- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06365645
Feasibility & Acceptability of App-based Cognitive Behavioral Therapy for Postpartum Depression Prevention
Examining the Feasibility and Acceptability of a Novel App-based Cognitive Behavioral Therapy Intervention for Preventing Postpartum Depression
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Overall, 10-15% of women are diagnosed with postpartum depression (PPD). Though the most significant risk factor for PPD is a history of depression or prior PPD, rates of PPD are as high as 25% among women without prior depression or PPD but with personal risk factors such as reporting little social support or food insecurity during pregnancy and structural factors such as being unmarried. There are profound maternal and pediatric consequences of postpartum mental illness: untreated PPD is associated with maternal morbidity9-11 and impaired child cognitive development. As such, the American College of Obstetricians & Gynecologists recommends screening all postpartum women for PPD.
There are, however, several structural barriers to the implementation of this recommendation. First, to be screened for PPD, women must attend postpartum visits, and <60% of women do so. Barriers such as lack of childcare or transportation reduce postpartum visit attendance and disproportionately affect low-income women. Second, pregnancy-related health insurance ends at 60 days postpartum, but PPD can persist for months after delivery, leaving low-income women without subsidized access to screening or treatment. Third, unlike those with known psychiatric illness, many pregnant women without prior mental illness do not receive antenatal mental health screening (unless via universal screening) leading to delayed recognition of and diagnosis of depressive symptoms. Tools to overcome these barriers are sorely needed, particularly for those with the least access who currently fall through the cracks.
Therapy preventing PPD delivered via smartphone applications (apps) may be such a tool. The USPSTF concluded that Cognitive Behavioral Therapy (CBT) - which teaches coping skills to modify maladaptive conditions, behaviors, and physiological responses24, 25 - reduces rates of PPD by 49%. The USPSTF highlighted the Mothers and Babies (MB) CBT program for reducing rates of PPD by 53% among low-income women of color. MB was originally designed as a preventive in-person therapy for low-income English- and Spanish-speaking women without psychiatric illness and contains one parenting education module and multiple CBT modules. MB has started to become a digital health intervention: online MB has been shown to be feasible, and text-message-base MB has been examined in one small study. However, to our knowledge, no studies of app-based MB exist. Online or text-message MB may increase access, but participation with an app would likely be higher for several reasons. Individuals are more likely to have smartphones than internet access: 96% of those aged 18-29 years own smartphones. Additionally, apps provide two advantages compared to other digital health programs: (1) App-based content is accessible without cellular or internet service, (2) Apps serve as just-in-time adaptive interventions,35-37 delivering support tailored to individual behaviors. Thus, app-based MB may decrease PPD while overcoming barriers to care.
Over the last two years, this NIH-funded study has utilized evidence-based user-centered digital intervention design techniques and qualitative research methodology to adapt the MB curriculum into a novel smartphone application, M.Bapp. Similar to MB, M.Bapp contains one parenting education module and multiple CBT-based modules.We now propose a pilot randomized control trial to examine the feasibility, acceptability, and preliminary estimates of effects of the full MB program via M.Bapp (intervention) when compared to app-based digital parenting education (an attention control group). Our long-term goal is to use M.Bapp to prevent PPD among perinatal women at high-risk for the condition due to those with structural or personal risk factors.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Rhode Island
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Providence, Rhode Island, United States, 02905
- Women & Infants Hospital of Rhode Island
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- English- or Spanish-speaking
- maternal age >18 years old
- smartphone ownership
- receiving prenatal care from a resident or nurse-practitioner/midwifery clinic at the Obstetric and Gynecologic Care Center at WIH
- plan to receive postpartum care at the OGCC,
- gestational age ≥32 weeks'.
