Be a Mom, a Web-Based Intervention to Promote Positive Mental Health Among Postpartum Women With Low Risk for Postpartum Depression: Exploring Psychological Mechanisms of Change.
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SUBMITTER: Monteiro F
PROVIDER: S-EPMC8316830 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Aim: Be a Mom is a self-guided, web-based intervention to prevent persistent postpartum depression symptoms [PPD], targeting both at-risk postpartum women and/or women presenting early-onset postpartum depressive symptoms (selective/indicated preventive intervention). Be a Mom is grounded on the principles of Cognitive-Behavior Therapy and incorporates the recent contributions of acceptance and compassion-based approaches (third-wave approaches) applied to the perinatal context. This study aimed to explore the processes underlying therapeutic change in the Be a Mom intervention, by: (1) exploring whether participation in the Be a Mom promotes the enhancement of self-regulatory skills (emotion regulation abilities, psychological flexibility and self-compassion) in comparison with women who did not participate in the program; and (2) exploring whether changes in self-regulatory skills are associated with changes in depressive symptoms, among women who participated in the Be a Mom program. Methods: A pilot randomized, two-arm controlled trial was conducted. Eligible women (presenting PPD risk-factors and/or early-onset PPD symptoms) were enrolled in the study and were randomly assigned to the intervention group (Be a Mom, n = 98) or to the waiting-list control group (n = 96). Participants in both groups completed baseline (T1) and post-intervention assessments (T2), including measures of depressive symptoms, emotion regulation abilities, psychological flexibility and self-compassion. Results: From baseline to post-intervention assessment, women in the intervention group showed a significantly greater decrease in the levels of emotion regulation difficulties (p < 0.001) and a significant greater increase in the levels of self-compassion (p < 0.001) compared to the control group. No significant differences were found concerning psychological flexibility. Moreover, a greater decrease in difficulties in emotion regulation and greater increase in self-compassion levels were significantly associated with a greater decrease in depressive symptoms, among women in the intervention group. Discussion: Be a Mom promotes the enhancement of women's emotion regulation abilities and self-compassion, and this seems to exert a protective effect in the presence of PPD risk factors (or early-onset symptoms) because it led to a reduction of depressive symptoms. By providing some insights into the processes that underlie treatment response to Be a Mom, this study highlights the important role of the targeted third-wave processes applied to the perinatal context.
| S-EPMC6401984 | biostudies-literature
Project description:Relapse rates following a depressive episode are high, with limited treatments available aimed at reducing such risk. Acceptance and commitment therapy (ACT) is a cognitive-behavioral approach that has gained increased empirical support in treatment of depression, and thus represents an alternative in relapse prevention. Psychological flexibility (PF) plays an important role in mental health according to the model on which ACT is based. This study aimed to investigate the role of PF and its subprocesses in reducing residual symptoms of depression and in improving positive mental health following an 8-week group-based ACT treatment. Adult participants (75.7% female) with a history of depression, but currently exhibiting residual symptoms (N = 106) completed measures before and after intervention, and at 6 and 12-month follow-up. A growth curve model showed that positive mental health increased over 12-months. Multilevel mediation modeling revealed that PF significantly mediated these changes as well as the reduction of depressive symptoms, and that processes of acceptance, cognitive defusion, values and committed action, in turn, mediated increased PF.
| S-EPMC7119364 | biostudies-literature
Project description:Postpartum depression (PPD)-the most common complication of childbirth-is a significant and prevalent public health problem that severely disrupts family interactions and can result in serious lasting consequences to the health of women and the healthy development of infants. These consequences increase in severity when left untreated; most women with PPD do not obtain help due to a range of logistical and attitudinal barriers.This pilot study was designed to test the feasibility, acceptability, and potential efficacy of an innovative and interactive guided Web-based intervention for postpartum depression, MomMoodBooster (MMB).A sample of 53 women who satisfied eligibility criteria (<9 months postpartum, ?18 years of age, home Internet access and use of personal email, Edinburgh Postnatal Depression Survey score of 12-20 or Patient Health Questionnaire score from 10-19) were invited to use the MMB program. Assessments occurred at screening/pretest, posttest (3 months following enrollment), and at 6 months follow-up.All six sessions of the program were completed by 87% (46/53) of participants. Participants were engaged with the program: visit days (mean 15.2, SD 8.7), number of visits (mean 20.1, SD 12.2), total duration of visits in hours (mean 5.1, SD 1.3), and number of sessions viewed out of six (mean 5.6, SD 1.3) all support high usage. Posttest data were collected from 89% of participants (47/53) and 6-month follow-up data were collected from 87% of participants (46/53). At pretest, 55% (29/53) of participants met PHQ-9 criteria for minor or major depression. At posttest, 90% (26/29) no longer met criteria.These findings support the expanded use and additional testing of the MMB program, including its implementation in a range of clinical and public health settings.
