JMIR Publications

ABSTRACT

Background:

Postpartum psychological distress, ranging from transient mood and anxiety disturbances to full-syndrome postpartum depression (PPD), is prevalent. Many postpartum individuals lack access to evidence-based interventions due to stigma and insufficient provider availability. The treatment gap is particularly pronounced among historically marginalized groups, including Black, Hispanic/Latina, and low-income mothers, who face higher PPD prevalence and systemic barriers to care. Digital health interventions offer scalable, accessible, and culturally informed emotional support to address these disparities.

Objective:

To evaluate the feasibility, acceptability, and preliminary efficacy of a smartphone application-delivered intervention for managing stress, anxiety, and mood in a diverse postpartum population.

Methods:

This randomized controlled trial recruited participants from the PowerMom study, a digital platform for maternal health research. Eligible individuals (≥16 years, <3 months postpartum) were randomized to Woebot for Postpartum Mood and Anxiety (W-PPMA) or a waitlist control condition. W-PPMA, an investigational digital mental health intervention, features a relational agent delivering cognitive behavioral therapy (CBT)-based psychoeducation via text-based conversations. Primary outcomes included feasibility, acceptability, and satisfaction at 8-week end-of-intervention (EOI). The secondary outcome was change in self-reported depressive symptoms (PHQ-8) at 8-week EOI among participants with elevated baseline symptoms. Exploratory outcomes included anxiety (GAD-7), perinatal depression (EPDS), stress (PSS), mother-infant bond (MIB), and therapeutic alliance (WAI-SR), assessed at baseline, mid-treatment (4 weeks), EOI, and follow-ups at 12 and 16 weeks. The study followed CONSORT guidelines and received IRB approval.

Results:

Participants (N=267; W-PPMA=144, Waitlist=123) represented diverse sociodemographic, mental health, and pregnancy backgrounds. W-PPMA users engaged with the app a median (Q1, Q3) of 9.0 (5.0, 23.8) days over 4.0 (2.0, 7.0) active weeks and reported high feasibility, acceptance, and satisfaction (URPI-F= 31 (28, 34), URPI-A= 30 (28, 34), CSQ-8= 26 (24, 29)). The secondary outcome indicated a small but favorable effect of W-PPMA on depressive symptoms (Cohen’s d=-0.16). Exploratory analyses showed positive trends in perceived stress (PSS) and perinatal depression (EPDS) at EOI. Therapeutic alliance (WAI-SR) was highest among Black participants and those from socioeconomically disadvantaged neighborhoods (ADI ≥75) at Baseline, and at EOI, among those with military healthcare insurance and socioeconomically disadvantaged neighborhoods (ADI ≥75). Satisfaction (CSQ-8) was highest among those with a high school or GED education, highlighting accessibility.

Conclusions:

Among a diverse postpartum cohort, W-PPMA demonstrated feasibility, acceptability, and modest preliminary efficacy in reducing depressive symptoms. Exploratory findings suggest broader benefits for stress and mood management. High engagement and satisfaction highlight W-PPMA’s potential as a scalable, accessible, and culturally informed digital mental health tool. These findings underscore its potential to bridge gaps in postpartum mental health care, particularly for marginalized populations. Further research is warranted. Clinical Trial: Clinicaltrials.gov NCT05662605