An Integrated Web-Based Mental Health Intervention of Assessment-Referral-Care to Reduce Stress, Anxiety, and Depression in Hospitalized Pregnant Women With Medically High-Risk Pregnancies: A Feasibility Study Protocol of Hospital-Based Implementation

Abstract

BackgroundAt prevalence rates of up to 40%, rates of depression and anxiety among women with medically complex pregnancies are 3 times greater than those in community-based samples of pregnant women. However, mental health care is not a component of routine hospital-based antenatal care for medically high-risk pregnant women.ObjectiveThe purpose of this study is to evaluate the effectiveness and feasibility of the hospital-based implementation of a Web-based integrated mental health intervention comprising psychosocial assessment, referral, and cognitive behavioral therapy (CBT) for antenatal inpatients.MethodsThis study is a quasi-experimental design. Pregnant women are eligible to participate if they are (1) <37 weeks gestation, (2) admitted to the antenatal inpatient unit for >72 hours, (3) able to speak and read English or be willing to use a translation service to assist with completion of the questionnaires and intervention, (4) able to complete follow-up email questionnaires, (5) >16 years of age, and (6) not actively suicidal. Women admitted to the unit for induction (eg, <72-hour length of stay) are excluded. A minimum sample of 54 women will be recruited from the antenatal high-risk unit of a large, urban tertiary care hospital. All women will complete a Web-based psychosocial assessment and 6 Web-based CBT modules. Results of the psychosocial assessment will be used by a Web-based clinical decision support system to generate a clinical risk score and clinician prompts to provide recommendations for the best treatment and referral options. The primary outcome is self-reported prenatal depression, anxiety, and stress symptoms at 6-8 weeks postrecruitment. Secondary outcomes are postpartum depression, anxiety, and stress symptoms; self-efficacy; mastery; self-esteem; sleep; relationship quality; coping; resilience; Apgar score; gestational age; birth weight; maternal-infant attachment; infant behavior and development; parenting stress/competence at 3-months postpartum; and intervention cost-effectiveness, efficiency, feasibility, and acceptability. All women will complete email questionnaires at 6-8 weeks postrecruitment and 3-months postpartum. Qualitative interviews with 10-15 health care providers and 15-30 women will provide data on feasibility and acceptability of the intervention.ResultsThe study was funded in September, 2014 and ethics was approved in November, 2014. Subject recruitment will begin January, 2015 and results are expected in December, 2015. Results of this study will determine (1) the effectiveness of an integrated Web-based prenatal mental health intervention on maternal and infant outcomes and (2) the feasibility of implementation of the intervention on a high-risk antenatal unit.ConclusionsThis study will provide evidence and guidance regarding the implementation of a Web-based mental health program into routine hospital-based care for women with medically high-risk pregnancies.

Web-based interventions for prevention and treatment of perinatal mood disorders: a systematic review

“…Thus an intervention administered during pregnancy may also prevent the development and/or progression of antenatal depression to postpartum depression following childbirth. Whilst there is preliminary evidence that CCBT interventions are acceptable during pregnancy [ 51 ], further studies are needed to investigate the impact of such an intervention during pregnancy [ 33 , 52 , 53 ]. Our review would also suggest there is a need for more rigor in this field, particularly harmonisation of symptom scores used to allow future meta-analyses of outcomes.…”

“…A CCBT resource for the self-management of perinatal depression could therefore represent an efficacious, accessible and economically sound resource [ 32 ]. CCBT also provides a level of anonymity not possible in clinical care, can be accessed at a time and place suitable for the participant and can be adapted to different cultures, languages and literacy levels to ensure the inclusion of vulnerable groups [ 33 ]. However, before CCBT is embedded in clinical practice for treatment of perinatal depression, there is a need for a systematic review of the existing evidence to determine whether web-interventions for pregnant and post-partum women are efficacious for prevention and treatment of perinatal mood disorders and potentially to inform the design of future studies if gaps in the current evidence base are identified.…”

Using Mobile Technology to Provide Personalized Reminiscence for People Living With Dementia and Their Carers: Appraisal of Outcomes From a Quasi-Experimental Study

“…An intervention of home-based personalized reminiscence, supported by a program of training and a novel iPad app, was examined for preliminary efficacy using 3 outcome measures pertaining to mutuality, emotional well-being, and quality of carer-patient relationships. The quasi-experimental design is appropriate and a common design for assessing the feasibility of novel technological interventions [ 37 - 39 ]. In line with quality standards, repeated measures testing was employed.…”

An assessment of depression, psychosocial factors, and resilience among women seeking prenatal care at an urban community health center

“…Depression, anxiety, and stress affect 15%–25% of women during pregnancy [1] and disproportionately affect minority and immigrant populations [2]. Chronic stress because of poverty, low socioeconomic position, or racism poses further challenges to women during the puerperium [3], and although considered a natural event in a woman’s lifespan, pregnancy can be fraught with adversity and risk.…”