JMIR Publications

ABSTRACT

Background:

Postpartum depression is a leading cause of maternal morbidity, yet many mothers lack ongoing support during this critical period. Comprehensive postpartum interventions that address the full year postpartum require evidence of usability and impact in diverse populations.

Objective:

This study evaluated the usability, engagement, and preliminary impact of Joyuus, a digital postpartum self-care intervention designed to support maternal well-being, and to identify self-care and when it shifts to the need to seek care for postpartum depression. The objective was to determine whether Joyuus enhances awareness of changes in the postpartum period, increases identification of health risks, and improves maternal functioning during the first year postpartum.

Methods:

We conducted a 12-week randomized controlled trial with postpartum participants (n=132) recruited through groups supporting individuals during the postpartum period. Participants were randomized to either Joyuus or standard postpartum care. Primary and secondary outcomes included Barkin Index of Maternal Functioning, Edinburgh Postnatal Depression Scale, State-Trait Anxiety Scale, and Connor Davidson Resilience scale. Student’s t-test, Fisher’s exact test and chi-squared test were used to assess differences between control and intervention arms of baseline measures. Participants who reported a score of 11+ or any positive response to question 10 on self-harm on the EPDS were considered at risk for depression and reviewed under the Safety Monitoring protocol. A predictive model was developed to identify postpartum women at elevated risk for depression using data from Joyuus integrating behavioral, psychosocial, and demographic inputs.

Results:

Baseline demographics were generally balanced across arms, and no significant differences were observed in education, income, or marital status. No significant differences were found between treatment and control groups in 12-week changes for the primary or secondary outcomes. Overall depression scores from the EPDS had an average score of 9.5 with intervention scores averaging 9.7 and control group scores averaging 9.3. In the overall sample, 60 of the 132 participants (44%) reported a score of 11+ or any positive response to question 10 on self-harm. A predictive model that used intake questionnaire data to predict postpartum depression risk showed a recall of 89%. That is, of women who had an EPDS score of >= 10, 89% of those were correctly identified by the model. Engagement was greater in the initial four weeks and decreased during the 12-week study. Qualitative open-ended queries produced responses indicating a lack of relevant postpartum resources available in general.

Conclusions:

Joyuus offers a viable approach to early identification of preventable conditions such as postpartum depression. Additional efforts are required to assess the most effective pathways for engagement to detect change resulting from use. Integrating comprehensive self-care platforms into maternal care pathways may reduce the risk of undiagnosed conditions such as PPD to improve early identification and treatment, especially in populations with limited postpartum support.