Effectiveness of a guided ACT-based self-help resilience training for depressive symptoms during pregnancy: Study protocol of a randomized controlled trial embedded in a prospective cohort

Abstract

Background During pregnancy, about 10 to 20% of women experience depressive symptoms. Subclinical depression increases the risk of peripartum depression, maternal neuro-endocrine dysregulations, and adverse birth and infant outcomes. Current treatments often comprise face-to-face psychological or pharmacological treatments that may be too intensive for women with subclinical depression leading to drop-out and moderate effectiveness. Therefore, easily accessible, resilience enhancing and less stigmatizing interventions are needed to prevent the development of clinical depression. This paper describes the protocol of a prospective cohort study with an embedded randomized controlled trial (RCT) that aims to improve mental resilience in a sample of pregnant women through a self-help program based on the principles of Acceptance and Commitment Therapy (ACT). Maternal and offspring correlates of the trajectories of peripartum depressive symptoms will also be studied. Methods Pregnant women (≥ 18 years) receiving care in Dutch midwifery practices will participate in a prospective cohort study (n ~ 3500). Between 12 and 18 weeks of pregnancy, all women will be screened for depression with the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS score ≥ 11 will be evaluated with a structured clinical interview. Participants with subclinical depression (n = 290) will be randomized to a 9-week guided self-help ACT-training or to care as usual (CAU). Primary outcomes (depressive symptoms and resilience) and secondary outcomes (e.g. anxiety and PTSD, bonding, infant development) will be collected via online questionnaires at four prospective assessments around 20 weeks and 30 weeks gestation and at 6 weeks and 4 months postpartum. Maternal hair cortisol concentrations will be assessed in a subsample of women with a range of depressive symptoms (n = 300). The intervention’s feasibility will be assessed through qualitative interviews in a subsample of participants (n = 20). Discussion This is the first study to assess the effectiveness of an easy to administer intervention strategy to prevent adverse mental health effects through enhancing resilience in pregnant women with antepartum depressive symptomatology. This longitudinal study will provide insights into trajectories of peripartum depressive symptoms in relation to resilience, maternal cortisol, psychological outcomes, and infant developmental milestones. Trial registration Netherlands Trial Register (NTR), NL7499. Registered 5 February 2019.

Resilience-enhancing interventions for antepartum depressive symptoms: systematic review

“…In addition, we found two ongoing trials evaluating the impact of ACT on depressive symptoms and anxiety. 74,75 In line with a recent review of reviews of psychological interventions for peripartum depression, 76 we conclude that ACT seems promising, but more research assessing its impact on ADS is needed.…”

Associations among fear of childbirth, resilience and psychological distress in pregnant women: A response surface analysis and moderated mediation model

“…There already exist resilience-enhancing programs for pregnant women. For instance, Witteveen et al developed a guided self-help ACT-based program for pregnant and the psychological distress symptoms were alleviated ( 61 ). In addition, resilience-based interventions have also been trialed on patients.…”

Commentary: Promoting positive mental health during pregnancy—reflections on Lähdepuro et al. (2023)

“…As (partner) social support is a crucial protective factor against peripartum mental health problems and offspring behavioral problems it might be beneficial to integrate social support, for example, via group therapy approaches or an (online) partner session, into positive mental health enhancing interventions. An ongoing randomized controlled trial currently investigates the effectiveness of ACT during pregnancy and also assesses its effect on maternal bonding and infant developmental milestones and temperament (Witteveen et al., 2020). This makes it possible to investigate the causal effects of ACT on infant outcomes and to study whether resilience‐enhancing factors (e.g., psychological flexibility) mediate the effects of ACT on infant outcomes.…”