| S-EPMC3841354 | biostudies-literature
Project description:In this study, we conducted a preliminary investigation of the efficacy of Be a Mom, a web-based self-guided intervention, in enhancing positive mental health among postpartum women at low risk for postpartum depression. Additionally, we examined Be a Mom's efficacy regarding secondary outcomes as well as its acceptability and adherence. A total of 367 participants were randomly assigned to the Be a Mom group (n = 191) or to the waiting-list control group (n = 176) and completed baseline (T1) and postintervention (T2) assessments. The intervention group reported significant increases in positive mental health between T1 and T2 compared to the control group. Additionally, group effects were found for depressive and anxiety symptoms. A significantly higher proportion of participants in the Be a Mom group had an improvement trajectory (from not flourishing at T1 to flourishing at T2). A total of 62 (32.5%) women completed Be a Mom, and most would use it again if needed (n = 82/113; 72.6%). This study provides preliminary evidence of Be a Mom's efficacy in increasing positive mental health among low-risk postpartum women. Our findings support mental health promotion strategies in the postpartum period and highlight the important role of web-based CBT interventions.
| S-EPMC7370106 | biostudies-literature
Project description:BACKGROUND:Research shows that individuals can improve mental health by increasing experiences of positive emotions. However, the role of positive emotions in perinatal mental health has not been investigated. This study explored the extent to which positive emotions during infant feeding are associated with maternal depression and anxiety during the first year postpartum. MATERIALS AND METHODS:One hundred and sixty-four women drawn from a longitudinal cohort of mother-infant dyads were followed from the third trimester through 12 months postpartum. We measured positive emotions during infant feeding at 2 months using the mean subscale score of the modified Differential Emotions Scale. Depression and anxiety symptoms were assessed with the Beck Depression Inventory-II and State Trait Anxiety Inventory-State subscale at months 2, 6, and 12. Generalized linear mixed models were used to estimate crude and multivariable associations. RESULTS:Among women with no clinical depression during pregnancy, higher positive emotions during infant feeding at 2 months were associated with significantly fewer depression symptoms at 2, 6, and 12 months and with lower odds of clinically significant depression symptoms at 2 and 6 months. In contrast to depression outcomes, women with clinical anxiety during pregnancy who experienced higher positive emotions had significantly fewer anxiety symptoms at 2, 6, and 12 months and lower odds of clinically significant anxiety at 2 and 6 months. CONCLUSIONS:Positive emotions during infant feeding are associated with depression and anxiety outcomes during the first year postpartum and may be a modifiable protective factor for maternal mental health.
| S-EPMC6390657 | biostudies-literature
Project description:BACKGROUND:Postpartum depression is a psychiatric disorder that starts from the second to the sixth week after birth. Breastfeeding is considered a protective factor for postpartum mood swings. This paper aims to examine the effect of breastfeeding on postpartum depression and anxiety, and how it affects child development. METHODS:The study included 209 pregnant women, 197 puerperea, and 160 women at the end of the third month after delivery, followed through three time-points. The instruments used in the study were the Edinburgh Postpartum Depression Scale (EPDS), Beck's Depression Inventory (BDI), and Beck's Anxiety Inventory (BAI). RESULTS:Postpartum mothers with low risk of PPD breastfed their children more often than mothers with a mild or severe risk of perinatal depression. Mean values on the BDI scale three months after giving birth were higher in mothers who did not breastfeed their child (M = 3.53) than those who did breastfeed their child (M = 2.28). Postpartum anxiety measured by BAI was statistically negatively correlated (rs-, 430) with the duration of breastfeeding. CONCLUSION:Nonbreastfeeding mothers are more depressed and anxious compared to breastfeeding mothers.
