Schwartz Hannah, McCusker Jane, Da Costa Deborah, Singh Santokh, Baskaran Sandhya, Belzile Eric, Van Roost Kaya
St. Mary's Hospital Center, Montréal, QC, Canada.
Department of Psychiatry, McGill University, Montréal, QC, Canada.
Internet Interv. 2022 Dec 23;31:100597. doi: 10.1016/j.invent.2022.100597. eCollection 2023 Mar.
Mental health problems are frequent in the postpartum period, but accessible treatment options are lacking. The MPOWER study investigated whether the use of trained lay coaches could increase the uptake and effectiveness of a web-based intervention (WBI) for women with postpartum depression and/or anxiety.
First, to compare the feasibility and acceptability of a WBI for women with postpartum depression and anxiety, with and without the addition of telephone coaching calls. Second, to estimate the effectiveness of the WBI at decreasing symptoms of depression and anxiety at 6 months, with and without coaching calls.
We conducted a pilot randomized controlled trial (RCT) that enrolled women who had recently given birth and had mild to moderate postpartum depression and/or anxiety. Study participants were provided access to the WBI. Women randomized to the intervention group also received up to 7 telephone coaching calls during the 6 months of follow up. We evaluated the feasibility of the intervention through participants' usage of the WBI, as well as the completion and fidelity of planned coach calls. We measured acceptability via two questionnaires on the usability of the WBI and participant satisfaction with the intervention. To determine the potential effectiveness of the intervention, the primary outcomes were defined as symptoms of depression and anxiety at 6 months and adjusted mean differences between groups for these outcomes were estimated using linear regression models.
We recruited 52 participants (25 intervention; 27 control). At 6 months, 88 % (22/25) of participants randomized to the intervention arm and 59 % (16/27) of participants randomized to the control arm remained in the study. The intervention group had an average of 11 (95 % CI: [5, 18]) more website logins than the control group. Intervention group participants completed a mean of 6.2 coaching calls with high fidelity. The estimates of the effect of the intervention on mental health outcomes at 6-months were imprecise but point estimates and confidence intervals were consistent with a moderate beneficial effect of the intervention on both symptoms of depression and anxiety (fully adjusted effects sizes: 0.51 (95 % CI: [-0.14, 1.17]) and 0.56 (95 % CI: [-0.09, 1.22]), respectively).
WBIs with coaching are feasible, acceptable, and potentially effective treatment options for women with mild to moderate postpartum depression and/or anxiety. The addition of coaching calls markedly increased engagement with the WBI, but a larger RCT is needed to determine the effectiveness of such an intervention.
心理健康问题在产后时期很常见，但缺乏可及的治疗选择。MPOWER研究调查了使用经过培训的非专业指导者是否能提高针对产后抑郁和/或焦虑女性的基于网络的干预措施（WBI）的接受度和有效性。
第一，比较有和没有增加电话指导的情况下，WBI对产后抑郁和焦虑女性的可行性和可接受性。第二，评估有和没有指导的情况下，WBI在6个月时减轻抑郁和焦虑症状的有效性。
我们进行了一项试点随机对照试验（RCT），纳入了近期分娩且患有轻度至中度产后抑郁和/或焦虑的女性。为研究参与者提供了使用WBI的机会。随机分配到干预组的女性在6个月的随访期间还接受了多达7次电话指导。我们通过参与者对WBI的使用情况、计划指导电话的完成情况和保真度来评估干预的可行性。我们通过两份关于WBI可用性和参与者对干预满意度的问卷来衡量可接受性。为了确定干预的潜在有效性，主要结局定义为6个月时的抑郁和焦虑症状，并使用线性回归模型估计这些结局在组间的调整平均差异。
我们招募了52名参与者（25名干预组；27名对照组）。在6个月时，随机分配到干预组的参与者中有88%（22/25）、随机分配到对照组的参与者中有59%（16/27）仍留在研究中。干预组的网站登录平均次数比对照组多11次（95%置信区间：[5, 18]）。干预组参与者平均完成了6.2次高保真的指导电话。干预对6个月时心理健康结局影响的估计不精确，但点估计值和置信区间与干预对抑郁和焦虑症状均有中度有益影响一致（完全调整后的效应量分别为：0.51（95%置信区间：[-0.14, 1.17]）和0.56（95%置信区间：[-0.09, 1.22]））。
对于轻度至中度产后抑郁和/或焦虑的女性，有指导的WBI是可行、可接受且可能有效的治疗选择。增加指导电话显著提高了对WBI的参与度，但需要更大规模的RCT来确定这种干预的有效性。
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