Smartphone-based intervention for postpartum depressive symptoms (Smart-e-Moms): study protocol for a randomized controlled trial

Background Postpartum depression constitutes a significant public health issue, with prevalence rates ranging between 8 and 19% in high-income nations. Nevertheless, numerous barriers, including time constraints, societal stigmatization, and feelings of shame, contribute to the limited utilization of healthcare services during the postpartum period. Digital interventions offer an opportunity to enhance care for women experiencing postpartum depressive symptoms. Methods We will conduct a two-arm randomized controlled trial to assess the effectiveness of a smartphone-based intervention in comparison to a treatment-as-usual control group in Germany. Our aim is to randomize 556 participants in a 1:1 ratio. Participants in the intervention group will be provided access to a preventive smartphone-based intervention called “Smart-e-Moms,” which incorporates therapeutic support and comprises 10 concise modules rooted in cognitive-behavioral therapy. For the intervention group, evaluations will take place at baseline (t0), prior to sessions 4 and 8 (intermediate assessments), and upon completing the intervention 6 weeks after baseline (t1). The control group’s assessments will be at baseline (t0) and 6 weeks after baseline. Follow-up assessments are scheduled at 12 and 24 weeks from baseline to examine the short-term stability of any observed effects. We anticipate that participants in the intervention group will exhibit improvements in their postpartum depressive symptoms (as measured with the Edinburgh Postnatal Depression Scale). Additionally, we will analyze secondary outcomes, including maternal bonding, stress levels, self-efficacy, satisfaction with the intervention, and healthcare utilization. Discussion If Smart-e-Moms proves to be effective, it has the potential to play a significant role in postpartum depression care within German-speaking regions. Ideally, this intervention could not only benefit maternal well-being but also improve the prospects for healthy child development. Trial registration German clinical trials registry DRKS00032324. Registered on January 26, 2024

SmartMoms – a web application to raise awareness and provide information on postpartum depression

Background Postpartum depression is a major public health concern, which is associated with negative consequences for both mothers and children. Unfortunately, many affected women neither understand the warning signs of postpartum depression nor do they know where to seek help. The aim of this study was to evaluate the feasibility of SmartMoms, a German mobile web application (web app) designed to inform women about postpartum depression, support them, and provide an easily accessible self-screening instrument. Methods After its development, SmartMoms was distributed through healthcare providers and social media. Feasibility was assessed by examining (1) the experience of postpartum women with the web app, (2) user behaviour, and (3) the experience of healthcare providers with the web app and its distribution. A mixed methods approach was used, including online surveys, usage data, and interviews. Results Most women used SmartMoms to prevent postpartum depression and rated the web app as good (on average 4.36 out of 5 stars). The majority of women (62.2%) accessing the self-screening instrument showed a risk for postpartum depression (Edinburgh Postnatal Depression scale score ≥ 12). Most providers (n = 12/13) felt supported through SmartMoms in discussing postpartum depression and considered it a useful offer. Suggestions for improvement were provided. Conclusions SmartMoms meets the needs and expectations of mothers and healthcare providers interested in postpartum depression but should be further adapted to include more specific support options and additional information for professionals

Postpartum depression—who cares? Approaches to care via midwifery, gynaecology, paediatrics and general practice

Hintergrund Die postpartale Depression (PPD) zählt zu den häufigsten psychischen Erkrankungen in der Postpartalzeit. Unbehandelt kann sie teils folgenschwere Auswirkungen auf die Mutter-Kind-Beziehung und die Entwicklung des Kindes haben. Um mögliche negative Auswirkungen verhindern zu können, sind eine frühzeitige Diagnostik betroffener Mütter und eine professionelle Betreuung essenziell. Ziel der Arbeit Der vorliegende Artikel exploriert das Zuständigkeitsgefühl der 4 Primärversorger:innen in der Postpartalzeit: Hebammen, Gynäkolog:innen, Hausärzt:innen und Pädiater:innen, und untersucht den Umgang mit der Erkrankung sowie die Barrieren und Optimierungsmöglichkeiten in der Versorgung. Material und Methoden Die primären Versorger:innen von Frauen nach einer Geburt in Deutschland wurden in 4 voneinander unabhängigen Studien befragt. Mit Hebammen, Gynäkolog:innen und Hausärzt:innen wurden quantitative Befragungen mittels Fragebögen durchgeführt, mit Vertreter:innen des deutschen Berufsverbands der Kinder- und Jugendärzte e. V. (BVKJ) eine qualitative Telefoninterviewbefragung. Es erfolgte eine systematische vergleichende Analyse. Ergebnisse und Diskussion Hebammen und Gynäkolog:innen zeigten ein deutlich höheres Zuständigkeitsgefühl für das Erkennen und die Therapie der PPD als Hausärzt:innen und Pädiater:innen. Als zentrale Voraussetzung für eine Verbesserung der Versorgungssituation in Deutschland wurden von allen 4 Berufsgruppen eine engere interdisziplinäre Zusammenarbeit und somit ein größeres Angebot an Überweisungs- und Therapiemöglichkeiten genannt. Auch eine einheitliche Regelung der finanziellen Vergütung ist für alle Versorger ein wichtiger Aspekt.Background Postpartum depression (PPD) is one of the most common mental illnesses in the postpartum period. If left untreated, it can have serious consequences for the mother–child relationship and the development of the child. In order to prevent possible negative effects, early diagnosis of affected mothers and professional care are essential. Aim of the study This article explores the sense of responsibility of the four primary care providers in the postpartum period—midwives, gynaecologists, general practitioners and paediatricians—and examines how they deal with the disease as well as the barriers and possibilities for optimisation in care. Materials and methods The primary care providers of postpartum women in Germany were interviewed in four independent studies. Quantitative questionnaires were used to interview midwives, gynaecologists and general practitioners, and a qualitative telephone survey was conducted with representatives of the German Association of Paediatricians and Adolescents (BVKJ). A systematic comparative analysis was carried out. Results and discussion Midwives and gynaecologists showed a significantly higher sense of responsibility for the recognition and treatment of PPD than general practitioners and paediatricians. Closer interdisciplinary cooperation and thus a wider range of referral and therapy options were named by all four professional groups as a central prerequisite for improving the care situation in Germany. A uniform regulation of financial remuneration is also an important aspect for all providers

Spatio-temporal oscillations of individual mitochondria in cardiac myocytes reveal modulation of synchronized mitochondrial clusters

Mitochondrial networks in cardiac myocytes under oxidative stress show collective (cluster) behavior through synchronization of their inner membrane potentials (ΔΨm). However, it is unclear whether the oscillation frequency and coupling strength between individual mitochondria affect the size of the cluster and vice versa. We used the wavelet transform and developed advanced signal processing tools that allowed us to capture individual mitochondrial ΔΨm oscillations in cardiac myocytes and examine their dynamic spatio-temporal properties. Heterogeneous frequency behavior prompted us to sort mitochondria according to their frequencies. Signal analysis of the mitochondrial network showed an inverse relationship between cluster size and cluster frequency as well as between cluster amplitude and cluster size. High cross-correlation coefficients between neighboring mitochondria clustered longitudinally along the myocyte striations, indicated anisotropic communication between mitochondria. Isochronal mapping of the onset of myocyte-wide ΔΨm depolarization further exemplified heterogeneous ΔΨm among mitochondria. Taken together, the results suggest that frequency and amplitude modulation of clusters of synchronized mitochondria arises by means of strong changes in local coupling between neighboring mitochondria