Online prevention of postpartum depression for Spanish- and English-speaking pregnant women: A pilot randomized controlled trial

Abstract

Background: Postpartum depression (PPD) is a maternal mental health problem that affects women from all regions of the world. Unfortunately, even in developed countries, half of the cases go undetected and, consequently, untreated. Individuals from low and middle income countries trend toward underutilization of mental health services, partly due to the limited number of available psychological resources. The primary aims of this pilot randomized controlled trial were to adapt to the Internet the Mothers and Babies Course/Curso Mamás y Bebés, a prevention of PPD intervention, to describe the characteristics of the pregnant women who engaged in the intervention site, and to obtain preliminary data on the efficacy of the Internet intervention to reduce the risk of PPD.

Methods: Pregnant women, 18 years or older who were interested in using the site for themselves were recruited and randomly assigned to a fully-automated self-help Internet intervention or to an information-only control condition. Randomized participants were invited to complete monthly depression assessments up to six months postpartum. To examine the prevention effects of the Internet intervention, pregnant women who did not meet current criteria for a major depressive episode, who engaged with the study website, and who provided depression data during the postpartum follow-up period were included in the study analyses.

Results: Participants were 111 predominantly Spanish-speaking (82.9%) and Latino/Hispanic (71.3%) pregnant women residing in 23 countries worldwide. The effect of the prevention intervention condition failed to reach significance at the a priori alpha-level. However, the observed coefficient trended in the hypothesized direction (b = -0.514, χ² (1) = 3.43, p = .061; HR = 0.598). The benefits of receiving the e-MB Internet intervention was greater for pregnant women reporting high (vs. low) levels of prenatal depression symptoms (b = -0.605, χ² (1) = 5.20, p =.023).

Conclusions: This study provides preliminary evidence that Internet interventions are a promising method toward expanding the reach of psychological resources to perinatal women at-risk for PPD.

Keywords: Internet intervention; Postpartum depression; Spanish-speaking; global mental health; prevention; women.

Figure 1. CONSORT Flow diagram from January to December 2009

Note. MDE: Major depressive episode; Control: Information-only brochure; e-MB: Mothers and Babies Internet Course/Curso Internet Mamás y Bebés; CES-D: Center for Epidemiological Depression Scale; EPDS: Edinburgh Postnatal Depression Scale.

Figure 2. Number of days to postpartum EPDS ≥ 10 by assigned condition and prenatal depression vulnerability

Note. CES-D: Center for Epidemiological Depression Scale; Control: Information-only brochure; e-MB: Mothers and Babies Internet Course/Curso Internet Mamás y Bebés; EPDS: Edinburgh Postnatal Depression Scale.