Internet Cognitive Behavioral Therapy for Women With Postnatal Depression: A Randomized Controlled Trial of MumMoodBooster

Abstract

BackgroundThere are few published controlled trials examining the efficacy of Internet-based treatment for postnatal depression (PND) and none that assess diagnostic status (clinical remission) as the primary outcome. This is despite the need to improve treatment uptake and accessibility because fewer than 50% of postnatally depressed women seek help, even when identified as depressed.ObjectiveIn a randomized controlled trial (RCT), we aimed to test the efficacy of a 6-session Internet intervention (the MumMoodBooster program, previously evaluated in a feasibility trial) in a sample of postnatal women with a clinical diagnosis of depression. The MumMoodBooster program is a cognitive behavioral therapy (CBT) intervention, is highly interactive, includes a partner website, and was supported by low-intensity telephone coaching.MethodsThis was a parallel 2-group RCT (N=43) comparing the Internet CBT treatment (n=21) to treatment as usual (n=22). At baseline and at 12 weeks after enrollment, women’s diagnostic status was assessed by telephone with the Standardized Clinical Interview for DSM-IV (SCID-IV) and symptom severity with the Beck Depression Inventory (BDI-II). Depression symptoms were measured repeatedly throughout the study period with the Patient Health Questionnaire (PHQ-9).ResultsAt the end of the study, 79% (15/19) of women who received the Internet CBT treatment no longer met diagnostic criteria for depression on the SCID-IV (these outcome data were missing for 2 intervention participants). This contrasted with only 18% (4/22) remission in the treatment as usual condition. Depression scores on the BDI-II showed a large effect favoring the intervention group (d=.83, 95% CI 0.20-1.45). Small to medium effects were found on the PHQ-9 and on measures of anxiety and stress. Adherence to the program was very good with 86% (18/21) of users completing all sessions; satisfaction with the program was rated 3.1 out of 4 on average.ConclusionsOur results suggest that our Internet CBT program, MumMoodBooster, is an effective treatment option for women clinically diagnosed with PND. This is one of only two controlled evaluations of specialized online psychological treatment among women clinically diagnosed with PND. MumMoodBooster appears to be a feasible, effective treatment option, which is potentially accessible to large numbers of women in metropolitan, rural, and remote areas. Future work might be focused profitably on establishing comparability with face-to-face treatments and purely self-guided delivery. We have commenced a larger RCT comparing MumMoodBooster with face-to-face CBT.Trial RegistrationAustralian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000113752; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363561 (Archived by WebCite® at http://www.webcitation.org/6f64kuyLf).

Therapist-Supported Internet-Based Cognitive Behavior Therapy for Stress, Anxiety, and Depressive Symptoms Among Postpartum Women: A Systematic Review and Meta-Analysis

“…All of the studies were conducted between 2011 [47] and 2016 [31], with 2016 having the highest number of publications (38%, 3/8) [28,29,31]. …”

“…Contrary to previous findings on the equivalent effect of support type for stress symptoms in a meta-analytic review [13], our finding showed that exclusive therapist support has a better effect than therapist support with self-care component in the subgroup analysis. A possible interpretation of this result is that the different attrition rates reached 2.9%–60.8% by therapist support with self-care components [28,32,33] compared with the 7.0%–31.3% rates by exclusive therapist support [29-31,46,47]. This finding supported the fact that exclusive therapist support was preferred to reduce stress symptoms, whether by phone, email, text, or interactive computer interface [10,11].…”

Postpartum psychiatric disorders

“…Currently, only such well-resourced, integrated management programs have provided evidence that perinatal mental health is improved by depression screening 171,172 . In this regard, e-screening and e-treatments to facilitate integrated, cost-effective care might be useful 173 . Few well-understood, validated screening approaches for PPDs that can ultimately improve morbidity and mortality are available.…”

Strategy Intervention to Prevent and Reduce Postpartum Depression: A Systematic Review

“…Interventions by utilizing information and technology are very useful at reducing postpartum depletion. This is evidenced by a study that explains that Internet Cognitive Behavioral Therapy interventions can reduce postpartum depletion (Milgrom et al, 2016). Internet-based development CBT can also be applied through CBT that is phonebased which results in a reduction in depressive symptoms that is far greater than the standard care during the postpartum period.…”