety in refugee women than current routine care; (3) to determine if a screening program for perinatal mental health in a maternity setting designed for refugee women is acceptable to women; and (4) to evaluate the feasibility and acceptability of the perinatal mental health screening program from the perspective of HCPs (including the barriers and enablers to implementation). Methods: This study uses an internationally recommended screening measure, the EPDS, and a locally developed psychosocial questionnaire, both administered in early pregnancy and again in the third trimester. These measures have been translated into the most common languages used by the women attending the clinic and are administered via an electronic platform (iCOPE). This platform automatically calculates the EPDS score and generates reports for the HCP and woman. A total of 119 refugee women and 155 nonrefugee women have been recruited to evaluate the screening program’s ability to detect depression and anxiety symptoms and will be compared with 34 refugee women receiving routine care. A subsample of women will participate in a qualitative assessment of the screening program’s acceptability and feasibility. Health service staff have been recruited to evaluate the integration of screening into maternity care. Results: The recruitment is complete, and data collection and analysis are underway. Conclusions: It is anticipated that screening will increase the identification and management of depression and anxiety symptoms in pregnancy. New information will be generated on how to implement such a program in feasible and acceptable ways that will improve health outcomes for refugee women. International Registered Report Identifier (IRRID): DERR1-10.2196/13271 %M 31429411 %R 10.2196/13271 %U http://www.researchprotocols.org/2019/8/e13271/ %U https://doi.org/10.2196/13271 %U http://www.ncbi.nlm.nih.gov/pubmed/31429411 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 5 %P e10778 %T A Group-Based Online Intervention to Prevent Postpartum Depression (Sunnyside): Feasibility Randomized Controlled Trial %A Duffecy,Jennifer %A Grekin,Rebecca %A Hinkel,Hannah %A Gallivan,Nicholas %A Nelson,Graham %A O'Hara,Michael W %+ Department of Psychiatry, College of Medicine, University of Illinois at Chicago, 912 S Wood, Chicago, IL, 60612, United States, 1 3124131225, jduffecy@gmail.com %K postpartum depression %K cognitive behavioral therapy %K internet %K social support %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Postpartum depression (PPD) has a 20% 3-month prevalence rate. The consequences of PPD are significant for the mother, infant, and the family. There is a need for preventive interventions for PPD, which are effective and accessible; however, many barriers exist for women who attempt to access perinatal depression prevention programs. Internet interventions for the treatment and prevention of depression are widely accepted as efficacious and may overcome some of the issues pertaining to access to treatment barriers perinatal women face. However, internet interventions offered without any human support tend to have low adherence but positive outcomes for those who do complete treatment. Internet support groups often have high levels of adherence but minimal data supporting efficacy as a treatment for depression. Taken together, these findings suggest that combining the treatment components of individual interventions with the support provided by an internet support group might create an intervention with the scalability and cost-effectiveness of an individual intervention and the better outcomes typically found in supported interventions. Objectives: This study aimed to describe the development of a cognitive behavioral therapy (CBT) internet intervention with peer support to prevent PPD and examine preliminary depression and site usage outcomes. Methods: User-centered design groups were used to develop the internet intervention. Once the intervention was developed, women who were 20 to 28 weeks pregnant with symptoms of depression (Patient Health Questionnaire-8 scores of 5-14) but who had no major depression diagnosis were enrolled in a randomized controlled trial (RCT) to compare 8 weeks of a CBT-based internet intervention with peer support to an individual internet intervention designed to prevent PPD. Assessments took place at baseline, 4 weeks, 8 weeks (end of treatment), and then 4 weeks and 6 weeks postpartum. Results: A total of 25 women were randomized. Of these, 24 women completed the RCT. Patient Health Questionnaire-9 scores at 6 weeks postpartum remained below the clinical threshold for referral for treatment in both groups, with depression measures showing a decrease in symptoms from baseline to postpartum. At 6 weeks postpartum, only 4% (1/24) met the criteria for PPD. There was no difference between groups in adherence to the intervention, with an average of 14.55 log-ins over the course of treatment. Conclusions: Results suggest women were responsive to both peer support and individual internet interventions to prevent PPD and that peer support may be a useful feature to keep participants adherent. Trial Registration: ClinicalTrials.gov NCT02121015; https://clinicaltrials.gov/ct2/show/NCT02121015 (archived by WebCite at http://www.webcitation.org/765a7qBKy) %M 31140443 %R 10.2196/10778 %U http://mental.jmir.org/2019/5/e10778/ %U https://doi.org/10.2196/10778 %U http://www.ncbi.nlm.nih.gov/pubmed/31140443 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e12794 %T Using Smartphone-Based Psychoeducation to Reduce Postnatal Depression Among First-Time Mothers: Randomized Controlled Trial %A Chan,Ko Ling %A Leung,Wing Cheong %A Tiwari,Agnes %A Or,Ka Lun %A Ip,Patrick %+ Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong,, China (Hong Kong), 852 2766 5709, koling.chan@polyu.edu.hk %K smartphone technology %K postnatal depression %K psychoeducation %K randomized controlled trial %D 2019 %7 14.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-based psychoeducation interventions may be a low-cost, user-friendly alternative to resource-consuming, face-to-face antenatal classes to educate expectant mothers. Objective: This study aimed to empirically examine whether such an intervention would lead to reduced postnatal depression, anxiety, or stress and result in a better health-related quality of life. Methods: A single-blind randomized controlled trial was conducted in Hong Kong. All first-time expectant mothers with less than 24 weeks of gestation remaining and attending the antenatal clinic at a public hospital were included. Participants were assigned to the intervention group or the control group by drawing lots. The lots, presented in sealed opaque envelopes, were randomly designated as “intervention” or “control” by stratified randomization. The intervention, a psychoeducational mobile app, was provided in addition to the treatment as usual (TAU) services from the hospital. Follow up with participants took place at 4 weeks postpartum. The primary outcome was the difference in the levels of antenatal and postnatal depression, assessed by the Edinburgh Postnatal Depression Scale (EPDS). The intention-to-treat approach was employed in the analyses. Results: The final sample was 660 expectant mothers (nintervention=330 and ncontrol=330). The mean difference in EPDS scores between the two groups was −0.65 (95% CI −1.29 to 0.00; P=.049) after adjusting for confounding factors. Associations were found between participation in the intervention and reduced depression, and attendance in