Effectiveness of Smartphone-Based Mindfulness Training on Maternal Perinatal Depression: Randomized Controlled Trial

Yaoyao Sun, Yanyan Li, Juan Wang, Qingyi Chen, Alessandra N Bazzano, Fenglin Cao, Yaoyao Sun, Yanyan Li, Juan Wang, Qingyi Chen, Alessandra N Bazzano, Fenglin Cao

Abstract

Background: Despite potential for benefit, mindfulness remains an emergent area in perinatal mental health care, and evidence of smartphone-based mindfulness training for perinatal depression is especially limited.

Objective: The objective of this study was to evaluate the effectiveness of a smartphone-based mindfulness training intervention during pregnancy on perinatal depression and other mental health problems with a randomized controlled design.

Methods: Pregnant adult women who were potentially at risk of perinatal depression were recruited from an obstetrics clinic and randomized to a self-guided 8-week smartphone-based mindfulness training during pregnancy group or attention control group. Mental health indicators were surveyed over five time points through the postpartum period by online self-assessment. The assessor who collected the follow-up data was blind to the assignment. The primary outcome was depression as measured by symptoms, and secondary outcomes were anxiety, stress, affect, sleep, fatigue, memory, and fear.

Results: A total of 168 participants were randomly allocated to the mindfulness training (n=84) or attention control (n=84) group. The overall dropout rate was 34.5%, and 52.4% of the participants completed the intervention. Mindfulness training participants reported significant improvement of depression (group × time interaction χ24=16.2, P=.003) and secondary outcomes (χ24=13.1, P=.01 for anxiety; χ24=8.4, P=.04 for positive affect) compared to attention control group participants. Medium between-group effect sizes were found on depression and positive affect at postintervention, and on anxiety in late pregnancy (Cohen d=0.47, -0.49, and 0.46, respectively). Mindfulness training participants reported a decreased risk of positive depressive symptom (Edinburgh Postnatal Depression Scale [EPDS] score>9) compared to attention control participants postintervention (odds ratio [OR] 0.391, 95% CI 0.164-0.930) and significantly higher depression symptom remission with different EPDS reduction scores from preintervention to postintervention (OR 3.471-27.986). Parity did not show a significant moderating effect; however, for nulliparous women, mindfulness training participants had significantly improved depression symptoms compared to nulliparous attention control group participants (group × time interaction χ24=18.1, P=.001).

Conclusions: Smartphone-based mindfulness training is an effective intervention in improving maternal perinatal depression for those who are potentially at risk of perinatal depression in early pregnancy. Nulliparous women are a promising subgroup who may benefit more from mindfulness training.

Trial registration: Chinese Clinical Trial Registry ChiCTR1900028521; http://www.chictr.org.cn/showproj.aspx?proj=33474.

Keywords: depression; mHealth; mindfulness; mobile health; perinatal care; pregnancy; psychosocial intervention.

Conflict of interest statement

Conflicts of Interest: None declared.

©Yaoyao Sun, Yanyan Li, Juan Wang, Qingyi Chen, Alessandra N Bazzano, Fenglin Cao. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 27.01.2021.

Figures

Figure 1
Figure 1
Screenshots of Spirits Healing mindfulness app.
Figure 2
Figure 2
Participant flow chart. EPDS: Edinburgh Postnatal Depression Scale; PHQ-9: Patient Health Questionnaire-9; ITT: intention to treat.
Figure 3
Figure 3
Overall intervention effect on Edinburgh Postnatal Depression Scale (EPDS) scores using the generalized estimated equation model in (A) intention-to-treat (ITT), (B) per-protocol (PP), and (C) per-protocol–intervention complete (PP-IC) samples. *significant between-group mean difference. ACG: attention control group; MTPG: mindfulness training in pregnancy group.
Figure 4
Figure 4
Overall intervention effect on Edinburgh Postnatal Depression Scale (EPDS) scores by parity. A1: Model in primipara; A2: Model in multipara. *significant between-group mean difference.

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