JMIR Publications

ABSTRACT

Background:

Postpartum minor and major depression (PPMD) has a 20% 3-month prevalence rate. The consequences of PPMD are significant for mother, infant, and family. There is a need for interventions that prevent PPMD that 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 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 may create an intervention with the scalability and cost effectiveness of an individual intervention and the better outcomes typically found in supported interventions.

Objective:

This report describes the development of a peer supported internet intervention to prevent postpartum depression and explore the feasibility and acceptability of this approach.

Methods:

Clinic based needs assessment and focus groups were used to develop the internet intervention. Once the intervention was developed, women who were 20-28 weeks pregnant with symptoms of depression (PHQ-9 scores of 5-14) but no major depression diagnosis were enrolled in an RCT to compare 8 weeks of a CBT based peer supported internet intervention to an individual internet intervention designed to prevent postpartum depression. Assessments took place at baseline, 4 weeks, 8 weeks (end of treatment), 4 weeks and 6 weeks postpartum.

Results:

Twenty-four women completed the RCT. PHQ-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 one woman out of twenty-four (4%) met criteria for PPMD. There was no difference between groups in adherence to the intervention, with an average of 14.55 logins over the course of treatment.

Conclusions:

Results suggest women were responsive to both peer support and individual internet interventions to prevent postpartum depression and that peer support may be a useful feature to keep participants adherent. Clinical Trial: Clinicaltrials.gov NCT02121015