Effectiveness and cost-effectiveness of an electronic mindfulness-based intervention (eMBI) on maternal mental health during pregnancy: the mindmom study protocol for a randomized controlled clinical trial

Abstract Background Mental disorders are common during the peripartum period and may have far-reaching consequences for both mother and child. Unfortunately, most antenatal care systems do not provide any structured screening for maternal mental health. As a consequence, mental illnesses are often overlooked and not treated adequately. If correctly diagnosed, cognitive behavioral therapy is currently the treatment of choice for mental illnesses. In addition, mindfulness-based interventions (MBIs) seem to represent a promising treatment option for anxiety and depression during the peripartum period. Considering the internet’s increasing omnipresence, MBIs can also be offered electronically via a (tablet) computer or smartphone (electronically based MBI = eMBI). Objective The current study aims to examine the clinical effectiveness and cost-effectiveness of an eMBI (the mindmom application) developed by an interdisciplinary team of gynecologists, psychologists, and midwives, teaching pregnant women how to deal with stress, pregnancy-related anxiety, and depressive symptoms. The study sample consists of pregnant women in their third trimester who screened positive for emotional distress. The mindmom study is a bicentric prospective randomized controlled trial (RCT), which is currently conducted at the University women’s hospitals of Heidelberg and Tübingen, Germany. Methods Within the scope of the routine prenatal care, pregnant women attending routine pregnancy care in Baden-Wuerttemberg, Germany, are invited to participate in a screening for mental distress based on the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS screening result > 9 will be referred to one of the mindmom coordinating study centers and are offered counseling either face-to-face or via videotelephony. After an initial psychological counseling, women are invited to participate in an eMBI in their last pregnancy trimester. The study will enroll N = 280 study participants (N = 140 per group), who are randomized 1:1 into the intervention (IG) or control group (treatment as usual = TAU). All participants are requested to complete a total of 7 digital assessments (5 visits pre- and 2 follow-up visits postpartum), involving self-report questionnaires, sociodemographic and medical data, physiological measures, and morning cortisol profiles. The primary outcome will be depressive and anxiety symptoms, measured by the Edinburgh Postnatal Depression Scale, the State Trait Anxiety Questionnaire, and the Pregnancy-Related Anxiety Questionnaire. Secondary outcomes include mindfulness, satisfaction with birth, quality of life, fetal attachment, bonding, mode of delivery, and cost-effectiveness. Discussion This is the first German RCT to examine the (cost-)effectiveness of an eMBI on maternal mental health during pregnancy. If successful, the mindmom app represents a low-threshold and cost-effective help for psychologically distressed women during pregnancy, thereby reducing the negative impact on perinatal health outcome. Trial registration Deutsches Register Klinischer Studien, German Clinical Trials Register DRKS00017210. Registered on 13 January 2020. Retrospectively registered.

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The Mental Health Characteristics of Pregnant Women With Depressive Symptoms Identified by the Edinburgh Postnatal Depression Scale

The Journal of Clinical Psychiatry ◽

10.4088/jcp.13m08646 ◽

2014 ◽

Vol 75 (04) ◽

pp. 393-398 ◽

Cited By ~ 42

Author(s):

Linda B. Lydsdottir ◽

Louise M. Howard ◽

Halldora Olafsdottir ◽

Marga Thome ◽

Petur Tyrfingsson ◽

...

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Pregnant Women ◽

Postnatal Depression ◽

Edinburgh Postnatal Depression Scale ◽

Depression Scale

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A Smartphone-Assisted Brief Behavioral Intervention for Pregnant Women with Depression: a Study Protocol of a Randomized Controlled Trial

10.21203/rs.3.rs-67826/v1 ◽

2021 ◽

Author(s):

Pedro Fonseca Zuccolo ◽

Mariana O. Xavier ◽

Alicia Matijasevich ◽

Guilherme Vanoni Polanczyk ◽

Daniel Fatori

Keyword(s):