TAU classes and increased stress levels. Conclusions: The smartphone-based intervention plus TAU services was effective in reducing postnatal depression at 4 weeks postpartum compared with a control condition of TAU only, making this a cost-effective alternative to TAU education for expectant mothers. Limitations of the study included the short postpartum period after which the follow-up assessment was conducted and the inclusion of first-time mothers rather than all mothers. Trial Registration: HKU Clinical Trials Registry HKUCTR-2024; http://www.hkuctr.com/Study/Show/ 34f62a2f6d594273a290491827206384 %M 31094354 %R 10.2196/12794 %U http://mhealth.jmir.org/2019/5/e12794/ %U https://doi.org/10.2196/12794 %U http://www.ncbi.nlm.nih.gov/pubmed/31094354 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e11800 %T Expanding Access to Depression Treatment in Kenya Through Automated Psychological Support: Protocol for a Single-Case Experimental Design Pilot Study %A Green,Eric P %A Pearson,Nicholas %A Rajasekharan,Sathyanath %A Rauws,Michiel %A Joerin,Angela %A Kwobah,Edith %A Musyimi,Christine %A Bhat,Chaya %A Jones,Rachel M %A Lai,Yihuan %+ Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, United States, 1 919 681 7289, eric.green@duke.edu %K telemedicine %K mental health %K depression %K artificial intelligence %K Kenya %K text messaging %K chatbot %K conversational agent %D 2019 %7 29.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression during pregnancy and in the postpartum period is associated with a number of poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown great potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings, but there are significant barriers to scale-up. We are addressing this gap by adapting Thinking Healthy for automated delivery via a mobile phone. This new intervention, Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users. Objective: The objective of this pilot study is to test the Healthy Moms perinatal depression intervention using a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya. Methods: We will invite patients to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants will be randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. Participants will be prompted to rate their mood via short message service every 3 days during the baseline and intervention periods. We will review system logs and conduct in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. We will use visual inspection, in-depth interviews, and Bayesian estimation to generate preliminary data about the potential response to treatment. Results: Our team adapted the intervention content in April and May 2018 and completed an initial prepilot round of formative testing with 10 women from a private maternity hospital in May and June. In preparation for this pilot study, we used feedback from these users to revise the structure and content of the intervention. Recruitment for this protocol began in early 2019. Results are expected toward the end of 2019. Conclusions: The main limitation of this pilot study is that we will recruit women who live in urban and periurban centers in one part of Kenya. The results of this study may not generalize to the broader population of Kenyan women, but that is not an objective of this phase of work. Our primary objective is to gather preliminary data to know how to build and test a more robust service. We are working toward a larger study with a more diverse population. International Registered Report Identifier (IRRID): DERR1-10.2196/11800 %M 31033448 %R 10.2196/11800 %U http://www.researchprotocols.org/2019/4/e11800/ %U https://doi.org/10.2196/11800 %U http://www.ncbi.nlm.nih.gov/pubmed/31033448 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e11513 %T Video-Delivered Family Therapy for Home Visited Young Mothers With Perinatal Depressive Symptoms: Quasi-Experimental Implementation-Effectiveness Hybrid Trial %A Cluxton-Keller,Fallon %A Williams,Melony %A Buteau,Jennifer %A Donnelly,Craig L %A Stolte,Patricia %A Monroe-Cassel,Maggie %A Bruce,Martha L %+ Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 650 4724, Fallon.P.Cluxton-Keller@dartmouth.edu %K videoconferencing %K family therapy, depression %D 2018 %7 10.12.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: The Federal Maternal, Infant, and Early Childhood Home Visiting Program is a national child abuse prevention strategy that serves families at risk for child maltreatment throughout the United States. Significant portions of the clients are young mothers who screen positive for clinically significant perinatal depressive symptoms and experience relational discord that worsens their symptoms. Although home visitors refer those who screen positive for depression to community-based treatment, they infrequently obtain treatment because of multiple barriers. These barriers are compounded for home visited families in rural areas. Objective: This pilot study aimed to explore the feasibility, acceptability, and effectiveness of a video-delivered family therapy intervention on reducing maternal depressive symptoms and improving family functioning and emotion regulation. Methods: A total of 13 home visited families received the video-delivered family therapy intervention. This study included a historical comparison group of mothers (N=13) who were previously enrolled in home visiting and screened positive for clinically significant perinatal depressive symptoms but refused treatment. A licensed marriage and family therapist delivered the family therapy intervention using Health Insurance Portability and Accountability Act–compliant videoconferencing technology on a computer from an office. Families participated in sessions in their homes using cell phones, tablets, and computers equipped with microphones and video cameras. Outcomes were measured following the final therapy session (post intervention) and 2 months later (follow-up). Depressive symptom scores of mothers who received the video-delivered family therapy intervention were compared with those of mothers in the historical comparison group over a 6-month period. Univariate statistics and correlations were calculated to assess measures of feasibility. Percentages and qualitative thematic analysis were used to assess acceptability. Wilcoxon signed-rank tests were used to assess changes in maternal and family outcomes. Results: No families dropped out of the study. All families reported that the technology was convenient and easy to use. All families reported high satisfaction with the video-delivered intervention. Nearly all families reported that they preferred video-delivered family therapy instead of clinic-based therapy. Therapeutic alliance was strong. Mothers demonstrated a statistically significant reduction in depressive symptoms (P=.001). When compared with mothers in the historical comparison group, those in the family therapy intervention showed a significant reduction in depressive symptoms (P=.001). Families demonstrated statistically significant improvements in family functioning (P=.02) and cognitive reappraisal (P=.004). Conclusions: This pilot study yielded preliminary findings that support the feasibility, acceptability, and effectiveness of the video-delivered family therapy intervention for underserved home visited families in rural areas. Our findings are very promising, but more research is needed to ultimately influence mental health practices and policies that pertain to video-delivered mental health interventions in unsupervised settings (eg, homes). %M 30530456 %R 10.2196/11513 %U http://mental.jmir.org/2018/4/e11513/ %U https://doi.org/10.2196/11513 %U http://www.ncbi.nlm.nih.gov/pubmed/30530456 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e11508 %T The Association Between the Use of Antenatal Care Smartphone Apps in Pregnant Women and Antenatal Depression: Cross-Sectional Study %A Mo,Yushi %A Gong,Wenjie %A Wang,Joyce %A Sheng,Xiaoqi %A Xu,Dong R %+ XiangYa School of Public Health, Central South University, 238 Shangmayuanling Lane, Xiangya Road, KaiFu District, Changsha,, China, 86 13607445252, gongwenjie@csu.edu.cn %K antenatal care %K antenatal depression %K app %K mobile phone %D 2018 %7 29.