SA35 - PPD ACT, AN APP-BASED POSTPARTUM DEPRESSION GENETIC STUDY

Abstract

Background Postpartum Depression (PPD), a subtype of Major Depressive Disorder (MDD), has a lifetime prevalence of 10–15% and is one of the most frequent complications of childbirth. PPD is particularly suited to genetic investigation as it is a more homogenous phenotype than MDD occurring outside of the perinatal period (i.e., women of childbearing age exposed to a similar biopsychosocial stressor). Therefore, we developed an iOS app (PPD ACT) with the goal of recruiting 100,000 women with a lifetime history of PPD to sufficiently power Genome-Wide Association Studies (GWAS). We used Apple's ResearchKit platform to put our research study in the hands of thousands of women internationally, becoming the first mobile health study focused on psychiatric genetics. Methods PPD ACT is a study with two basic components: 1) participant screening for PPD and 2) collection of DNA from PPD cases. Women who believe they may have had PPD download the app, complete a basic eligibility quiz, and are presented with Informed Consent (IC) for PPD screening. To assess for comprehension of study procedures, women must complete a quiz prior to finger-signing the IC document. Participants are then screened for PPD using the lifetime version of the EPDS and those identified as cases are then invited to participate in DNA collection. If they wish to participate, they complete another IC process (presentation of IC contents, quiz, signature) and are sent a spit kit via USPS. To validate app findings, we performed clinical validation in UNC Hospitals and assessed recall validity using a second PPD screen (6 – 8 months after initial assessment). Results PPD ACT was released to the US App Store on March 21, 2016. The data presented here are from the first-year post-launch. PPD ACT was downloaded 13,869 times. Following download 10,473 participants completed a basic eligibility screen and consent for phenotyping, with 7,607 PPD cases identified. After one year, 3,038 saliva samples have been biobanked. The lifetime EPDS threshold for PPD case status was ≥ 13 but the median score in cases was 23 (IQR: 20 – 25). This sample of PPD cases was notably severely affected. PPD ACT had a sensitivity of 100% in a clinical validation sample (n=43). In addition, 2,149 women participated a second lifetime EPDS assessment. There was a 92% agreement in case status (AC1=0.92, 95% CI: 0.91 – 0.93) among participants who took place in reassessment. Discussion PPD ACT is the first mobile health application for a psychiatric genetics study, screening and collecting samples directly from participants. Overall, we enrolled a population of cases that experienced severe episodes of PPD and a large proportion of cases reported symptoms so severe they sought professional help or were prescribed medication. With the response we obtained in just the first year of our study, we are confident that we are well on the way to helping all women who suffer with postpartum depression.