Abstract
BackgroundSmartphone-based psychoeducation interventions may be a low-cost, user-friendly alternative to resource-consuming, face-to-face antenatal classes to educate expectant mothers.ObjectiveThis study aimed to empirically examine whether such an intervention would lead to reduced postnatal depression, anxiety, or stress and result in a better health-related quality of life.MethodsA single-blind randomized controlled trial was conducted in Hong Kong. All first-time expectant mothers with less than 24 weeks of gestation remaining and attending the antenatal clinic at a public hospital were included. Participants were assigned to the intervention group or the control group by drawing lots. The lots, presented in sealed opaque envelopes, were randomly designated as “intervention” or “control” by stratified randomization. The intervention, a psychoeducational mobile app, was provided in addition to the treatment as usual (TAU) services from the hospital. Follow up with participants took place at 4 weeks postpartum. The primary outcome was the difference in the levels of antenatal and postnatal depression, assessed by the Edinburgh Postnatal Depression Scale (EPDS). The intention-to-treat approach was employed in the analyses.ResultsThe final sample was 660 expectant mothers (nintervention=330 and ncontrol=330). The mean difference in EPDS scores between the two groups was −0.65 (95% CI −1.29 to 0.00; P=.049) after adjusting for confounding factors. Associations were found between participation in the intervention and reduced depression, and attendance in TAU classes and increased stress levels.ConclusionsThe smartphone-based intervention plus TAU services was effective in reducing postnatal depression at 4 weeks postpartum compared with a control condition of TAU only, making this a cost-effective alternative to TAU education for expectant mothers. Limitations of the study included the short postpartum period after which the follow-up assessment was conducted and the inclusion of first-time mothers rather than all mothers.Trial RegistrationHKU Clinical Trials Registry HKUCTR-2024; http://www.hkuctr.com/Study/Show/ 34f62a2f6d594273a290491827206384
Highlights
Antenatal anxiety and depression occur in approximately 20% of pregnant women with potentially deleterious effects to mother and child
Attending group therapy significantly reduced worry and depression symptoms over pregnancy into the postpartum compared to women receiving no therapy
Women attended an average of 4.405 sessions (SD=1.235), there was no difference between the groups
Summary
Antenatal anxiety and depression occur in approximately 20% of pregnant women with potentially deleterious effects to mother and child. While effective in reducing symptoms, some pregnant women are often reluctant to take psychotropic medications. The effects of depression, anxiety and worry on the pregnant woman and her unborn baby are an increasing concern for women and their care providers. The levels of depression and anxiety symptoms are often highest at the onset of pregnancy, tending to decrease over the course of the pregnancy and into postpartum [3]. This trend in decreasing depression symptoms over the perinatal period is seen regardless of whether or not the symptom scores indicate that the woman meets the criteria for depression or if she is being treated. The prevalence of depressive symptoms is highest in the first three months and gradually falls over the first year [6]
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