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Antenatal care smartphone apps are increasingly used by pregnant women, but studies on their use and impact are scarce. Objective: This study investigates the use of antenatal care apps in pregnant women and explores the association between the use of these apps and antenatal depression. Methods: This study used a convenient sample of pregnant women recruited from Hunan Provincial Maternal and Child Health Hospital in November 2015. The participants were surveyed for their demographic characteristics, use of antenatal care apps, and antenatal depression. Factors that influenced antenatal pregnancy were analyzed using logistic regression. Results: Of the 1304 pregnant women, 71.31% (930/1304) used antenatal care apps. Higher usage of apps was associated with urban residency, nonmigrant status, first pregnancy, planned pregnancy, having no previous children, and opportunity to communicate with peer pregnant women. The cutoff score of the Edinburgh Postnatal Depression Scale was 10, and 46.11% (601/1304) of the pregnant women had depression. Logistic regression showed that depression was associated with the availability of disease-screening functions in the apps (odds ratio (OR) 1.78, 95% CI 1.03-3.06) and spending 30 minutes or more using the app (OR 2.05, 95% CI 1.19-3.52). Using apps with social media features was a protective factor for antenatal depression (OR 0.33, 95% CI 0.12-0.89). Conclusions: The prevalence of the use of prenatal care apps in pregnant women is high. The functions and time spent on these apps are associated with the incidence of antenatal depression. %M 30497996 %R 10.2196/11508 %U http://mhealth.jmir.org/2018/11/e11508/ %U https://doi.org/10.2196/11508 %U http://www.ncbi.nlm.nih.gov/pubmed/30497996 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e10007 %T A Mobile App for the Self-Report of Psychological Well-Being During Pregnancy (BrightSelf): Qualitative Design Study %A Doherty,Kevin %A Barry,Marguerite %A Marcano-Belisario,José %A Arnaud,Bérenger %A Morrison,Cecily %A Car,Josip %A Doherty,Gavin %+ School of Computer Science and Statistics, Trinity College Dublin, College Green, Dublin,, Ireland, 353 1 8963858, Gavin.Doherty@tcd.ie %K engagement %K mental health %K mHealth %K midwifery %K perinatal depression %K pregnancy %K self-report %K well-being %K mobile phone %D 2018 %7 27.11.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Maternal mental health impacts both parental well-being and childhood development. In the United Kingdom, 15% of women are affected by depression during pregnancy or within 1 year of giving birth. Suicide is a leading cause of perinatal maternal mortality, and it is estimated that >50% of perinatal depression cases go undiagnosed. Mobile technologies are potentially valuable tools for the early recognition of depressive symptoms, but complex design challenges must be addressed to enable their use in public health screening. Objective: The aim of this study was to explore the issues and challenges surrounding the use of mobile phones for the self-report of psychological well-being during pregnancy. Methods: This paper presents design research carried out as part of the development of BrightSelf, a mobile app for the self-report of psychological well-being during pregnancy. Design sessions were carried out with 38 participants, including pregnant women, mothers, midwives, and other health professionals. Overall, 19 hours of audio were fully transcribed and used as the basis of thematic analysis. Results: The study highlighted anxieties concerning the pregnancy journey, challenges surrounding current approaches to the appraisal of well-being in perinatal care, and the midwife-patient relationship. Designers should consider the framing of perinatal mental health technologies, the experience of self-report, supporting self-awareness and disclosure, providing value to users through both self-report and supplementary features, and designing for longitudinal engagement. Conclusions: This study highlights the needs, motivations, and anxieties of women with respect to technology use in pregnancy and implications for the design of mobile health technologies. %M 30482742 %R 10.2196/10007 %U http://mental.jmir.org/2018/4/e10007/ %U https://doi.org/10.2196/10007 %U http://www.ncbi.nlm.nih.gov/pubmed/30482742 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 11 %P e11624 %T Comparing the Effectiveness of Clinicians and Paraprofessionals to Reduce Disparities in Perinatal Depression via the Mothers and Babies Course: Protocol for a Cluster-Randomized Controlled Trial %A Jensen,Jessica K %A Ciolino,Jody D %A Diebold,Alicia %A Segovia,Melissa %A Degillio,Aria %A Solano-Martinez,Jesus %A Tandon,S Darius %+ Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, United States, 1 3125036808, jessica.jensen@northwestern.edu %K depression %K postpartum %K pregnancy %K randomized controlled trial %K community health %D 2018 %7 20.11.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum depression is highly prevalent in low-income women and has significant health and mental health effects on mother and child. Home visiting (HV) programs provide services to large numbers of perinatal women in the United States and are a logical setting for delivering mental health services. Although there are interventions that reduce the risk of developing postpartum depression among low-income women, none have used nonhealth or nonmental health professionals as interventionists. Objective: This study aimed to outline the protocol of a cluster randomized trial funded by the Patient-Centered Outcomes Research Institute that evaluates whether the Mothers and Babies (MB) group intervention, when led by paraprofessional home visitors, is more efficacious than usual care. It will also examine if MB, when led by home visitors, is not inferior to MB delivered by mental health professionals (MHPs). MB has previously demonstrated efficacy when delivered by MHPs, and pilot work indicated promising results using home visitors to deliver the intervention. Methods: A cluster randomized trial is being conducted with 38 HV programs. Sixteen HV programs will deliver MB using MHPs, 16 will deliver MB using paraprofessional home visitors, and 6 will deliver usual HV services. The study employs a modified covariate-constrained randomization design at the site level. We anticipate recruiting 933 women aged ≥16 years enrolled in HV programs, who are 33 or more weeks’ gestation and speak either English or Spanish. Women in the 2 intervention arms will receive the 6-session MB group intervention. Baseline, postintervention, 12-week postpartum, and 24-week postpartum assessments will be conducted to assess client outcomes. The primary outcome will be the change in Quick Inventory of Depressive Symptomatology Self-Report 16 scores from baseline to 24-week follow-up. Secondary outcomes