Mental Health ◽

Physical Activity ◽

Social Support ◽

Pregnant Women ◽

Active Control ◽

Behavioral Intervention ◽

Maternal Mental Health ◽

Smartphone Applications ◽

Randomized Controlled ◽

Brief Behavioral Intervention

Abstract Background: Pregnancy is strongly associated with increased risk for depression, but treating pregnant women is challenging. The use of psychiatric medications might result in developmental problems in the child, therefore must be used with caution. Psychosocial interventions require specialized professionals which are scarce, especially in low- and middle-income countries. In this context, smartphone-based interventions show immense potential. We created Motherly, a smartphone app designed to promote maternal mental health. The Motherly app delivers a package of interventions, including mental health, sleep, nutrition, physical activity, social support, prenatal/postnatal support, and psychoeducational content. With this study, we will test the effectiveness of the Motherly app in addition to brief cognitive-behavioral therapies (CBT) to treat maternal depression. Methods: We will conduct a 2-arm parallel randomized controlled clinical trial in which 70 pregnant women between 16-40 years with depression will be randomized to intervention or active control. The intervention group will have access to the Motherly app. The active control group will have access to a simplified version of the app consisting exclusively of psychoeducational content. Both groups will undergo four sessions of CBT in 8 weeks. Participants will be evaluated by assessors blind to randomization and allocation status at baseline (T0), midpoint (T1, week 4-5), posttreatment (T2, week 8), and follow-up (T3, when the child is two months-old). Maternal mental health (prenatal anxiety, psychological well-being, perceived stress, depression, depression severity, and sleep quality), quality of life, physical activity levels, and infant developmental milestones and social/emotional problems will be measured. Our primary outcome is the change in maternal prenatal depression from baseline to posttreatment (8 weeks). Discussion: There is a growing literature on interventions using smartphone applications to promote mental health, both with or without the intermediation of a mental health professional. Our study adds to the literature by testing whether an app providing an intervention package, including CBT, psychoeducation, nutrition, physical activity, and social support, can treat depression, a condition for which the use of digital technologies is still scarce. Smartphone applications designed to treat maternal depression have the potential to circumvent barriers that prevent pregnant women from accessing mental health care.Trial Registration: A Smartphone-Assisted Brief Behavioral Intervention for Pregnant Women With Depression (clinicaltrials.gov, registry number: NCT04495166, prospectively registered in 29/07/2020).

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Associations between Coparenting Relationships and Maternal Depressive Symptoms and Negative Bonding to Infant

Healthcare ◽

10.3390/healthcare9040375 ◽

2021 ◽

Vol 9 (4) ◽

pp. 375

Author(s):

Yoko Takeishi ◽

Yasuka Nakamura ◽

Mikako Yoshida ◽

Maiko Kawajiri ◽

Fumi Atogami ◽

...

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Maternal Mental Health ◽

Secondary Analysis ◽

Depression Scale ◽

Mental Illnesses ◽

Child Rearing ◽

Postpartum Depressive Symptoms ◽

First Child ◽

Early Postpartum

Maternal mental illnesses during early postpartum may be caused by lack of the coparenting relationship parents share and cooperate regarding child-rearing. This study clarifies the association of the coparenting relationship and negative mental health of mothers at one and three months after childbirth. This study conducted a secondary analysis of data from an intervention study wherein 24 mothers rearing their first child with a cohabitant (husband/partner) participated. Maternal mental health was evaluated using the Edinburgh Postnatal Depression Scale to determine postpartum depressive symptoms and the Mother-to-Infant Bonding Scale to assess negative bonding. Mothers’ average age was 31.5 ± 4.2 years old. All mothers were not working during the research period. The prevalence of postpartum depression and bonding disorder were approximately 13% and 21%, respectively. A better coparenting relationship was associated with lower postpartum depressive symptoms at both one month (β = −0.617, p = 0.002) and three months (β = −0.709, p < 0.01) postpartum. In contrast, no association was found between a coparenting relationship and negative bonding. The results indicate that the coparenting relationship may possibly prevent maternal depression during the early postpartum period.

