Strongest Families™ Managing Our Mood (MOM): a randomized controlled trial of a distance intervention for women with postpartum depression
- 987 Downloads
The present study investigated whether a distance-delivered intervention could significantly decrease mild to moderate postpartum depression (PPD) in mothers as compared to usual care. Mothers with PPD (n = 62) were randomly assigned to the intervention or standard community care. Participants receiving the intervention followed a 12-session cognitive behavioural informed handbook supplemented with telephone-based coaching support. Diagnostic status and depressive symptoms were assessed at baseline and 3, 6 and 12 months postrandomization. Odds ratios indicated that intervention group participants were 1.5 times as likely to experience diagnostic remission at 3 months (mid-intervention) (p = 0.742), 1.54 times as likely at 6 months (p = 0.696) and 12.5 times as likely at 12 months (p = 0.009). Intervention ‘dosage’ significantly moderated this effect; for every additional coaching session completed, individuals had a 1.4 times greater chance of showing improvement at 3 and 6 months. Mothers reported high satisfaction with the intervention. Findings suggest positive outcomes at each time point and superior outcomes to the control condition at the long-term follow-up. Caution in interpreting these results is warranted due to small sample size and incomplete data; however, they support further investigation into the use of distance interventions as an accessible and effective solution for women with PPD.
KeywordsPostpartum depression Randomized controlled trial Telehealth Cognitive behavioural intervention Health care access
The authors would like to thank the following individuals for their significant contributions to the advisory committee: Cathy Thurston, Helen Gould, Kathy Inkpen, Lee Johnson, Jenny MacCormick, Marilyn Martin, Nancy Thurston, Karen Blanchard, Anne MacKenzie, Lisa MacRae, Darla MacPherson, Kim MacClellan, Michelle Pickles, Christine Saulnier, Kim Barro and Liz MacKay. We thank the study staff. We sincerely thank all referring health professionals from across Nova Scotia’s health regions and, most importantly, all mothers who volunteered their valued time to participate.
PJ-M and P-LP conceived of the study and developed the background, methods and design. LM-W and J-O drafted the manuscript and critically revised it for important intellectual content. K-T provided overall trial management and staff supervision and provided substantial revision to the content of the manuscript. W-C and B-C conducted statistical analysis and drafted the main results. All authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
Dr. McGrath is a volunteer Chair of the Board and Dr. Lingley-Pottie and Jillian Kennedy are paid employees of the Strongest Families Institute, a not-for-profit organization. Dr. Lingley-Pottie’s academic time on this study was in-kind.
The study was funded by the Women’s Health in Rural Communities (WHIRC) research program funded by the Canadian Institutes of Health Research (CIHR; Funding Reference Number 70789).
- American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. APA, Washington.Google Scholar
- Arnberg FK, Linton SJ, Hultcrantz M, Heintz E, Jonsson U (2014) Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness. PLoS One 9(5):e98118. doi: 10.1371/journal.pone.0098118 CrossRefPubMedPubMedCentralGoogle Scholar
- Beck AT, Steer RA, Brown GK (1996) Manual for the Beck Depression Inventory—II. Psychological Corporation, San AntonioGoogle Scholar
- Corkum P, Lingley-Pottie P, Davidson F, McGrath PJ, Chambers C, Mullane J, Laredo S, Woodford K, Weiss S (2016) Better nights/better days—distance intervention for insomnia in school-aged children with/without ADHD: a randomized controlled trial. J Pediatr Psychol 41(6):701–713CrossRefPubMedGoogle Scholar
- Cornish AM, Mcmahon CA, Ungerer JA, Barnett B, Kowalenko N, Tennant C (2005) Postnatal depression and infant cognitive and motor development in the second postnatal year: the impact of depression chronicity and infant gender. Infant Behav Dev 28(4):407–417. doi: 10.1016/j.infbeh.2005.03.004 CrossRefGoogle Scholar