associated with core MB content will also be examined. Semistructured interviews will be conducted with home visitors and MHPs who are group facilitators and 90 study participants to gain data on intervention successes and challenges. Analyses will proceed at the participant level. Primary analyses for depressive symptoms score at 24 weeks postpartum will involve a linear mixed model, controlling for baseline symptoms and other covariates, and random effects to account for clustering. Results: We have recruited 838 women through the end of August 2018. Recruitment will be completed at the end of September 2018. Conclusions: There is considerable potential to disseminate MB to HV programs throughout the United States. Should our results demonstrate home visitor efficacy when compared with usual care and/ noninferiority between home visitors and MHPs in improving mental health outcomes, no additional financial resources would be required for the existing HV staff to implement MB. Should this study determine that home visitors are less effective than MHPs, we will generate more wide-scale evidence on MB effectiveness when led by MHPs. Trial Registration: ClinicalTrials.gov NCT02979444; https://clinicaltrials.gov/ct2/show/NCT02979444 (Archived by Webcite at http://www.webcitation.org/archive.php) International Registered Report Identifier (IRRID): PRR1-10.2196/11624 %M 30459138 %R 10.2196/11624 %U http://www.researchprotocols.org/2018/11/e11624/ %U https://doi.org/10.2196/11624 %U http://www.ncbi.nlm.nih.gov/pubmed/30459138 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e38 %T Digital Peer-Support Platform (7Cups) as an Adjunct Treatment for Women With Postpartum Depression: Feasibility, Acceptability, and Preliminary Efficacy Study %A Baumel,Amit %A Tinkelman,Amanda %A Mathur,Nandita %A Kane,John M %+ Department of Community Mental Health, University of Haifa, Abba Khoushy Ave 199, Haifa,, Israel, 972 482 4011, abaumel@univ.haifa.ac.il %K mhealth %K postpartum depression %K perinatal mood disorder %K peer support %K online %K self-help %D 2018 %7 13.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Peer support is considered to be an important framework of support for mothers experiencing postpartum depression (PPD); however, some barriers exist that may limit its use including peer availability and mothers’ lack of time due to child care. Objective: This non-randomized study was designed to examine the feasibility, acceptance, and preliminary clinical outcomes of using 7 Cups of Tea (7Cups), a digital platform that delivers self-help tools and 24/7 emotional support delivered by trained volunteers, as an adjunct treatment for mothers diagnosed with PPD. Methods: Mothers with PPD were referred during intake to the study coach who provided guidance about 7Cups. 7Cups features included self-help tools and chats with trained volunteers who had experienced a perinatal mood disorder in their past. Acceptability was measured by examining self-reports and user engagement with the program. The primary outcome was the Edinburgh Postnatal Depression Scale (EPDS) change score between pre- and postintervention at 2 months, as collected in usual care by clinicians blinded to the study questions. Using a propensity score matching to control for potential confounders, we compared women receiving 7Cups to women receiving treatment as usual (TAU). Results: Participants (n=19) proactively logged into 7Cups for a median of 12 times and 175 minutes. Program use was mostly through the mobile app (median of mobile use 94%) and between 18:00 and 08:00 when clinicians are unavailable (68% of total program use time). Participants chatted with volunteers for a total of 3064 minutes and have indicated in their responses 0 instances in which they felt unsafe. Intent-to-treat analysis revealed that 7Cups recipients experienced significant decreases in EPDS scores (P<.001, Cohen d=1.17). No significant difference in EPDS decrease over time was found between 7Cups and TAU, yet the effect size was medium favoring 7Cups (P=.05, Cohen d=0.58). Conclusions: This study supports using a computerized method to train lay people, without any in-person guidance or screening, and engage them with patients diagnosed with mental illness as part of usual care. The medium effect size (d=0.58) favoring the 7Cups group relative to TAU suggests that 7Cups might enhance treatment outcomes. A fully powered trial has to be conducted to examine this effect. %M 29439944 %R 10.2196/mhealth.9482 %U http://mhealth.jmir.org/2018/2/e38/ %U https://doi.org/10.2196/mhealth.9482 %U http://www.ncbi.nlm.nih.gov/pubmed/29439944 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e37 %T Text-Based Program Addressing the Mental Health of Soon-to-be and New Fathers (SMS4dads): Protocol for a Randomized Controlled Trial %A Fletcher,Richard %A May,Chris %A Attia,John %A Garfield,Craig Franklin %A Skinner,Geoff %+ Family Action Centre, Faculty of Health and Medicine, University of Newcastle, Academic Office Block, University Drive, Callaghan, 2308, Australia, 61 0429152405, richard.fletcher@newcastle.edu.au %K perinatal %K fathers %K online intervention %K randomized controlled trial %K mental health %D 2018 %7 06.02.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent estimates indicating that approximately 10% of fathers experience Paternal Perinatal Depression (PPND) and the increasing evidence of the impact of PPND on child development suggest that identifying and assisting distressed fathers is justified on public health grounds. However, addressing new fathers’ mental health needs requires overcoming men’s infrequent contact with perinatal health services and their reluctance to seek help. Text-based interventions delivering information and support have the potential to reach such groups in order to reduce the impact of paternal perinatal distress and to improve the wellbeing of their children. While programs utilising mobile phone technology have been developed for mothers, fathers have not been targeted. Since text messages can be delivered to individual mobile phones to be accessed at a time that is convenient, it may provide a novel channel for engaging with “hard-to-reach” fathers in a critical period of their parenting. Objective: The study will test the efficacy of SMS4dads, a text messaging program designed specifically for fathers including embedded links to online information and regular invitations (Mood Tracker) to monitor their mood, in order to reduce self-reported depression, anxiety and stress over the perinatal period. Methods: A total of 800 fathers-to-be or new fathers from within Australia will be recruited via the SMS4dads website and randomized to the intervention or control arm. The intervention arm will receive 14 texts per month addressing fathers’ physical and mental health, their relationship with their child, and coparenting with their partner. The control, SMS4health, delivers generic health promotion messages twice per month. Messages are timed according to the babies’ expected or actual date of birth and fathers can enroll from 16 weeks into the pregnancy until their infant is 12 weeks of age. Participants complete questionnaires assessing depression, anxiety, stress, and alcohol at baseline and 24 weeks postenrolment. Measures of coparenting and parenting confidence are also completed at baseline and 24 weeks for postbirth enrolments. Results: Participant were recruited between October 2016 and September 2017. Follow-up data collection has commenced and will be completed in March 2018 with results expected in June 2018. Conclusions: This study’s findings will assess the efficacy of a novel text-based program specifically targeting fathers in the perinatal period to improve their depression, anxiety and distress symptoms, coparenting quality, and parenting self-confidence. