Online prevention of postpartum depression for Spanish- and English-speaking pregnant women: A pilot randomized controlled trial

AbstractBackgroundPostpartum depression (PPD) is a maternal mental health problem that affects women from all regions of the world. Unfortunately, even in developed countries, half of the cases go undetected and, consequently, untreated. Individuals from low and middle income countries trend toward underutilization of mental health services, partly due to the limited number of available psychological resources. The primary aims of this pilot randomized controlled trial were to adapt to the Internet using the Mothers and Babies Course/Curso Mamás y Bebés, a prevention of PPD intervention, to describe the characteristics of the pregnant women who engaged in the intervention site, and to obtain preliminary data on the efficacy of the Internet intervention to reduce the risk of PPD.MethodsPregnant women, 18years or older who were interested in using the site for themselves were recruited and randomly assigned to a fully-automated self-help Internet intervention or to an information-only control condition. Randomized participants were invited to complete monthly depression assessments up to six months postpartum. To examine the prevention effects of the Internet intervention, pregnant women who did not meet current criteria for a major depressive episode, who engaged with the study website, and who provided depression data during the postpartum follow-up period were included in the study analyses.ResultsParticipants were 111 predominantly Spanish-speaking (82.9%) and Latino/Hispanic (71.3%) pregnant women residing in 23 countries worldwide. The effect of the prevention intervention condition failed to reach significance at the a priori alpha-level. However, the observed coefficient trended in the hypothesized direction (b=−0.514, χ2 (1)=3.43, p=.061; HR=0.598). The benefits of receiving the e-MB Internet intervention were greater for pregnant women reporting high (vs. low) levels of prenatal depression symptoms (b=−0.605, χ2 (1)=5.20, p=.023).ConclusionsThis study provides preliminary evidence that Internet interventions are a promising method toward expanding the reach of psychological resources to perinatal women at-risk for PPD

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

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

Comparing brief internet-based compassionate mind training and cognitive behavioral therapy for perinatal women: Study protocol for a randomized controlled trial.

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.N/

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

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

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

BackgroundThe 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. ObjectiveThis 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]). MethodsIn 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. ResultsOn 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. ConclusionsThis 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 RegistrationClinicalTrials.gov NCT03420755; https://clinicaltrials.gov/ct2/show/NCT0342075

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

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

Estudio de preferencias sobre contenidos y formatos para un programa de prevención de la depresión: un estudio en mujeres perinatales

Antecedentes: este trabajo explora las diferencias étnicas en preferencias de contenido y formato de un programa preventivo de depresión perinatal. Método: participaron 163 mujeres en etapa perinatal (66.9% embarazadas; 33.1% en el posparto) que se identificaron como latinas (45.4%) y no latinas (64.6%). Resultados: el formato preferido fue individual y en persona para todos los contenidos. Solo cuando el contenido tenía que ver con la comunicación de pareja, considerarían incluir a la pareja. No se encontraron diferencias significativas en función de la etnia en las preferencias de formato. En cuanto al contenido, las mujeres prefirieron “información sobre el proceso de embarazo, incluyendo cambios físicos y psicológicos”. Las mujeres no latinas mostraron una mayor preferencia por “realizar evaluaciones regulares sobre su estado emocional” en comparación a las latinas. Conclusiones: estos resultados deberían considerarse a la hora de diseñar futuros programas de prevención para la depresión perinatal y evidencian la necesidad de trabajar más en las intervenciones online si queremos que se valoren más favorablemente por las mujeres perinatales.Background: this study investigated ethnic differences in the preferred content and delivery method of a depression prevention program for perinatal women. Method: participants were 163 pregnant (66.9%) and postpartum (33.1%) women. Women identified themselves as Latinas (45.4%) or non-Latinas (54.6%). Results: overall, women preferred individual and onsite therapy across contents. Only when the content was related to improving communication, they were willing to incorporate the partner. There were no ethnic differences in the preferred format. Regard-ing content, women preferred to receive “information on the pregnancy process including physical and psychological changes.” Non-Latinas had a higher prefer-ence for “receiving regular checkins on their emotional state” than Latinas. Conclusions: these results should be considered when developing future perinatal depression prevention programs and evidence that work needs to be done if we want online interventions to be viewed more favorably by perinatal women

International Spanish/English Internet Smoking Cessation Trial Yields 20% Abstinence Rates at 1 Year

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