Baumel Amit, Tinkelman Amanda, Mathur Nandita, Kane John M
Department of Community Mental Health, University of Haifa, Haifa, Israel.
Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, United States.
JMIR Mhealth Uhealth. 2018 Feb 13;6(2):e38. doi: 10.2196/mhealth.9482.
Peer support is considered to be an important framework of support for mothers experiencing postpartum depression (PPD); however, some barriers exist that may limit its use including peer availability and mothers' lack of time due to child care.
This non-randomized study was designed to examine the feasibility, acceptance, and preliminary clinical outcomes of using 7 Cups of Tea (7Cups), a digital platform that delivers self-help tools and 24/7 emotional support delivered by trained volunteers, as an adjunct treatment for mothers diagnosed with PPD.
Mothers with PPD were referred during intake to the study coach who provided guidance about 7Cups. 7Cups features included self-help tools and chats with trained volunteers who had experienced a perinatal mood disorder in their past. Acceptability was measured by examining self-reports and user engagement with the program. The primary outcome was the Edinburgh Postnatal Depression Scale (EPDS) change score between pre- and postintervention at 2 months, as collected in usual care by clinicians blinded to the study questions. Using a propensity score matching to control for potential confounders, we compared women receiving 7Cups to women receiving treatment as usual (TAU).
Participants (n=19) proactively logged into 7Cups for a median of 12 times and 175 minutes. Program use was mostly through the mobile app (median of mobile use 94%) and between 18:00 and 08:00 when clinicians are unavailable (68% of total program use time). Participants chatted with volunteers for a total of 3064 minutes and have indicated in their responses 0 instances in which they felt unsafe. Intent-to-treat analysis revealed that 7Cups recipients experienced significant decreases in EPDS scores (P<.001, Cohen d=1.17). No significant difference in EPDS decrease over time was found between 7Cups and TAU, yet the effect size was medium favoring 7Cups (P=.05, Cohen d=0.58).
This study supports using a computerized method to train lay people, without any in-person guidance or screening, and engage them with patients diagnosed with mental illness as part of usual care. The medium effect size (d=0.58) favoring the 7Cups group relative to TAU suggests that 7Cups might enhance treatment outcomes. A fully powered trial has to be conducted to examine this effect.
同伴支持被认为是为经历产后抑郁症（PPD）的母亲提供支持的重要框架；然而，存在一些障碍可能会限制其使用，包括同伴的可获得性以及母亲因照顾孩子而缺乏时间。
这项非随机研究旨在检验使用“七杯茶”（7Cups）作为被诊断为PPD的母亲的辅助治疗方法的可行性、可接受性和初步临床结果。“七杯茶”是一个数字平台，提供自助工具以及由训练有素的志愿者提供的全天候情感支持。
患有PPD的母亲在入组时被转介给研究指导者，后者提供有关“七杯茶”的指导。“七杯茶”的功能包括自助工具以及与过去曾经历围产期情绪障碍的训练有素的志愿者聊天。通过检查自我报告和用户对该项目的参与度来衡量可接受性。主要结局是干预前和干预后2个月的爱丁堡产后抑郁量表（EPDS）变化得分，由对研究问题不知情的临床医生在常规护理中收集。使用倾向得分匹配来控制潜在的混杂因素，我们将接受“七杯茶”治疗的女性与接受常规治疗（TAU）的女性进行了比较。
参与者（n = 19）主动登录“七杯茶”的中位数为12次，时长为175分钟。项目使用主要通过移动应用程序（移动使用的中位数为94%），且在临床医生无法提供服务的18:00至08:00之间（占项目总使用时间的68%）。参与者与志愿者聊天的总时长为3064分钟，且在回复中表示没有感到不安全的情况。意向性分析显示，接受“七杯茶”治疗的参与者的EPDS得分显著降低（P <.001，科恩d = 1.17）。在“七杯茶”组和TAU组之间，未发现EPDS随时间下降的显著差异，但效应量中等，有利于“七杯茶”组（P =.05，科恩d = 0.58）。
本研究支持使用一种计算机化方法来培训非专业人员，无需任何面对面指导或筛查，并让他们与被诊断患有精神疾病的患者接触，作为常规护理的一部分。相对于TAU组，有利于“七杯茶”组的中等效应量（d = 0.58）表明“七杯茶”可能会改善治疗效果。必须进行一项充分有力的试验来检验这种效果。