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000261415; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370085 (Archived by WebCite at http://www.webcitation.org/6wav55wII). %M 29410387 %R 10.2196/resprot.8368 %U http://www.researchprotocols.org/2018/2/e37/ %U https://doi.org/10.2196/resprot.8368 %U http://www.ncbi.nlm.nih.gov/pubmed/29410387 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 1 %P e35 %T The Effectiveness and Cost-Effectiveness of Web-Based and Home-Based Postnatal Psychoeducational Interventions for First-Time Mothers: Randomized Controlled Trial Protocol %A He,Honggu %A Zhu,Lixia %A Chan,Sally Wai Chi %A Chong,Yap-Seng %A Jiao,Nana %A Chan,Yiong Huak %A Luo,Nan %A Shorey,Shefaly %+ Alice Lee Centre for Nursing Studies, National University of Singapore, Level 2 Clinical Research Centre, Block MD 11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66011294 ext 1294, nurssh@nus.edu.sg %K mothers %K education %K postpartum period %K Internet %D 2018 %7 31.01.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: In addition to recuperating from the physical and emotional demands of childbirth, first-time mothers are met with demands of adapting to their social roles while picking up new skills to take care of their newborn. Mothers may not feel adequately prepared for parenthood if they are situated in an unsupported environment. Postnatal psychoeducational interventions have been shown to be useful and can offer a cost-effective solution for improving maternal outcomes. Objective: The objective of this study was to examine the effectiveness and cost-effectiveness of Web-based and home-based postnatal psychoeducational programs for first-time mothers on maternal outcomes. Methods: A randomized controlled three-group pre- and posttests experimental design is proposed. This study plans to recruit 204 first-time mothers on their day of discharge from a public tertiary hospital in Singapore. Eligible first-time mothers will be randomly allocated to either a Web-based psychoeducation group, a home-based psychoeducation group, or a control group receiving standard care. The outcomes include maternal parental self-efficacy, social support, psychological well-being (anxiety and postnatal depression), and cost evaluation. Data will be collected at baseline, 1 month, 3 months, and 6 months post-delivery. Results: The recruitment (n=204) commenced in October 2016 and was completed in February 2017, with 68 mothers in each group. The 6-month follow-up data collection was completed in August 2017. Conclusions: This study may identify an effective and cost-effective Web-based postnatal psychoeducational program to improve first-time mothers’ health outcomes. The provision of a widely-accessed Web-based postnatal psychoeducational program will eventually lead to more positive postnatal experiences for first-time mothers and positively influence their future birth plans. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 45202278; http://www.isrctn.com/ISRCTN45202278 (Archived by WebCite at http://www.webcitation.org/6whx0pQ2F). %M 29386175 %R 10.2196/resprot.9042 %U http://www.researchprotocols.org/2018/1/e35/ %U https://doi.org/10.2196/resprot.9042 %U http://www.ncbi.nlm.nih.gov/pubmed/29386175 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e42 %T Pregnant Women’s Perceptions of the Risks and Benefits of Disclosure During Web-Based Mental Health E-Screening Versus Paper-Based Screening: Randomized Controlled Trial %A Kingston,Dawn %A Biringer,Anne %A Veldhuyzen van Zanten,Sander %A Giallo,Rebecca %A McDonald,Sarah %A MacQueen,Glenda %A Vermeyden,Lydia %A Austin,Marie-Paule %+ University of Calgary, 2500 University Ave NW, Calgary, AB, T2N 1N4, Canada, 1 4032202634, dawn.kingston@ucalgary.ca %K pregnancy %K mental health %K screening %K prenatal care %K computers %D 2017 %7 20.10.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Pregnant women’s perceptions of the risks and benefits during mental health screening impact their willingness to disclose concerns. Early research in violence screening suggests that such perceptions may vary by mode of screening, whereby women view the anonymity of e-screening as less risky than other approaches. Understanding whether mode of screening influences perceptions of risk and benefit of disclosure is important in screening implementation. Objective: The objective of this randomized controlled trial was to compare the perceptions of pregnant women randomized to a Web-based screening intervention group and a paper-based screening control group on the level of risk and benefit they perceive in disclosing mental health concerns to their prenatal care provider. A secondary objective was to identify factors associated with women’s perceptions of risk and benefit of disclosure. Methods: Pregnant women recruited from maternity clinics, hospitals, and prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a computer tablet, whereas the control group completed them on paper. The primary outcome was women’s perceptions of the risk and benefits of mental health screening using the Disclosure Expectations Scale (DES). A completer analysis was conducted. Statistical significance was set at P<.05. We used t tests to compare the means of the risk and benefit subscales between groups. Results: Of the 675 eligible women approached, 636 (94.2%) agreed to participate and were randomized to the intervention (n=305) and control (n=331) groups. There were no significant baseline differences between groups. The mode of screening was not associated with either perceived risk or benefit of screening. There were no differences in groups in the mean scores of the risk and benefit of disclosure subscales. Over three-quarters of women in both intervention and control groups perceived that mental health screening was beneficial. However, 43.1% (272/631) of women in both groups reported feeling very, moderately, or somewhat vulnerable during mental health screening. We found that women of low income, those treated previously for depression or anxiety, and those pregnant with their first child were more likely to perceive greater risk. However, these associations were very small. Conclusions: Pregnant women in both the e-screening and paper-based screening groups perceived benefit and risk of disclosure similarly, suggesting that providers can implement the mode of screening that is most ideal for their clinical setting. Regardless of the mode of screening, a substantial number of women reported feeling vulnerable during mental health screening, highlighting the importance of the need to reduce women’s vulnerability throughout the screening process with strategies such as addressing women’s concerns, explaining the rationale for screening, and discussing how results will be used. Trial Registration: Clinicaltrials.gov NCT01899534; https://clinicaltrials.gov/ct2/show/NCT01899534 (Archived by WebCite at http://www.webcitation.org/6tRKtGC4M) %M 29054833 %R 10.2196/mental.6888 %U http://mental.jmir.org/2017/4/e42/ %U https://doi.org/10.2196/mental.6888 %U http://www.ncbi.nlm.nih.gov/pubmed/29054833 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 9 %P e236 %T The Implementation of Internet Interventions for Depression: A Scoping Review %A Drozd,Filip %A Vaskinn,Linda %A Bergsund,Hans Bugge %A Haga,Silje Marie %A Slinning,Kari %A Bjørkli,Cato Alexander %+ National Network for Infant Mental Health, Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, PO Box 4623 Nydalen, Oslo, 0405, Norway, 47 975 16 188, filip.drozd@r-bup.no %K depression %K scoping review %K implementation %K Internet interventions %D 2016 %7 08.09.