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Maternal Mental Health Following Ultrasonographic Detection of Fetal Structural Anomaly in the Midst of the COVID-19 Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182412900 ◽

2021 ◽

Vol 18 (24) ◽

pp. 12900

Author(s):

Nur Rowaidah Roslan ◽

Mohd Fadhli Mohd Fauzi ◽

Lim Wan Teng ◽

Abdul Ghani Nur Azurah

Keyword(s):

Mental Health ◽

Pregnant Women ◽

Repeated Measures ◽

Maternal Stress ◽

Maternal Mental Health ◽

Depression Scale ◽

Tertiary Hospital ◽

Anxiety And Depression ◽

Hospital Anxiety ◽

Structural Anomaly

Prenatal ultrasonographic detection of fetal structural anomaly may adversely affect maternal mental health throughout pregnancy, particularly in the current COVID-19 pandemic. This study aims to prospectively assess maternal stress, anxiety, and depression following ultrasonographic detection of fetal structural anomaly from diagnosis until delivery during the COVID-19 pandemic. A total of 141 pregnant women at a tertiary hospital who underwent detailed scans between 16 and 24 gestational weeks were included and categorized into the study (anomaly finding, n = 65) and comparison (normal finding, n = 76) groups. Self-administered questionnaires of 10-item Perceived Stress Scale (PSS-10) and Hospital Anxiety and Depression Scale (HADS) were used to assess maternal stress, anxiety, and depression at prior detection (T1), two-to-four weeks post-detection (T2), one-to-two weeks prior to delivery (T3), and one-to-two weeks post-delivery (T4). Repeated measures of analysis of variance (ANOVA) were conducted to assess time-, between-group, and time–group interaction effect. In general, maternal stress improved, but anxiety worsened, while depression persisted, over the time from T1 to T4. The average maternal stress and anxiety levels were significantly higher among groups with fetal anomaly. The maternal stress and anxiety level were significantly affected within one-to-two weeks post-detection of fetal structural anomaly. In conclusion, maternal mental health parameters were affected differently during the COVID-19 pandemic, with higher vulnerability of stress and anxiety among pregnant women with fetal structural anomaly particularly within one-to-two weeks post-detection.

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351-OR: Continuous Glucose Monitoring in Pregnant Women with Type 1 Diabetes: Cost-Effectiveness Analyses of the CONCEPTT Randomized Controlled Trial

Diabetes ◽

10.2337/db19-351-or ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 351-OR

Author(s):

HELEN R. MURPHY ◽

DENICE FEIG ◽

NASHITA PATEL

Keyword(s):

Randomized Controlled Trial ◽

Type 1 Diabetes ◽

Cost Effectiveness ◽

Pregnant Women ◽

Continuous Glucose Monitoring ◽

Controlled Trial ◽

Glucose Monitoring ◽

Randomized Controlled

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Role of social integration in the protection against depression in the Chilean elderly population

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1053 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

L de Albuquerque Araújo ◽

N Bello Escamilla ◽

V Sabando Franulic

Keyword(s):

Mental Health ◽

Older Adults ◽

Social Integration ◽

Old Age ◽

Protective Factor ◽

Depression Scale ◽

Mental Illnesses ◽

National Study ◽

Close Relatives ◽

Negative Gradient

Abstract Chile has improved survival however this process occurs under a framework of socioeconomic and gender inequalities, which results in an impact of mental health, especially in vulnerable groups. The objective was to determine the association between depression and social integration in Chilean older adults. Cross-sectional study from the National Study of Dependence in Old Person 2010. The risk of depression was amount with Geriatric Depression Scale (>5). The social integration were quantity as frequency of meeting with close relatives (child, partner, daughter/ son-in-law, grandchildren); with other relatives (brother, brothers-in-law, nephews or other relatives) and with friends and neighbors in the last 12 months in 5 categories (never visit; less frequently; 1-2 times a month; 1-2 times a week; every day or almost). Logistic regression models considered the sampling design of the survey to identify association with odd ratio (OR) (never as reference category), adjustment for sex, age, ethnicity, household income, education, housing arrangement and chronic diseases (p ≤ 0,5). Total of 4179 older adults 25,3% reported risk of depression, the significative association with close relatives was in daily or almost frequency OR:0.42 (95%CI 0.27-0.67), 1-2 times a week OR: 0,57 (95%CI 0,33-0,99), 1-2 times/month OR: 0,56 (95%CI 0,99); other relatives were lower frequency OR: 0.54 (95%CI 0.38-0.78); 1-2 times/month OR; 0.50 (95%CI 0.31-0.81); 1-2 times/week OR:0.35 (95%CI 0.22-0.55); daily or almost OR:0.27 (95%CI 0.18-0.42). And meeting with friends and neighbors in the same frequency order were OR: 0.66 (95%CI 0.44-0.99); OR:0.43 (95%CI 0.26-0.73); OR:0.4 (95%CI 0.25-0.62); OR: 0.32 (95%CI 0.21-0.47). There is a negative gradient between depression and the frequency of meeting with friends, neighbors and family, independent of sociodemographic and health characteristics. Social integration must be promoted as a protective factor of mental health in elderly. Key messages Depression is one of the most common mental illnesses in old age and we found a negative gradient between the frequency of meeting friends, neighbors and family and the possibility of depression. It seems essential for public health to have strategies that address social life in old age to strengthen quality of live and mental health.

