A Mobile Health Mindfulness Intervention for Women With Moderate to Moderately Severe Postpartum Depressive Symptoms: Feasibility Study (Preprint)

Abstract

BACKGROUND Postpartum depression (PPD) is the leading complication of childbirth impacting up to 20% of postpartum women. Half of the women with PPD do not receive treatment due to barriers to current treatment options such as a shortage of mental health care providers and limited access to care. Therefore, it is critical to identify safe, effective, and scalable intervention options for PPD. While traditional mindfulness programs have been effective in reducing depressive symptoms in many populations, access remains a barrier. A self-paced mindfulness-based mobile health application (mHealth) may fit the lifestyle of busy moms who are unable to attend in-person classes. Thus, they have the potential to improve adherence and efficacy. Research is needed to assess the effectiveness of mHealth mindfulness interventions in postpartum women with depression symptoms. OBJECTIVE To assess the feasibility and acceptability of an mHealth mindfulness-based intervention for postpartum women with moderate-to-moderately severe depression symptoms. METHODS We conducted a mixed-methods single-arm trial of an mHealth mindfulness intervention within Kaiser Permanente Northern California (KPNC), a large integrated healthcare system. Participants were identified through KPNC’s universal perinatal depression screening program and recruited via clinician referral or contact from the study team. English-speaking women, up to 6 months postpartum with an 8-item Patient Health Questionnaire (PHQ-8) score 10-19, and no regular mindfulness, meditation, or yoga practice were eligible. Participants were asked to use a commercially-available mindfulness mobile app, HeadspaceTM, 10-20 minutes/day for 6 weeks. Baseline and post-intervention surveys captured data on patient-reported outcomes (depression and stress symptoms, sleep, and mindfulness). Qualitative interviews were conducted post-intervention to assess acceptability. Retention and adherence to the intervention were used to assess feasibility. RESULTS Of the 27 women enrolled, 19 (70%) completed the study. The median age of participants was 31 years (range: 22-40), 30% were non-Hispanic White, and, on average, participants were 12.3 weeks postpartum (range 5-24). Of the women who completed the study, 100% used the Headspace app at least once and nearly half (47%) used the app ≥50% of the days during the 6-week intervention period. Of the 16 participants who completed the post-intervention interview, 69% reported that they were “very” or “extremely” satisfied with the app. Interviews indicate that women appreciated the variety of meditations available and felt the program led to reduced anxiety and improved sleep. Significant improvements in pre-post intervention scores were observed for depression symptoms (PHQ-8: -3.8, P=.004), perceived stress (10-item Perceived Stress Scale: -6.0, P=.005) and sleep quality (Pittsburgh Sleep Quality Index: -2.1, P=.02, indicating less sleep disturbance). Improvements in mindfulness were also significant (Five Facet Mindfulness Questionnaire short form: +10.9, P=.01). CONCLUSIONS Findings suggest an mHealth mindfulness intervention for postpartum women with moderate-to-moderately severe depression symptoms is feasible and acceptable. An efficacy trial is warranted. CLINICALTRIAL N/A