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is one of the most common mental health problems among adults, but effective treatments are not widely accessible. The Internet holds promise as a cost-effective and convenient delivery platform of interventions for depression. However, studies suggest that Internet interventions are not widely available in routine settings. Objective: The aim of this study was to review the literature and examine whether there are systematic differences in reporting of the various implementation components on Internet interventions for depression, and then to examine what is known about and is characteristic of the implementation of these Internet interventions in regular care settings. Methods: We performed a scoping review, drawing upon a broad range of the literature on Internet interventions for depression in regular care, and used the active implementation framework to extract data. Results: Overall, the results suggested that knowledge about the implementation of Internet interventions for depression in regular care is limited. However, guided support from health professionals emphasizing program adherence and recruitment of end users to the interventions emerged as 2 main themes. We identified 3 additional themes among practitioners, including their qualifications, training, and supervision, but these were scarcely described in the literature. The competency drivers (ie, staff and user selection, training, and supervision) have received the most attention, while little attention has been given to organizational (ie, decision support, administration, and system intervention) and leadership drivers. Conclusions: Research has placed little emphasis on reporting on the implementation of interventions in practice. Leadership and organizational drivers, in particular, have been largely neglected. The results of this scoping review have implications for future research and efforts to successfully implement Internet interventions for depression in regular care. %M 27608548 %R 10.2196/jmir.5670 %U http://www.jmir.org/2016/9/e236/ %U https://doi.org/10.2196/jmir.5670 %U http://www.ncbi.nlm.nih.gov/pubmed/27608548 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e140 %T Baby Steps - An Online Program Promoting the Well-Being of New Mothers and Fathers: A Study Protocol %A Hamilton,Kyra %A Kavanagh,David %A Connolly,Jennifer %A Davis,Leigh %A Fisher,Jane %A Halford,Kim %A Hides,Leanne %A Milgrom,Jeannette %A Rowe,Heather %A Sanders,Davina %A Scuffham,Paul A %A Tjondronegoro,Dian %A Walsh,Anne %A White,Katherine M %A Wittkowski,Anja %+ Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, 62 Graham Street, Brisbane, 4101, Australia, 1 7 3069 7327, david.kavanagh@qut.edu.au %K Perinatal %K Wellbeing %K Fathers %K Mothers %K Online Intervention %K Randomized Controlled Trial %K Quality of Life %K Mental Health %D 2016 %7 01.07.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Parental well-being can be seriously impacted during the challenging perinatal period. Most research and support services focus on perinatal psychopathology, leaving a need for programs that recognize and enhance the strengths and well-being of parents. Furthermore, fathers have received minimal attention and support relative to mothers, despite experiencing perinatal distress. New parents have limited time and energy to invest in program attendance, and web-based programs provide an ideal platform for delivering perinatal well-being programs. Such programs are globally accessible, available at any time, and can be accessed anywhere with an Internet connection. Objective: This paper describes the protocol of a randomized controlled trial investigating the effects on first-time parents’ perinatal well-being, comparing two versions of the online program Baby Steps. Methods: The clinical trial will randomize 240 primiparous mother-father couples to either (1) Babycare, an online information-only program providing tips on selected childcare issues, or (2) Well-being, an online interactive program including all content from the Babycare program, plus parental well-being-focused content with tools for goal-setting and problem solving. Both programs will be supported by short message service (SMS) texts at two, four, seven, and ten weeks to encourage continued use of the program. Primary outcomes will be measures of perinatal distress and quality of life. Secondary outcomes will be couple relationship satisfaction, parent self-efficacy, and social support. Cost-effectiveness will also be measured for each Baby Steps program. Results: Participant recruitment commenced March, 2015 and continued until October, 2015. Follow-up data collection has commenced and will be completed May, 2016 with results expected in July, 2016. Conclusions: Perinatal distress has substantial impacts on parents and their infants, with potential to affect later childhood adjustment, relationships, and development. This study aims to test the impact of a highly accessible online program to support parental coping, and maximize the well-being of both parents. By including fathers in the program, Baby Steps has the potential to engage and support this often neglected group who can make a substantial contribution to familial well-being. ClinicalTrial: Australian & New Zealand Clinical Trials Registry: ANZCTR12614001256662; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=367277 (Archived by WebCite at http://www.webcitation.org/6ibUsjFIL) %M 27370711 %R 10.2196/resprot.5706 %U http://www.researchprotocols.org/2016/3/e140/ %U https://doi.org/10.2196/resprot.5706 %U http://www.ncbi.nlm.nih.gov/pubmed/27370711 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 2 %P e18 %T A Thematic Analysis of Stigma and Disclosure for Perinatal Depression on an Online Forum %A Moore,Donna %A Ayers,Susan %A Drey,Nicholas %+ Centre for Maternal and Child Health, School of Health Sciences, City University London, Northampton Square, London, EC1V OHB, United Kingdom, 44 207 040 5060, Donna.Moore.1@city.ac.uk %K perinatal %K online %K Internet %K depression %K eHealth %D 2016 %7 19.05.