A Mobile Health Mindfulness Intervention for Women With Moderate to Moderately Severe Postpartum Depressive Symptoms: Feasibility Study

Abstract

Background Approximately 20% of women suffer from postpartum depression (PPD). Due to barriers such as limited access to care, half of the women with PPD do not receive treatment. Therefore, it is critical to identify effective and scalable interventions. Traditional mindfulness programs have been effective in reducing depressive symptoms, however access remains a barrier. A self-paced mobile health (mHealth) mindfulness program may fit the lifestyle of busy mothers who are unable to attend in-person classes. However, little is known regarding the feasibility or efficacy of mHealth mindfulness interventions in postpartum women with depressive symptoms. Objective This study aims to assess the feasibility, acceptability, and preliminary efficacy of an mHealth mindfulness intervention for postpartum women with moderate to moderately severe depressive symptoms. Methods We conducted a single-arm feasibility trial of an mHealth mindfulness intervention within Kaiser Permanente Northern California (KPNC), a large integrated health care system. Participants were identified through clinician referral and electronic health records via KPNC's universal perinatal depression screening program and recruited by the study team. Inclusion criteria included the following: English-speaking, up to 6 months postpartum with a Patient Health Questionnaire (PHQ-8) score of 10 to 19, and no regular mindfulness/meditation practice. Participants were asked to use a mindfulness app, Headspace, 10 to 20 min/day for 6 weeks. Baseline and postintervention surveys captured data on patient-reported outcomes (depression and stress symptoms, sleep quality, and mindfulness). Semistructured interviews captured acceptability. Retention and adherence were used to assess feasibility. Results Of the 115 women who were contacted and met the eligibility criteria or declined participation before eligibility assessment, 27 (23%) were enrolled. In addition, 70% (19/27) completed the study. The mean age of participants was 31 years (SD 5.2), 30% (8/27) were non-Hispanic White, and, on average, participants were 12.3 weeks postpartum (SD 5.7). Of the women who completed the study, 100% (19/19) used the Headspace app at least once, and nearly half (9/19, 47%) used the app on ≥50% of the days during the 6-week intervention period. Of the 16 participants who completed the postintervention interview, 69% (11/16) reported that they were very or extremely satisfied with the app. Interviews indicated that women appreciated the variety of meditations and felt that the program led to reduced anxiety and improved sleep. Significant improvements in pre- and postintervention scores were observed for depressive symptoms (PHQ-8: −3.8, P=.004), perceived stress (10-item Perceived Stress Scale: −6.0, P=.005), and sleep quality (Pittsburgh Sleep Quality Index: −2.1, P=.02, indicating less sleep disturbance). Improvements in mindfulness were also significant (Five Facet Mindfulness Questionnaire-Short Form: 10.9, P=.01). Conclusions An mHealth mindfulness intervention for postpartum women with moderate to moderately severe depressive symptoms is feasible and acceptable. An efficacy trial is warranted.

Factors Influencing Adherence to mHealth Apps for Prevention or Management of Noncommunicable Diseases: Systematic Review

“…The included studies reported that automated and interactive data collection and processing positively affected adherence [ 101 , 106 ]. The studies also showed that customizable features such as tracking stress and mood [ 109 ], visualizing personal progress, and immediate feedback positively affected adherence [ 103 ].…”

“…The positive influence of passive and automated data collection, processing, and transmission was reported in 5% (5/97) of studies from the health domains NCD self-management [ 31 , 34 ], other NCDs [ 117 ], mindfulness [ 101 ], and meditation [ 106 ]. Thus, developers can increase adherence by automating repetitive tasks to reduce user burden.…”

“…Monetary incentives such as vouchers, lottery tickets, or direct cash contributions were given to participants in 31 of the 97 included primary studies [ 30 , 33 , 44 , 45 , 47 , 48 , 51 , 53 , 56 , 61 , 62 , 64 , 65 , 68 - 72 , 77 , 81 , 88 , 90 , 98 , 101 , 104 - 106 , 108 , 109 , 114 , 116 ]. However, the qualitative synthesis did not yield results regarding the effect of such monetary incentives as an additional intervention component on adherence.…”

Effects of mHealth on the psychosocial health of pregnant women and mothers: a systematic review

“…Thirteen studies assessed the roles of mHealth in anxiety symptoms among pregnant women and mothers 35 36 39 40 44 46 47 50 54 61–63 73. Four studies found positive effects, six studies had mixed findings and three studies found no significant effect (GRADE certainty of evidence: low).…”

“…64 65 A few studies among the seven qualitative studies [66][67][68][69][70][71][72] lacked information on the positionality of researchers and potential bias may have risen due to the recruitment strategy. Seven mixedmethods study [73][74][75][76][77][78][79] also did not provide any information on confounding. Furthermore, online supplemental file 7 shows the results of the GRADE certainty of evidence assessment.…”