| S-EPMC7216213 | biostudies-literature
Project description:BackgroundForty-percent of the variance in psychological treatment outcomes is estimated to be explained by symptom change by the third treatment session. However, change may not be uniform across patient groups and symptom domains. This study aimed to identify subgroups of patients with different trajectories of depression and anxiety symptom change during psychological therapy and identify baseline patient characteristics associated with these trajectories.Methods4394 patients attending two psychological treatment services completed sessional, self-report depression and anxiety measures. Trajectories of symptom change were investigated using latent class growth analysis. Multinomial logistic regression was used to explore associations between baseline patient characteristics and trajectory classes.ResultsA number of distinct trajectories were identified. Anxiety symptom trajectories could be distinguished by the third treatment session, but for depression symptoms there was a class displaying limited change until session six followed by rapid improvement in symptoms thereafter. Compared to the non-responding trajectories, depression and anxiety trajectories indicating treatment response were associated with lower baseline severity, better social functioning and lower incidence of phobic anxiety, but not with medication prescription status.LimitationsData came from two services, so wider generalisability is unknown. Predictors were limited to data routinely collected in the services; unmeasured factors may have improved the prediction of trajectories.ConclusionsBaseline characteristics and symptom change early in therapy can help identify different trajectories of symptom change. This knowledge could aid clinical decision making and help improve treatment outcomes. By ignoring distinct trajectories, clinicians may incorrectly consider patients as "not-on-track" and unnecessarily change or end therapy that would otherwise benefit patients.
| S-EPMC6428692 | biostudies-literature
Project description:BackgroundInternet-delivered psychological interventions (IPIs) have been shown to be effective for a variety of psychological concerns, including postpartum depression. Human-supported programs produce better adherence and larger effect sizes than unsupported programs; however, what it is about support that affects outcomes is not well understood. Therapeutic alliance is one possibility that has been found to contribute to outcomes; however, the specific mechanism is not well understood. Participant perspectives and qualitative methodology are nearly absent from the IPI alliance research and may help provide new directions.ObjectiveIn this study, we aimed to provide participant perspectives on engagement with an IPI for postpartum depression to help inform alliance research, development of new IPIs, and inform resource allocation.MethodsA qualitative methodology was used to explore participant perspectives of veteran women's engagement with the MomMoodBooster program, a human-supported internet-delivered intervention for postpartum depression. Participants were asked 4 open-ended questions with the 3-month postintervention survey, "In what ways did you find the MomMoodBooster most helpful?" "How do you think the MomMoodBooster could have been improved?" "In what ways did you find the personal coach calls to be helpful?" and "How do you think the personal coach calls could have been improved?"ResultsData were collected from 184 participants who responded to at least 1 of the open-ended questions. These were analyzed using thematic analysis and a process of reaching a consensus among coders. The results suggest that not only the engagement with the support person is perceived as a significant contributor to participant experiences while using the MomMoodBooster content but also the relationship factors are particularly meaningful. The results provide insights into the specific qualities of the support person that were perceived as most impactful, such as warmth, empathy and genuineness, and feeling normalized and supported. In addition, the results provide insight into the specific change processes that can be targeted through support interactions, such as encouraging self-reflection and self-care and challenging negative thinking.ConclusionsThese data emphasize the importance of relationship factors between support persons and an IPI program for postpartum depression. The findings suggest that focusing on specific aspects of the alliance and the therapeutic relationship could yield fruitful directions for the training of support personnel and for future alliance-based research of internet-delivered treatments.
