A bespoke mobile application for the longitudinal assessment of depression and mood during pregnancy: protocol of a feasibility study

Jose Salvador Marcano Belisario, Kevin Doherty, John O'Donoghue, Paul Ramchandani, Azeem Majeed, Gavin Doherty, Cecily Morrison, Josip Car, Jose Salvador Marcano Belisario, Kevin Doherty, John O'Donoghue, Paul Ramchandani, Azeem Majeed, Gavin Doherty, Cecily Morrison, Josip Car

Abstract

Introduction: Depression is a common mental health disorder during pregnancy, with important consequences for mothers and their children. Despite this, it goes undiagnosed and untreated in many women attending antenatal care. Smartphones could help support the prompt identification of antenatal depression in this setting. In addition, these devices enable the implementation of ecological momentary assessment techniques, which could be used to assess how mood is experienced during pregnancy. With this study, we will assess the feasibility of using a bespoke mobile application (app) running on participants' own handsets for the longitudinal (6 months) monitoring of antenatal mood and screening of depression.

Methods and analysis: We will use a randomised controlled study design to compare two types of assessment strategies: retrospective + momentary (consisting of the Edinburgh Postnatal Depression Scale plus five momentary and two contextual questions), and retrospective (consisting of the Edinburgh Postnatal Depression Scale only). We will assess the impact that these strategies have on participant adherence to a prespecified sampling protocol, dropout rates and timeliness of data completion. We will evaluate differences in acceptance of the technology through a short quantitative survey and open-ended questions. We will also assess the potential effect that momentary assessments could have on retrospective data. We will attempt to identify any patterns in app usage through the analysis of log data.

Ethics and dissemination: This study has been reviewed and approved by the National Research Ethics Service Committee South East Coast-Surrey on 15 April 2016 as a notice of substantial amendment to the original submission (9 July 2015) under the Research Ethics Committee (REC) reference 15/LO/0977. This study is being sponsored by Imperial College London under the reference number 15IC2687 and has been included in the UK Clinical Research Network Study Portfolio under the Central Portfolio Management System number 19280. The findings of this study will be disseminated through academic peer-reviewed publications, poster presentations and abstracts at academic and professional conferences, discussion with peers, and social media. The findings of this study will also inform the PhD theses of JSMB and KD.

Keywords: Antenatal care; Depression & mood disorders

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
BrightSelf—Check Back (screenshot).
Figure 2
Figure 2
BrightSelf—Check In (screenshot).
Figure 3
Figure 3
Sampling protocols for the retrospective plus momentary assessments and for the retrospective assessments. EPDS, Edinburgh Postnatal Depression Scale.