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: Perinatal mental illness is a global health concern; however, many women do not get the treatment they need to recover. Some women choose not to seek professional help and get no treatment because they feel stigmatized. Online forums for various health conditions, including perinatal mental health, can be beneficial for members. Little is known about the role that online forums for perinatal mental illness play in reducing stigma and subsequent disclosure of symptoms to health care providers and treatment uptake. Objective: This study aimed to examine stigma and disclosure in forums and describe any potential disadvantages of forum use. Methods: An online forum for mothers was examined and 1546 messages extracted from 102 threads from the antenatal and postnatal depression section. These messages were subjected to deductive systematic thematic analysis to identify common themes regarding stigma and disclosure of symptoms and potential disadvantages of forum use. Results: Two major themes were identified: stigma and negative experiences of disclosure. Stigma had 3 subthemes: internal stigma, external stigma, and treatment stigma. Many women were concerned about feeling like a “bad” or “failed” mother and worried that if they disclosed their symptoms to a health care provider they would be stigmatized. Posts in response to this frequently encouraged women to disclose their symptoms to health care providers and accept professional treatment. Forum discourse reconstructed the ideology of motherhood as compatible with perinatal mental illness, especially if the woman sought help and adhered to treatment. Many women overcame stigma and replied that they had taken advice and disclosed to a health care provider and/or taken treatment. Conclusions: Forum use may increase women's disclosure to health care providers by challenging their internal and external stigma and this may strengthen professional treatment uptake and adherence. However, a few posts described negative experiences when disclosing to health care providers. %M 27197516 %R 10.2196/mental.5611 %U http://mental.jmir.org/2016/2/e18/ %U https://doi.org/10.2196/mental.5611 %U http://www.ncbi.nlm.nih.gov/pubmed/27197516 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 2 %P e65 %T Comparing Brief Internet-Based Compassionate Mind Training and Cognitive Behavioral Therapy for Perinatal Women: Study Protocol for a Randomized Controlled Trial %A Kelman,Alex R %A Stanley,Meagan L %A Barrera,Alinne Z %A Cree,Michelle %A Heineberg,Yotam %A Gilbert,Paul %+ Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, United States, 1 650 396 9349, akelman@paloaltou.edu %K perinatal depression %K comparative trial %K Internet intervention %K Amazon Mechanical Turk %D 2016 %7 15.04.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression that occurs during the perinatal period has substantial costs for both the mother and her baby. Since in-person care often falls short of meeting the global need of perinatal women, Internet interventions may function as an alternate to help women who currently lack adequate access to face-to-face psychological resources. However, at present there are insufficient empirically supported Internet-based resources for perinatal women. Objective: The aim of this study is to compare the relative efficacy of Internet-based cognitive behavioral therapy (CBT) to a novel Internet-based compassionate mind training approach (CMT) across measures of affect, self-reassurance, self-criticizing, self-attacking, self-compassion, depression, and anxiety. While CBT has been tested and has some support as an Internet tool for perinatal women, this is the first trial to look at CMT for perinatal women over the Internet. Methods: Participants were recruited through Amazon Mechanical Turk (MTurk) and professional networks. Following completion of demographic items, participants were randomly assigned to either the CBT or CMT condition. Each condition consisted of 45-minute interactive didactic and follow-up exercises to be completed over the course of two weeks. Results: Post course data was gathered at two weeks. A 2x2 repeated measures analysis of variance will be conducted to analyze differences between conditions at post course. Conclusions: The implications of the trial will be discussed as well as the strengths and limitations of MTurk as a tool for recruitment. We will also briefly introduce the future directions along this same line of research. Trial Registration: ClinicalTrials.gov NCT02469324; https://clinicaltrials.gov/ct2/show/NCT02469324 (Archived by WebCite at http://www.webcitation.org/6fkSG3yuW) %M 27084301 %R 10.2196/resprot.5332 %U http://www.researchprotocols.org/2016/2/e65/ %U https://doi.org/10.2196/resprot.5332 %U http://www.ncbi.nlm.nih.gov/pubmed/27084301 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 1 %P e11 %T Adjusting an Available Online Peer Support Platform in a Program to Supplement the Treatment of Perinatal Depression and Anxiety %A Baumel,Amit %A Schueller,Stephen M %+ The Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY, 11030, United States, 1 7184708267, abaumel@northwell.edu %K online %K peer %K support %K perinatal %K postpartum %K depression %K anxiety %D 2016 %7 21.03.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: Perinatal depression and anxiety are common and debilitating conditions. Novel, cost effective services could improve the uptake and the impact of mental health resources among women who suffer from these conditions. E-mental health products are one example of such services. Many publically available e-mental health products exist, but these products lack validation and are not designed to be integrated into existing health care settings. Objective: The objective of the study was to present a program to use 7 Cups of Tea (7Cups), an available technological platform that provides online peer (ie, listener) based emotional support, to supplement treatment for women experiencing perinatal depression or anxiety and to summarize patient’s feedback on the resultant program. Methods: This study consisted of two stages. First, five clinicians specializing in the treatment of perinatal mood disorders received an overview of 7Cups. They provided feedback on the 7Cups platform and ways it could complement the existing treatment efforts to inform further adjustments. In the second stage, nine women with perinatal depression or anxiety used the platform for a single session and provided feedback. Results: In response to clinicians’ feedback, guidelines for referring patients to use 7Cups as a supplement for treatment were created, and a training program for listeners was developed. Patients found the platform usable and useful and their attitudes toward the trained listeners were positive. Overall, patients noted a need for support outside the scheduled therapy time and believed that freely available online emotional support could help meet this need. Most patients were interested in receiving support from first time mothers and those who suffered in the past from perinatal mood disorders. Conclusions: The study results highlight the use of 7Cups as a tool to introduce accessible and available support into existing treatment for women who suffer from perinatal mood disorders. Further research should focus on the benefits accrued from such a service. However, this article highlights how a publicly available eHealth product can be leveraged to create new services in a health care setting. %M 27001373 %R 10.2196/mental.5335 %U http://mental.jmir.org/2016/1/e11/ %U https://doi.org/10.2196/mental.5335 %U http://www.ncbi.nlm.nih.gov/pubmed/27001373 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e54 %T Internet Cognitive Behavioral Therapy for Women With Postnatal Depression: A Randomized Controlled Trial of MumMoodBooster %A Milgrom,Jeannette %A Danaher,Brian G %A Gemmill,Alan W %A Holt,Charlene %A Holt,Christopher J %A Seeley,John R %A Tyler,Milagra S %A Ross,Jessica %A Ericksen,Jennifer %+ Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital Austin Health 330 Waterdale Road Heidelberg Heights, Melbourne, 3081, Australia, 61 03 9496 ext 4468, alan.gemmill@austin.org.au %K postnatal depression %K postpartum depression %K cognitive behavioral therapy %K Internet-based intervention %K randomized controlled trial %D 2016 %7 07.