| S-EPMC10466152 | biostudies-literature
Project description:BackgroundWomen with antenatal depression often have a higher risk of developing postpartum depression (PPD) after delivery. A number of factors associated with the PDD in those previously reporting antenatal depression have been suggested, but further research is needed. This study aimed to investigate factors associated with developing subsequent postnatal depression in women who had screened positive for antenatal depression.MethodsThis study was carried out in Hangzhou women's Hospital. 578 women who experienced antenatal depression from this cohort were enrolled in this study. The sociodemographic and clinical characteristics of the participants were collected and tabulated against the incidence of postnatal depression. Binary logistic regression was used to estimate the effects of the principal underlying variables. The Chinese-version Edinburgh Postnatal Depression Scale (EPDS) was used to screen for PPD. Antenatal screening for depression was conducted at 28-34 weeks during pregnancy and postpartum depressive symptoms were assessed at 6 weeks after childbirth in the women. Path Analysis of Structural Equation Model (SEM) was employed to explore the direct, indirect, and total effects of risk factors of PPD.Results57.6% (n = 333) of the participants subsequently developed PPD in our study. The results of the logistic analysis indicated that ages ≤ 35 years old (OR = 1.852; 95%CI: 1.002-3.423), non-one-child families (OR = 1.518; 95%CI: 1.047-2.200), and rare care from partner during pregnancy (OR = 2.801; 95%CI: 1.038-7.562), the antenatal EPDS score (OR = 1.128; 95%CI: 1.052-1.209), pyrexia during pregnancy (OR = 2.43; 95%CI: 1.358-4.345), fairly good (OR = 1.836; 95%CI: 1.009-3.340), fairly bad (OR = 3.919; 95%CI:2.072-7.414) and very bad postpartum sleep quality (OR = 9.18; 95%CI: 2.335-36.241) were associated with increased risk of PPD (compared to very good postpartum sleep quality). In path analysis model, antenatal EPDS score (standardized total β = 0.173) and pyrexia during pregnancy (standardized total β = 0.132) had both direct and indirect effects (the impact on outcome variables needs to be determined through other variables) on PPD. Sleep quality after delivery (standardized β = 0.226) and one-child family (standardized β = 0.088) had direct effects only on PPD.ConclusionThe results from our study indicated that more than 50% of the women who experienced antepartum depression would subsequently develop PPD. Depressive symptoms and pyrexia during pregnancy increase PPD scores, and these effects were in part mediated via poor sleep quality during the postpartum period.
| S-EPMC10394808 | biostudies-literature
Project description:BackgroundAdherence to self-guided interventions tends to be very low, especially in people with depression. Prior studies have demonstrated that enhancements may increase adherence, but little is known about the efficacy of various enhancements in comparison to, or in combination with, one another.ObjectiveThe aim of our study is to test whether 3 enhancements-facilitator contact (FC), an online discussion board, and virtual badges (VB)-alone, or in combination, improve adherence to a self-guided, web-based intervention for depression. We also examined whether age, gender, race, ethnicity, comfort with technology, or baseline depression predicted adherence or moderated the effects that each enhancement had on adherence.MethodsParticipants were recruited through web-based sources and, after completing at least 4 out of 7 daily emotion reports, were sequentially assigned to 1 of 9 conditions-the intervention alone; the intervention plus 1, 2, or all 3 enhancements; or an emotion reporting control condition. The intervention was a positive psychological program consisting of 8 skills that specifically targeted positive emotions, and it was delivered over 5 weeks in a self-guided, web-based format. We operationalized adherence as the number of skills accessed.ResultsA total of 602 participants were enrolled in this study. Participants accessed, on average, 5.61 (SD 2.76) of 8 skills. The total number of enhancements participants received (0-3) did not predict the number of skills accessed. Participants who were assigned to the VB+FC condition accessed significantly more skills than those in the intervention only conditions. Furthermore, participants in arms that received the combination of both the VB and FC enhancements (VB+FC and VB+FC+online discussion board) accessed a greater number of skills relative to the number of skills accessed by participants who received either VB or FC without the other. Moderation analyses revealed that the receipt of VB (vs no VB) predicted higher adherence among participants with moderately severe depression at baseline.ConclusionsThe results suggested that the VB+FC combination significantly increased the number of skills accessed in a self-guided, web-based intervention for elevated depression. We have provided suggestions for refinements to these enhancements, which may further improve adherence.Trial registrationClinicalTrials.gov NCT02861755; http://clinicaltrials.gov/ct2/show/NCT02861755.
| S-EPMC8495567 | biostudies-literature