References

    1. Stewart DE. Depression during pregnancy. N Engl J Med Overseas Ed 2011;365:1605–11. 10.1056/NEJMcp1102730
    1. Mental Health Foundation. Fundamental facts about mental health 2015. London: Mental Health Foundation, 2015.
    1. Gavin NI, Gaynes BN, Lohr KN, et al. . Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 2005;106(5 Pt 1):1071–83. 10.1097/01.AOG.0000183597.31630.db
    1. Lee AM, Lam SK, Sze Mun Lau SM, et al. . Prevalence, course, and risk factors for antenatal anxiety and depression. Obstet Gynecol 2007;110:1102–12. 10.1097/01.AOG.0000287065.59491.70
    1. Bennett HA, Einarson A, Taddio A, et al. . Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 2004;103:698–709. 10.1097/01.AOG.0000116689.75396.5f
    1. Heron J, O'Connor TG, Evans J, et al. ; ALSPAC Study Team. The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 2004;80:65–73. 10.1016/j.jad.2003.08.004
    1. Kinsella MT, Monk C. Impact of maternal stress, depression and anxiety on fetal neurobehavioral development. Clin Obstet Gynecol 2009;52:425–40. 10.1097/GRF.0b013e3181b52df1
    1. Pearson RM, Evans J, Kounali D, et al. . Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years. JAMA Psychiatry 2013;70:1312–9. 10.1001/jamapsychiatry.2013.2163
    1. Braithwaite EC, Murphy SE, Ramchandani PG. Effects of prenatal depressive symptoms on maternal and infant cortisol reactivity. Arch Womens Ment Health 2016;19:581–90. 10.1007/s00737-016-0611-y
    1. Howard LM, Molyneaux E, Dennis CL, et al. . Non-psychotic mental disorders in the perinatal period. Lancet 2014;384:1775–88. 10.1016/S0140-6736(14)61276-9
    1. Kingston D, Austin MP, Heaman M, et al. . Barriers and facilitators of mental health screening in pregnancy. J Affect Disord 2015;186:350–7. 10.1016/j.jad.2015.06.029
    1. Goodman JH. Women's attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth 2009;36:60–9. 10.1111/j.1523-536X.2008.00296.x
    1. BinDhim NF, Alanazi EM, Aljadhey H, et al. . Does a mobile phone Depression-Screening app motivate mobile phone users with high depressive symptoms to seek a health care professional's Help? J Med Internet Res 2016;18:e156 10.2196/jmir.5726
    1. BinDhim NF, Shaman AM, Trevena L, et al. . Depression screening via a smartphone app: cross-country user characteristics and feasibility. J Am Med Inform Assoc 2015;22:29–34. 10.1136/amiajnl-2014-002840
    1. Woo YS, Bahk WM, Hong J, et al. . Use of a smartphone application to screen for bipolar spectrum disorder in a community sample. Health Informatics J 2016;22:779–88. 10.1177/1460458215589601
    1. Torous J, Chan SR, Yee-Marie Tan S, et al. . Patient smartphone ownership and interest in mobile apps to monitor symptoms of mental health conditions: a survey in four geographically distinct psychiatric clinics. JMIR Ment Health 2014;1:e5 10.2196/mental.4004
    1. Moskowitz DS, Young SN. Ecological momentary assessment: what it is and why it is a method of the future in clinical psychopharmacology. J Psychiatry Neurosci 2006;31:13–20.
    1. Asselbergs J, Ruwaard J, Ejdys M, et al. . Mobile Phone-Based unobtrusive ecological momentary assessment of Day-to-Day mood: an explorative study. J Med Internet Res 2016;18:e72 10.2196/jmir.5505
    1. Shiffman S, Stone AA, Hufford MR. Ecological momentary assessment. Annu Rev Clin Psychol 2008;4:1–32. 10.1146/annurev.clinpsy.3.022806.091415
    1. Marcano Belisario JS, Jamsek J, Huckvale K, et al. . Comparison of self-administered survey questionnaire responses collected using mobile apps versus other methods. Cochrane Database Syst Rev 2015;27:MR000042 10.1002/14651858.MR000042.pub2
    1. Ofcom. Facts & figures. [date accessed: 30 August 2016].
    1. Marcano-Belisario JS, Gupta AK, O'Donoghue J, et al. . Tablet computers for implementing NICE antenatal mental health guidelines: protocol of a feasibility study. BMJ Open 2016;6:e009930 10.1136/bmjopen-2015-009930
    1. National Collaborating Centre for Mental Health. Antenatal and postnatal mental health: clinical management and service guidance—updated edition. Leicester and London: The British Psychological Society and The Royal College of Psychiatrists, 2014.
    1. Whooley MA, Avins AL, Miranda J, et al. . Case-finding instruments for depression. two questions are as good as many. J Gen Intern Med 1997;12:439–45.
    1. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. development of the 10-item edinburgh postnatal depression scale. Br J Psychiatry 1987;150:782–6. 10.1192/bjp.150.6.782
    1. Gibson J, McKenzie-McHarg K, Shakespeare J, et al. . A systematic review of studies validating the Edinburgh postnatal depression scale in antepartum and postpartum women. Acta Psychiatr Scand 2009;119:350–64. 10.1111/j.1600-0447.2009.01363.x
    1. Blake F. Mumshine – The App: The design of a micro on-line intervention for postnatal women to improve mood and well-being using an app for the smart phone. Presented at: Clahrc East Of England Fellows Showcase Event 2014.
    1. Lund AM. Measuring usability with the USE questionnaire. Usability Interface 2001;8:3–6.
    1. Schoenau-Fog H. storytelling I, Hooked!–evaluating engagement as continuation desire in interactive narratives. Berlin, Heidelberg: Springer, 2011:219–30. .
    1. Snap® Surveys Limited. Powerful and flexible software. (accessed 14 December 2016).
    1. Stata. Stata statistical software [Program]. 2015. Version 14.
    1. Atlas.ti. Atlas.ti qualitative data analysis [Program]. Version 8 2016.
    1. Schwartz JE, Stone AA. Strategies for analyzing ecological momentary assessment data. Health Psychol 1998;17:6–16. 10.1037/0278-6133.17.1.6
    1. Shiffman S. Conceptualizing analyses of ecological momentary assessment data. Nicotine Tob Res 2014;16(Suppl 2):S76–S87. 10.1093/ntr/ntt195

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner