Background Adolescents and young adults aged <25 years (youth) are at a higher risk of perinatal depression than older adults, and they experience elevated barriers to in-person care. Digital platforms such as social media offer an accessible avenue to deliver group cognitive behavioral therapy (CBT) to perinatal youth. Objective We aim to develop the Interactive Maternal Group for Information and Emotional Support (IMAGINE) intervention, a facilitated social media group CBT intervention to prevent perinatal depression in youth in the United States, by adapting the Mothers and Babies (MB) course, an evidence-based in-person group CBT intervention. In this study, we report perspectives of youth and health care providers on perinatal youths’ mental health needs and document how they informed IMAGINE design. Methods We conducted 21 semistructured in-depth individual interviews with 10 pregnant or postpartum youths aged 14-24 years and 6 health care workers. All interviews were recorded, transcribed, and analyzed using deductive and inductive approaches to characterize perceptions of challenges and facilitators of youth perinatal mental health. Using a human-centered design approach, stakeholder perspectives were incorporated into the IMAGINE design. We classified MB adaptations to develop IMAGINE according to the Framework for Modification and Adaptation, reporting the nature, timing, reason, and goal of the adaptations. Results Youth and health care workers described stigma associated with young pregnancy and parenting, social isolation, and lack of material resources as significant challenges to youth mental wellness. They identified nonjudgmental support, peer companionship, and access to step-by-step guidance as facilitators of youth mental wellness. They endorsed the use of a social media group to prevent perinatal depression and recommended that IMAGINE facilitate peer support, deliver content asynchronously to accommodate varied schedules, use a confidential platform, and facilitate the discussion of topics beyond the MB curriculum, such as navigating support resources or asking medical questions. IMAGINE was adapted from MB to accommodate stakeholder recommendations and facilitate the transition to web-based delivery. Content was tailored to be multimodal (text, images, and video), and the language was shortened and simplified. All content was designed for asynchronous engagement, and redundancy was added to accommodate intermittent access. The structure was loosened to allow the intervention facilitator to respond in real time to topics of interest for youth. A social media platform was selected that allows multiple conversation channels and conceals group member identity. All adaptations sought to preserve the fidelity of the MB core components. Conclusions Our findings highlight the effect of stigmatization of young pregnancy and social determinants of health on youth perinatal mental health. Stakeholders supported the use of a social media group to create a supportive community and improve access to evidence-based depression prevention. This study demonstrates how a validated intervention can be tailored to this unique group.
BACKGROUND Adolescents and young adults age <25 (youth) are at higher risk of perinatal depression than older women and experience elevated barriers to in-person care. Digital platforms such as social media offer an accessible avenue to deliver group cognitive behavioral therapy (CBT) to perinatal youth. OBJECTIVE Our goal was to develop the IMAGINE intervention, a facilitated social media group CBT intervention to prevent perinatal depression in US youth, by adapting the Mothers and Babies (MB) course, an evidence-based in-person group CBT intervention. In order to inform this adaptation, we sought perspectives of youth and healthcare provider stakeholders on perinatal youth’s mental health needs and social media group design recommendations. We report findings from stakeholder interviews and document the IMAGINE adaptation process. METHODS We conducted 21 semi-structured in-depth individual interviews with 10 pregnant or postpartum youth age 14-24 and 6 healthcare workers. All interviews were recorded, transcribed, and analyzed using deductive and inductive approaches to characterize perceptions of challenges and facilitators to youth perinatal mental health. Using a human-centered design approach, stakeholder perspectives were incorporated into IMAGINE design. We classified MB adaptations to develop IMAGINE according to the Framework for Modification and Adaptation, reporting the nature, timing, reason and goal of the adaptations. RESULTS Youth and healthcare workers described stigma associated with young pregnancy and parenting, social isolation, and lack of material resources as significant challenges to youth mental wellness. They identified non-judgmental support, peer companionship, and access to step-by-step guidance as facilitators of youth mental wellness. They endorsed the utility of a social media group to prevent perinatal depression and recommended that IMAGINE facilitate peer support, deliver content asynchronously to accommodate varied schedules, use a confidential platform, and facilitate discussion of topics beyond the MB curriculum, such as navigating support resources or asking medical questions. IMAGINE was adapted from MB to accommodate stakeholder recommendations and facilitate transition to online delivery. Content was tailored to be multimodal (text, images and video) and language was shortened and simplified. All content was designed for asynchronous engagement and redundancy was added to accommodate intermittent access. Structure was loosened to allow the intervention facilitator to respond in real-time to youth topics of interest. A social media platform was selected that allows multiple conversation “channels” and conceals group member identity. All adaptations sought to preserve fidelity to MB core components. CONCLUSIONS Our findings highlight the impact of stigmatization of young pregnancy and social determinants of health on youth perinatal mental health. Stakeholders supported use of a social media group to create a supportive community and improve access to evidence-based depression prevention. Our study demonstrates how a validated intervention can be tailored to this unique group.
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.
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