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The hidden burden of adolescent pregnancies in rural Sri Lanka; findings of the Rajarata Pregnancy Cohort

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03977-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Thilini Chanchala Agampodi ◽

Nuwan Darshana Wickramasinghe ◽

Hemali Gayathri Jayakodi ◽

Gayani Shashikala Amarasinghe ◽

Janith Niwanthaka Warnasekara ◽

...

Keyword(s):

Mental Health ◽

Sri Lanka ◽

Pregnant Women ◽

Adolescent Mothers ◽

Depression Scale ◽

Ultra Sound ◽

Physical And Mental Health ◽

Pregnancy Cohort ◽

Contraceptive Usage ◽

Adolescent Pregnancies

Abstract Background Adolescent fertility is a main indicator of the Sustainable Developmental Goal (SGD) three. Although Sri Lanka is exemplary in maternal health, the utilization of Sexual and Reproductive Health services (SRH) by adolescents is less documented. We describe the hidden burden, associated biological and psychosocial factors and utilization patterns of pre-conceptional services among pregnant adolescents in rural Sri Lanka. Methods The study is based on the baseline assessment of the Rajarata Pregnancy Cohort (RaPCo) in Anuradhapura. Pregnant women newly registered from July to September 2019 were recruited to the study. The period of gestation was confirmed during the second follow-up visit (around 25–28 weeks of gestation) using ultra sound scan data. A history, clinical examination, anthropometric measurements, blood investigations were conducted. Mental health status was assessed using the Edinburgh Postpartum Depression Scale (EPDS). Results Baseline data on gestation was completed by 3,367 pregnant women. Of them, 254 (7.5%) were adolescent pregnancies. Among the primigravida mothers (n = 1037), 22.4% (n = 233) were adolescent pregnancies. Maternal and paternal low education level, being unmarried, and less time since marriage were statistically significant factors associated with adolescent pregnancies (p < 0.05). Contraceptive usage before pregnancy, utilization of pre-conceptional health care services, planning pregnancy and consuming folic acid was significantly low among adolescents (p < 0.001). They also had low body mass index (p < 0.001) and low hemoglobin levels (p = 0.03). Adolescent mothers were less happy of being pregnant (p = 0.006) and had significantly higher levels of anxiety (p = 0.009). Conclusion One fifth of women in their first pregnancy in this study population are adolescents. Nulli-parous adolescents exert poor social stability and compromised physical and mental health effects. The underutilization and/or unavailability of SRH services is clearly associated with adolescent pregnancies.

