Internet Therapy Promising for Postnatal Depression

Caroline Cassels

October 23, 2013

Internet-based therapy may be an effective treatment for women with postnatal depression (PND), new research suggests.

Results from a randomized, controlled, phase 2 study suggest that women who received Internet-based treatment for PND experienced a greater reduction in symptoms of depression and anxiety as well as less work and social impairment.

"To our knowledge, this is the first RCT [randomized controlled trial] demonstrating the clinical potential of a supported online intervention specifically developed for PND," the authors, led by Heather O'Mahen, PhD, University of Exeter, United Kingdom, write.

The study was published online October 22 in Psychological Medicine.

Unique Barriers

An estimated 13% of women suffer from depression, the authors note. Further, they point out that depression not only has a significant impact on mothers but has been shown to have long-term negative effects on the cognitive, social, and emotional development of children.

In addition, PND is undertreated, partly because recognition of it by health professionals is poor and only 17% to 25% of women seek help. In addition, the authors point out that the postpartum period presents unique barriers to treatment. For example, many women prefer psychotherapy over antidepressants, particularly if they are breastfeeding, but the time commitment and scheduling associated with having a young child can make scheduling regular appointments challenging.

In addition, some women are concerned that if they seek help for PND, they may risk having their children taken away from them.

Internet-based delivery systems offer "an alternative, promising approach that may circumvent many of the difficulties of face-to-face delivery," the authors note. Also, previous research showed that mothers were more likely to report sensitive information regarding their mood over the Internet.

The study included 249 women recruited through a UK parenting Web site. A total of 83 women met Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) criteria for major depressive disorder and were randomly assigned to receive either 12-session, modular, Internet behavioral activation (BA) treatment (n = 41) or usual care (n = 42).

The active treatment consisted of 5 core Internet BA sessions and a relapse prevention session. Women also chose 2 optional modules from a list of 6. In addition, women in the active treatment group received weekly telephone call support from mental health workers. Women who missed sessions were actively followed up via telephone and text messaging to reschedule appointments.

Study outcomes included change in the Edinburgh Postnatal Depression Scale (EPDS), the Generalized Anxiety Disorder 7-Item Scale, the Work and Social Adjustment Scale, the Postnatal Bonding Questionnaire, and the Social Provisions Scale.

Lower Attrition Rate

Of the total study group, 86% (n = 71) completed the EPDS post-treatment, and 71% (59%) presented at 6-month follow-up. More women in the Internet BA group completed the study than women in the usual care group (90% vs 81%). At 6-month follow-up, EPDS was completed by 76% of women in the Internet BA group vs 68% of women receiving usual care.

The results showed a "reliable and clinically significant improvement" in depression scores in 62.2% of those in the Internet BA group post-treatment vs 29.4% in those receiving usual care. After adjusting for baseline EPDS, the odds ratio (OR) for a reliable and clinically significant improvement in the treatment vs the control group was 0.26 (95% confidence interval [CI], 0.10 - 0.71).

The investigators report that the between-group effect size of the Internet program was "large and...clinically significant for over 60% of users."

They also note that "although the 95% CI was wide, spanning a medium to very large effect size, these results compare favourably with effect sizes from meta-analyses of face-to-face treatments for PND and with online CBT treatments for MDD that provide an element of guided support...."

According to Dr. O'Mahen, these preliminary findings suggest that Internet-based therapy for PND may improve access and treatment uptake by removing treatment barriers encountered by this patient population.

"Such an intervention may hold promise for reaching groups of women who do not have local access to empirically supported treatments, struggle with issues of stigma, or have a particular need for flexibility and in-home treatment delivery," the authors conclude.

The authors report no relevant financial relationships.

Psychol Med. Published online October 22, 2013.

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