JMIR Publications

ABSTRACT

Background:

Perinatal depression is a major public health concern, and internet-based interventions may increase access to empirically based interventions. Investigating the contributing components of internet-based interventions is critical to implementation research and sustainability efforts within healthcare systems.

Objective:

This randomized components trial investigated the impact of an internet-based cognitive behavioral therapy intervention for perinatal depression, comparing the online intervention alone to the online intervention plus phone coaching, assessed with quantitative and qualitative outcomes.

Methods:

Pregnant and postpartum Veterans (N = 51) were randomized to 1) MomMoodBooster (MMB) or 2) MomMoodBooster + phone coaching (MMBPC) and completed three study assessments (baseline, 3-month follow-up, 6-month follow-up). The intervention consisted of six weekly modules and two optional booster modules. Linear mixed-effects modeling was used to determine the impact of intervention condition over time on depressive symptoms, behavioral activation, and negative automatic thoughts. The impact of intervention condition throughout the intervention was assessed using the Patient Health Questionnaire-9 at weeks 1, 3, and 5 of the intervention. Qualitative analyses identified themes related to helpful aspects of the program and areas for improvement.

Results:

Veterans who completed the welcome call, required for login to the intervention, were included in the analyses (n = 46). Between-assessment analyses were limited by attrition observed across both conditions. Results indicated that significant improvements in depressive symptom severity (F(2, 54.28) = 6.16, P = .004), behavioral activation (F(2, 41.68) = 4.21, P = 0.02), and negative automatic thoughts (F(2, 39.77) = 4.10, P = 0.02) were observed over time but not by condition (ps > .05). Within-intervention change also indicated a significant main effect of time (F(2, 63.88) = 21.62, p < .001), but not condition (p > .05). Qualitative analyses indicated positivity about the intervention and desire for more interaction.

Conclusions:

Perinatal Veterans experienced therapeutic benefit during and after the online CBT intervention. Despite value of, or desire for, interaction depending on condition, both conditions experienced improvements in the depression, the primary outcome, and the targeted therapeutic processes. Future work should continue to explore contributing components of empirically based interventions for implementation, dissemination, and scalability efforts. Clinical Trial: The study was pre-registered on ClinicalTrials.gov (NCT05196152).