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: There are few published controlled trials examining the efficacy of Internet-based treatment for postnatal depression (PND) and none that assess diagnostic status (clinical remission) as the primary outcome. This is despite the need to improve treatment uptake and accessibility because fewer than 50% of postnatally depressed women seek help, even when identified as depressed. Objective: In a randomized controlled trial (RCT), we aimed to test the efficacy of a 6-session Internet intervention (the MumMoodBooster program, previously evaluated in a feasibility trial) in a sample of postnatal women with a clinical diagnosis of depression. The MumMoodBooster program is a cognitive behavioral therapy (CBT) intervention, is highly interactive, includes a partner website, and was supported by low-intensity telephone coaching. Methods: This was a parallel 2-group RCT (N=43) comparing the Internet CBT treatment (n=21) to treatment as usual (n=22). At baseline and at 12 weeks after enrollment, women’s diagnostic status was assessed by telephone with the Standardized Clinical Interview for DSM-IV (SCID-IV) and symptom severity with the Beck Depression Inventory (BDI-II). Depression symptoms were measured repeatedly throughout the study period with the Patient Health Questionnaire (PHQ-9). Results: At the end of the study, 79% (15/19) of women who received the Internet CBT treatment no longer met diagnostic criteria for depression on the SCID-IV (these outcome data were missing for 2 intervention participants). This contrasted with only 18% (4/22) remission in the treatment as usual condition. Depression scores on the BDI-II showed a large effect favoring the intervention group (d=.83, 95% CI 0.20-1.45). Small to medium effects were found on the PHQ-9 and on measures of anxiety and stress. Adherence to the program was very good with 86% (18/21) of users completing all sessions; satisfaction with the program was rated 3.1 out of 4 on average. Conclusions: Our results suggest that our Internet CBT program, MumMoodBooster, is an effective treatment option for women clinically diagnosed with PND. This is one of only two controlled evaluations of specialized online psychological treatment among women clinically diagnosed with PND. MumMoodBooster appears to be a feasible, effective treatment option, which is potentially accessible to large numbers of women in metropolitan, rural, and remote areas. Future work might be focused profitably on establishing comparability with face-to-face treatments and purely self-guided delivery. We have commenced a larger RCT comparing MumMoodBooster with face-to-face CBT. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000113752; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363561 (Archived by WebCite® at http://www.webcitation.org/6f64kuyLf). %M 26952645 %R 10.2196/jmir.4993 %U http://www.jmir.org/2016/3/e54/ %U https://doi.org/10.2196/jmir.4993 %U http://www.ncbi.nlm.nih.gov/pubmed/26952645 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 4 %P e120 %T An Internet-Based Intervention (Mamma Mia) for Postpartum Depression: Mapping the Development from Theory to Practice %A Drozd,Filip %A Haga,Silje Marie %A Brendryen,Håvar %A Slinning,Kari %+ National Network for Infant Mental Health, Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, PO Box 4623 Nydalen, Oslo, N-0405, Norway, 47 975 16 188, filip.drozd@r-bup.no %K early intervention %K Internet %K intervention mapping %K Mamma Mia %K postpartum depression %K pregnancy %K well-being %D 2015 %7 12.10.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: As much as 10-15% of new mothers experience depression postpartum. An Internet-based intervention (Mamma Mia) was developed with the primary aims of preventing depressive symptoms and enhancing subjective well-being among pregnant and postpartum women. A secondary aim of Mamma Mia was to ease the transition of becoming a mother by providing knowledge, techniques, and support during pregnancy and after birth. Objective: The aim of the paper is to provide a systematic and comprehensive description of the intervention rationale and the development of Mamma Mia. Methods: For this purpose, we used the intervention mapping (IM) protocol as descriptive tool, which consists of the following 6 steps: (1) a needs assessment, (2) definition of change objectives, (3) selection of theoretical methods and practical strategies, (4) development of program components, (5) planning adoption and implementation, and (6) planning evaluation. Results: Mamma Mia is a fully automated Internet intervention available for computers, tablets, and smartphones, intended for individual use by the mother. It starts in gestational week 18-24 and lasts up to when the baby becomes 6 months old. This intervention applies a tunneled design to guide the woman through the program in a step-by-step fashion in accordance with the psychological preparations of becoming a mother. The intervention is delivered by email and interactive websites, combining text, pictures, prerecorded audio files, and user input. It targets risk and protective factors for postpartum depression such as prepartum and postpartum attachment, couple satisfaction, social support, and subjective well-being, as identified in the needs assessment. The plan is to implement Mamma Mia directly to users and as part of ordinary services at well-baby clinics, and to evaluate the effectiveness of Mamma Mia in a randomized controlled trial and assess users’ experiences with the program. Conclusions: The IM of Mamma Mia has made clear the rationale for the intervention, and linked theories and empirical evidence to the contents and materials of the program. This meets the recent calls for intervention descriptions and may inform future studies, development of interventions, and systematic reviews. %M 26476481 %R 10.2196/resprot.4858 %U http://www.researchprotocols.org/2015/4/e120/ %U https://doi.org/10.2196/resprot.4858 %U http://www.ncbi.nlm.nih.gov/pubmed/26476481 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e6 %T Keywords to Recruit Spanish- and English-Speaking Participants: Evidence From an Online Postpartum Depression Randomized Controlled Trial %A Barrera,Alinne Z %A Kelman,Alex R %A Muñoz,Ricardo F %+ Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, United States, 1 650 433 3854, abarrera@paloaltou.edu %K Internet intervention %K prevention %K depression, postpartum %K research subject recruitment %K women %K Spanish speaking %D 2014 %7 09.01.2014 %9 Original Paper %J J Med Internet Res %G English %X 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 (ie, 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). %M 24407163 %R 10.2196/jmir.2999 %U http://www.jmir.org/2014/1/e6/ %U https://doi.org/10.2196/jmir.2999 %U http://www.ncbi.nlm.nih.gov/pubmed/24407163 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 11 %P e242 %T MomMoodBooster Web-Based Intervention for Postpartum Depression: Feasibility Trial Results %A Danaher,Brian G %A Milgrom,Jeannette %A Seeley,John R %A Stuart,Scott %A Schembri,Charlene %A Tyler,Milagra S %A Ericksen,Jennifer %A Lester,Whitney %A Gemmill,Alan W %A Kosty,Derek B %A Lewinsohn,Peter %+ Oregon Research Institute, 1776 Millrace Drive, Eugene, OR, 97403, United States, 1 541 484 2123 ext 2201, briand@ori.org %K postpartum depression %K Web-based intervention %D 2013 %7 01.11.2013 %9 Original Paper %J J Med Internet Res %G English %X 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. Trial Registration: Clinicaltrials.gov NCT00942721; http://clinicaltrials.gov/ct2/show/NCT00942721 (Archived by WebCite at http://www.webcitation.org/6KjYDvYkQ). %M 24191345 %R 10.2196/jmir.2876 %U http://www.jmir.org/2013/11/e242/ %U https://doi.org/10.2196/jmir.2876 %U http://www.ncbi.nlm.nih.gov/pubmed/24191345