JMIR Publications

ABSTRACT

Background:

Perinatal depression, defined as depression during pregnancy or the first year postpartum, affects 10-25% of perinatal individuals, with higher risk among youth age <25. The Mothers and Babies course (MB) is an evidence-based intervention for prevention of perinatal depression grounded in cognitive behavioral therapy (CBT), attachment theory, and psychoeducation.

Objective:

We developed a digital adaptation of MB (named IMAGINE) and evaluated it in a pre-post mixed methods pilot among young perinatal people in the US.

Methods:

The IMAGINE intervention was a structured digital group of up to 7 participants, with scheduled MB content and open discussion over 12 weeks, facilitated by a social worker. Scheduled content included asynchronous text messages, graphics, pre-recorded videos, and mood polls, as well as optional weekly synchronous video calls. Eligible participants were pregnant or 180 days postpartum, age 16-24 years during pregnancy, had daily access to a smartphone, spoke English, and had PHQ9 score <10. Participants were recruited throughout the US during August 2020-January 2021 through paid social media ads, in-person outreach at partner clinics, and respondent-driven sampling. Participants completed quantitative questionnaires at enrollment and 3 months, and qualitative individual interviews at 3 months. We determined uptake, acceptability (by AIM score), and utility (by use of CBT skills). We compared depression symptoms (by PHQ9 score), social support (by abbreviated SSB score), and perceived stress (by PSS-4 score) between enrollment and follow-up by paired two-sided t-test.

Results:

Among 68 individuals who contacted the study, 22 were screened, 13 were eligible, and 10 enrolled, for an uptake of 76.9%. Four participants (40%) were pregnant at enrollment. Participants had a median age of 17.9 years, 67% identified as Black, 56% identified as Latinx, and 67% used Medicaid health insurance. Nine participants (90%) completed follow-up. Among these, we found a mean acceptability score of 4.3 out of 5 and all participants said they would recommend IMAGINE to a friend. Of the 11 CBT skills asked about, participants reported using a median of 7 skills at least half the days (IQR 5-7). We found no significant changes in depression symptoms, perceived stress or social support. Qualitatively, participants reported one-to-one support from the facilitator, connection with other parents, and regular opportunities to reflect on their mood were especially helpful aspects of the intervention. Additionally, participants reported that the intervention normalized their mental health challenges, improved their ability to manage their mood, and increased their openness to mental healthcare.

Conclusions:

This pilot study provides promising evidence of the acceptability and utility of a digital group adaptation of MB among perinatal youth. Our study’s small sample size was not powered to detect changes in clinical outcomes; our findings suggest IMAGINE warrants larger-scale evaluation.