- de Graaf LE, Gerhards SA, Arntz A, Riper H, Metsemakers JFM, Evers SMAA, Severens JL, Widdershoven G, Huibers MJH (2009) Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial. Brit J Psych 195 (1):73–80Google Scholar
- Donkin L, Hickie IB, Christensen H, Naismith SL, Neal B, Cockayne NL, Glozier N (2013) Rethinking the dose-response relationship between usage and outcome in an online intervention for depression: randomized controlled trial. JMIR 15(10):e231. doi: 10.2196/jmir.2771
- Feldman R, Granat A, Pariente C, Kanety H, Kuint J, Gilboa-Schechtman E (2009) Maternal depression and anxiety across the postpartum year and infant social engagement, fear regulation, and stress reactivity. J Am Acad Child Adolesc Psychiatry 48(9):919–927. doi: 10.1097/chi.0b013e3181b21651 CrossRefPubMedGoogle Scholar
- First MB, Spitzer RL, Gibbon M, Williams JBW (2002) Structured clinical interview for DSM–IV-TR axis I disorders, research version, patient edn. Biometrics Research, New York State Psychiatric Institute, New YorkGoogle Scholar
- Glenn D, Golinelli D, Rose RD, Roy-Byrne P, Stein MB, Sullivan G, Craske MG (2013) Who gets the most out of cognitive behavioral therapy for anxiety disorders? The role of treatment dose and patient engagement. J Consult Clin Psychol 81(4):639–649. doi: 10.1037/a0033403 CrossRefPubMedPubMedCentralGoogle Scholar
- Handley TE, Kay-Lambkin FJ, Inder KJ, Lewin TJ, Attia JR, Fuller J, Kelly BJ (2014) Self-reported contacts for mental health problems by rural residents: predicted service needs, facilitators and barriers. BMC Psychiatry 14:249. doi: 10.1186/s12888-014-0249-0 CrossRefPubMedPubMedCentralGoogle Scholar
- Hegel MT, Unützer J, Tang L, Areán PA, Katon W, Noël PH, Williams JW, Lin EH (2005) Impact of comorbid panic and posttraumatic stress disorder on outcomes of collaborative care for late-life depression in primary care. Am J Geriatr Psychiatry 13(1):48–58. doi: 10.1097/00019442-200501000-00008 CrossRefPubMedGoogle Scholar
- McGrath PJ, Lingley-Pottie P, Thurston C, MacLean C, Cunningham C, Waschbusch DA, Watters C, Stewart S, Bagnell A, Santor D, Chaplin W (2011) Telephone-based mental health interventions for child disruptive behavior or anxiety disorders: randomized trials and overall analysis. J Am Acad Child Adolesc Psychiatry 50(11):1162–1172. doi: 10.1016/j.jaac.2011.07.013 CrossRefPubMedGoogle Scholar
- Milgrom J, Danaher BG, Gemmill AW, Holt C, Holt CJ, Seeley JR, Tyler MS, Ross J, Ericksen J (2016) Internet cognitive behavioral therapy for women with postnatal depression: a randomized controlled trial of MumMoodBooster. J Med Internet Res 18(3):e54. doi: 10.2196/jmir.4993 CrossRefPubMedPubMedCentralGoogle Scholar
- O’Hara MW (1997) The nature of postpartum depressive disorders. In: Murray L, Cooper PJ (eds) Postpartum depression and child development. Guilford, New York, pp 3–31Google Scholar
- O’Mahen HA, Richards DA, Woodford J, Wilkinson E, Mcginley J, Taylor RS, Warren FC (2013a) Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression. Psychol Med 44(08):1675–1689. doi: 10.1017/s0033291713002092 CrossRefPubMedPubMedCentralGoogle Scholar
- Pearson RM, Melotti R, Heron J, Joinson C, Stein A, Ramchandani PG, Evans J (2012) Disruption to the development of maternal responsiveness? The impact of prenatal depression on mother–infant interactions. Infant Behav Dev 35(4):613–626. doi: 10.1016/j.infbeh.2012.07.020 CrossRefPubMedGoogle Scholar
- Perkins D, Fuller J, Kelly BJ, Lewin TJ, Fitzgerald M, Coleman C, Buss R (2013) Factors associated with reported service use for mental health problems by residents of rural and remote communities: cross-sectional findings from a baseline survey. BMC Health Serv Res 13(1):157. doi: 10.1186/1472-6963-13-157 CrossRefPubMedPubMedCentralGoogle Scholar
- Priest S, Henderson J, Evans S, Hagan R (2003) Stress debriefing after childbirth: a randomized controlled trial. Med J Aust 178:542–5Google Scholar
- Sourander A, McGrath PJ, Ristkari T, Cunningham C, Huttunen J, Lingley-Pottie P, Yli-Hinkka-Salomäki S, Kinnunen M, Vuorio J, Sinokki A, Fossum S, Unruh A (2016) Internet-assisted parent training intervention for disruptive behavior in 4-year-old children: a randomized clinical trial. JAMA Psychiatry 73(4):378–387. doi: 10.1001/jamapsychiatry.2015.3411 CrossRefPubMedGoogle Scholar