JMIR Publications

ABSTRACT

Background:

Women are vulnerable to depression during pregnancy, which is one of the strongest risk factors for developing postpartum depression (PPD). The ability to address the problem in theses women with antenatal depressive symptoms is of significant importance in preventing PPD. However, little was known about the effect of Internet-based cognitive behavioral therapy (ICBT) on preventing PPD among this high risk group.

Objective:

We aimed to evaluate both the short-term and long-term effect of ICBT among women with antenatal depressive symptoms on preventing PPD.

Methods:

Participants were screened for antenatal depressive symptoms by using Edinburgh Postnatal Depression Scale (EPDS) and randomly allocated (1:1) to the ICBT group (receiving weekly online modules initiated antenatally and continued into early postpartum) or control group (observed without treatment). Follow-up assessments were completed to 12 months postpartum with data analyzed using generalized estimating equations. Primary outcome was prevalence of depressive symptoms at 6 weeks postpartum. Subgroup analysis of participants with different severity in antenatal depressive symptoms was also conducted. Secondary outcomes were ICBT long-term effect on maternal depression, and effects on anxiety, sleep quality, social support, parenting stress, co-parenting relationship, and infant development.

Results:

Between August 2020 to September 2021, 300 pregnant individuals were recruited from five centers across China. No significant differences were found in depressive symptoms at 6 weeks postpartum (P=0.179) or any longer-term follow-up time point (P=0.180). However, post-hoc subgroup analysis revealed that among participants with antenatal EPDS score of 10 to 12, the ICBT group had lower risks of developing depression across the first year postpartum (OR = 0.534, 95%CI: 0.313-0.912, P=0.021), but not for participants with more severe depression. Besides, higher level of co-parenting relationship was found in this subgroup (P=0.025).

Conclusions:

In individuals with antenatal depression, ICBT did not prevent developing depression postnatally. ICBT might be a preferable option for individuals with mild to moderate antenatal depressive symptoms. Future research is warranted to examine ICBT modifications to treat individuals with more severe depressive symptoms. Clinical Trial: Chinese Clinical Trial Registry (ChiCTR2000033433).https://www.chictr.org.cn/showproj.html?proj=54482