JMIR Publications

ABSTRACT

Background:

Pregnancy is a vulnerable period for women, exposing them to various mental health issues such as depression and anxiety. The perinatal period is particularly crucial because the mother's mental health significantly affects the mother’s physical health, pregnancy outcomes, fetal development, postnatal outcomes, and infant development. Psychotherapeutic approaches for depression are vital because medication use is limited during pregnancy. However, perinatal women with depression often face barriers in accessing psychotherapeutic interventions. Digital health may offer a solution for overcoming these barriers.

Objective:

In this study, we evaluated the effectiveness of Avecmom, a self-guided mindfulness-based mobile intervention, in reducing depression among pregnant women. We also evaluated the impact of the mobile app on positive/negative emotions, mental well-being, and maternal-fetal attachment.

Methods:

Participants were recruited online and offline. After screening, 90 out of 158 participants met the study criteria and were randomly assigned to either the intervention or the control group. The intervention group used both apps, whereas the control group used only the Big 4+ app. Depressive symptoms, anxiety, and stress were evaluated as the primary outcomes at baseline and posttest. Mindfulness, mental well-being, positive/negative emotions, and maternal-fetal attachment were also assessed as secondary outcomes. Analysis of covariance (ANCOVA) was performed with post-test scores as the dependent variable, adjusting for baseline scores. The bootstrapping technique from PROCESS Model 6 was applied to estimate the mechanism of change after using the Avecmom mobile app.

Results:

A total of 86 pregnant women were included in the intervention group (n=42; age: mean 34.10, SD 3.04) and the control group (n=44, age: mean 33.80, SD 3.42). The overall dropout rate was 4% (4/90). The intervention group showed lower depression scores, mindfulness, maternal-fetal attachment, mental well-being, and positive affect compared to the control group. Serial mediation analysis indicated that use of the Avecmom app influenced mental well-being through sequential improvements in mindfulness and decreases in depressive symptoms (standardized β=.33, BootSE=0.12, 95% BootCI[0.12; 0.58]).

Conclusions:

Mindfulness-based mobile interventions designed for pregnant women may be more effective than self-monitoring alone in improving perinatal depression. Enhanced mindfulness through the use of a mobile app seems to lead to a decrease in depressive symptoms and, consequently, improved mental well-being. Clinical Trial: KCT0008887.