Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 11, 2020
Date Accepted: Dec 29, 2020
Effectiveness of a smartphone-based mindfulness training on maternal perinatal depression: randomized controlled trial
ABSTRACT
Background:
Despite potential benefits, mindfulness is an emergent area in perinatal care, and evidence for smartphone-based mindfulness training for perinatal depression are especially limited.
Objective:
The objective of this study is to evaluate effectiveness of a smartphone-based mindfulness training during pregnancy (MTP) on perinatal depression and other mental health problems with randomized controlled design.
Methods:
Pregnant adult women with potential risk of perinatal depression were recruited from obstetrics clinics and randomized to fully automated 8-week smartphone-based mindfulness training during pregnancy group (MTPG) or attention-controlled group (ACG). Maternal mental health indicators were measured over four time points through postpartum by online self-assessed surveys. The assessor who collected the follow-up data was blind to the assignment. Outcomes indicators include primary outcome (depression) and secondary outcomes (anxiety, stress, affect, sleep, fatigue, memory and fear).
Results:
A total of 168 pregnant women were randomly allocated to MTPG (n = 84) or ACG (n = 84). Overall dropout rate of this study is 34.5%, and completion rate of MTP is 52.4%. Participants in MTPG reported decreased risk of positive depressive symptom (EPDS > 9) than ACG at post-intervention (OR: 0.391, 95%CI: 0.164~0.930) and significant higher depression remission with different EPDS reduction scores from pre-intervention to post-intervention (OR ranges from 2.601 to 27.986). From longer-term perspectives, participants who have received MTP reported significantly improved depression, anxiety and positive compared to participants in ACG (Group × Time effect: 2 = 16.212, P = .003; 2 = 13.097, P = .011; 2 = 8.435, P = .038, respectively). Medium effect sizes were found on depression and positive affect at post-intervention and anxiety at late pregnancy (Cohen’s d = 0.47, -0.49, 0.46, respectively). Parity did not show significantly moderating effect on intervention effect. But for nulliparous women, participants who received MTP showed significantly improved depression symptoms than those who received ACG (Group × Time effect: 2 = 18.114, P = .001).
Conclusions:
Smartphone-based mindfulness training is an effective intervention in improving maternal perinatal depression for those who are in potential risk of perinatal depression in early pregnancy. Nulliparous women are promising subgroups who may benefit more from mindfulness training and needs to be addressed in clinic. Clinical Trial: Chinese Clinical Trial Registry: ChiCTR1900028521; http://www.chictr.org.cn/showproj.aspx?proj=33474
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