Exclusion Criteria:
- Active diagnosis or history within five years of depression, anxiety, or other psychiatric condition, as documented in the electronic medical record
- Endorsing active suicidality on intake survey or screening positive on EPDS (≥10) or Patient Health Questionnaire (PHQ)-9 (≥10) or GAD-7 (≥8)
- prisoners
- inability to consent.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Single Group Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: App-based digital parenting education
App-based digital parenting education will be delivered through a smartphone app with similar features as M.Bapp, but the content delivered through this attention-matched control app will not contain any CBT modules or psychoeducation.
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Please see active comparator group description.
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Experimental: M.Bapp
M.Bapp contains the same app-based digital parenting education provided to the active comparator group as well as 9 additional interactive modules based on the MB cognitive behavioral therapy curriculum.
M.Bapp contains interactive features and EMA-based voluntary daily assignments that provide the opportunity to receive additional final reimbursement.
Those who complete all modules will receive a digital certificate of completion.
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Please see experimental group description.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility
Time Frame: Randomization and six months postpartum
|
50% of those who are eligible based on prescreening and who are approached to participate consent to participate and 80% of those randomized to M.Bapp view at least 5 of the 10 modules
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Randomization and six months postpartum
|
Acceptability
Time Frame: Six months postpartum
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Scoring at least 80% on two well-validated scales: the System Usability Scale (focusing on perceived usability of technology) and the Client Satisfaction Questionnaire (focusing on satisfaction with mental health therapy).
These surveys will also contain questions covering additional themes about participant experience with the study intervention (either M.Bapp or app-based parenting education)-(1) helpfulness; (2) satisfaction; and (3) ease of interface with technical aspects of the program.
|
Six months postpartum
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Edinburgh Postnatal Depression Scale
Time Frame: Baseline (32-36 weeks' gestation), within one week of delivery, 2 months postpartum, 4 months postpartum, and 6 months postpartum
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10-item Score from 0 to 30.
Screen positive: score ≥10 or suicidal ideation
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Baseline (32-36 weeks' gestation), within one week of delivery, 2 months postpartum, 4 months postpartum, and 6 months postpartum
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General Anxiety Disorder-7
Time Frame: Baseline (32-36 weeks' gestation), within one week of delivery, 2 months postpartum, 4 months postpartum, and 6 months postpartum
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7-item self-report on anxiety symptoms
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Baseline (32-36 weeks' gestation), within one week of delivery, 2 months postpartum, 4 months postpartum, and 6 months postpartum
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Perceived Stress-Scale 4
Time Frame: Baseline (32-36 weeks' gestation), 2 months postpartum, and 6 months postpartum
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4-item self-report on stress symptoms
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Baseline (32-36 weeks' gestation), 2 months postpartum, and 6 months postpartum
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Dyadic Adjustment Scale
Time Frame: Baseline (32-36 weeks' gestation), 2 months postpartum, and 6 months postpartum
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7-item survey measuring relationship satisfaction, decision-making and cohesion
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Baseline (32-36 weeks' gestation), 2 months postpartum, and 6 months postpartum
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UCLA Loneliness Scale
Time Frame: Baseline (32-36 weeks' gestation), 2 months postpartum, and 6 months postpartum
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20-item survey measuring loneliness
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Baseline (32-36 weeks' gestation), 2 months postpartum, and 6 months postpartum
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Frequency of Mothers and Babies Skills Use
Time Frame: 6 months postpartum
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10-item survey created by MB to evaluate perceived helpfulness of intervention
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6 months postpartum
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
De novo psychiatric diagnosis
Time Frame: Within one week of delivery, 2 months postpartum, 4 months postpartum, and 6 months postpartum
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Initiation of antidepressant or other psychotropic medication during study period
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Within one week of delivery, 2 months postpartum, 4 months postpartum, and 6 months postpartum
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Screening positive on study survey
Time Frame: Within one week of delivery, 2 months postpartum, 4 months postpartum, and 6 months postpartum
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Screening positive for anxiety, depression, or stress
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Within one week of delivery, 2 months postpartum, 4 months postpartum, and 6 months postpartum
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Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2138752
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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