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Screening for depression with the Edinburgh Postnatal Depression Scale and finding borderline personality disorder

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867418804067 ◽

2018 ◽

Vol 53 (5) ◽

pp. 424-432 ◽

Cited By ~ 7

Author(s):

Fiona Judd ◽

Stephanie Lorimer ◽

Richard H Thomson ◽

Angela Hay

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Personality Traits ◽

Pregnant Women ◽

Postnatal Depression ◽

Edinburgh Postnatal Depression Scale ◽

Past History ◽

Depression Scale ◽

Borderline Personality ◽

Borderline Personality Traits

Objective: The aim of the study was to explore the range of psychiatric diagnoses seen in pregnant women who score above the ‘cut-off’ on the Edinburgh Postnatal Depression Scale when this is used as a routine screening instrument in the antenatal period. Method: Subjects were all pregnant women referred to and seen by the Perinatal Consultation-Liaison Psychiatry Team of a tertiary public hospital over a 14-month period. Edinburgh Postnatal Depression Scale score at maternity ‘booking-in’ visit, demographic and clinical data were recorded and diagnoses were made according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria following clinical interview(s) and review of documented past history. Data were analysed using descriptive statistics. Results: A total of 200 patients who had completed the Edinburgh Postnatal Depression Scale were seen for assessment; 86 (43%) scored ⩾13 on Edinburgh Postnatal Depression Scale. Of those scoring 13 or more on Edinburgh Postnatal Depression Scale, 22 (25.6%) had a depressive disorder. In total, 12 patients (14%) had an anxiety disorder, 14 (16.3%) had borderline personality disorder and 13 (15.1%) had a substance use disorder. An additional 23 women (26.7%) had two or more borderline personality traits. Conclusion: Psychiatric assessment of women who scored 13 or more on the Edinburgh Postnatal Depression Scale at routine antenatal screening identified a significant number with borderline personality disorder or borderline personality traits rather than depressive or anxiety disorders. Clinical Practice Guidelines note the importance of further assessment for all women who score 13 or more on the Edinburgh Postnatal Depression Scale. The findings here suggest that this assessment should be made by a clinician able to identify personality pathology and organise appropriate and timely interventions.

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The ‘new normal’ includes online prenatal exercise: Exploring pregnant women’s experiences during the pandemic and the role of virtual group fitness on maternal mental health

10.21203/rs.3.rs-151871/v1 ◽

2021 ◽

Author(s):

Cristina Silva-Jose ◽

Taniya S Nagpal ◽

Javier Coterón ◽

Ruben Barakat ◽

Michelle F Mottola

Keyword(s):

Mental Health ◽

Physical Activity ◽

Pregnant Women ◽

Maternal Mental Health ◽

Exercise Program ◽

Well Being ◽

Group Exercise ◽

Exercise Classes ◽

Prenatal Exercise ◽

Online Group

Abstract Background: Prenatal anxiety and depressive symptoms have significantly increased since the onset of the coronavirus (COVID-19) pandemic. Furthermore, home confinement regulations have caused a drastic increase in time spent sedentary. Online group fitness classes may be an effective strategy that can increase maternal physical activity and improve mental health outcomes by providing an opportunity for social connectedness. The present study explores the experiences of pregnant women who participated in an online group exercise program during the pandemic and identifies relationships with maternal mental health and well-being. In addition, we present person-informed recommendations on how to improve the delivery of future online prenatal exercise programs.Methods: Semi-structured interviews were conducted with pregnant women (8-39 weeks of pregnancy) who participated in an online group exercise program, from March to October 2020 in Spain. A phenomenological approach was taken, and open-ended questions were asked to understand women’s experiences throughout the pandemic and the role the online exercise classes may have had on their physical activity levels, mental health, and other health behaviours such as diet. A thematic analysis was performed to evaluate data. In addition, women completed the State-Trait Anxiety Inventory (STAI) and these data supplemented qualitative findings. Results: Twenty-four women were interviewed, and the average STAI score was 32.23 ± 9.31, ranging from low to moderate anxiety. Thematic analysis revealed that women felt safe exercising from home, an increased availability of time to schedule a structured exercise class, and consequently an improvement in their adherence to the program and other behaviours (i.e., healthier diet). Women emphasized feeling connected to other pregnant women when they exercised online together, and overall, this had a positive effect on their mental well-being. Women suggested that future online exercise programs should include flexible options, detailed instructions and facilitation by a qualified exercise professional.Conclusion: Pregnant women are receptive to online group exercise classes and expressed that these are an accessible option to accommodating physical activity during the pandemic. In addition, the online group environment provides an important sense of connectivity among pregnant women exercising together and this may mitigate the detrimental effect of COVID-19 on maternal mental health.

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