Web-Based Cognitive Behavioral Intervention for Women with Postpartum Depression

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DESCRIPTION (provided by applicant): Background: The postpartum period offers uniquely important public health challenges and opportunities. It is a time that many women find stressful, and unexpected depressive symptoms occur in what would otherwise be a positive time of life. Postpartum depression (PPD) afflicts many women. If left untreated, it has serious consequences for maternal mental health and infant development. Most research in this area has focused on clinic-based PPD treatment programs. But recent evidence for significantly poor uptake of this treatment is related to women's concerns about stigma, limited availability of treatment programs targeted to their needs, program costs, and/or the fact that coping with a newborn makes it impossible to find the time to schedule trips outside of the home. The proposed research is innovative: 1) it tests a new Web-based approach that integrates existing data and treatments; and b) it has the potential to increase uptake of PPD treatment by offering a viable (effective, available) treatment option accessible to a large number of women. The proposed intervention builds on an established record of successfully using a cognitive behavioral intervention (CBT) to treat many types of depression and it extends the rapidly-growing evidence base for Web-based health behavior interventions. Finally, the proposed research brings together a very strong International team (US and Australia) that contributes critically important components to make the project a success. Objectives: We propose to follow appropriate formative steps to develop an interactive, Web-based treatment program targeted to women suffering with PPD and then to perform a feasibility test evaluating its efficacy relative to a control website. Methods: In the proposed study, 100 women with PPD will be randomized (50 women per condition) to one of two Web-based conditions. The cutting-edge Enhanced Intervention Condition offering an online CBT intervention targeted to PPD includes engaging content with interactivity, guided behavioral strategies for a personalized depression treatment, online videos of women who have used the recommended strategies, Web forums (peer and "Ask an Expert"), and periodic phone coaching. The Basic Control Condition will present information about PPD that women could obtain through a typical Google search (e.g., relatively detailed information about PPD including what research-based information says about its sources and treatment). Measures: We propose to measure: a) each Web programs' ameliorating effects on PPD symptoms at a 6-week posttest and a 3-month follow-up; b) how much participants use the program; and c) how well the program is received by women with PPD. Benefits: This proposed research addresses a key theme identified by the NIMH: namely, the impact of Internet-based psycho-educational interventions on health-related problems. And we believe it is vital to NIMH's initiatives on women's mental health in pregnancy and the postpartum. Our proposed research has the potential of developing a viable tool that can reach a large number of postpartum women and can help relieve their immediate and long-term suffering. PUBLIC HEALTH RELEVANCE: Postpartum depression (PPD) afflicts many women and, if left untreated, it has serious consequences for maternal mental health and infant development. Recent evidence shows that significantly poor uptake of clinic-based PPD treatment is related to women's concerns about stigma, limited availability of treatment programs targeted to their needs, program costs, and/or the fact that coping with a newborn makes it impossible to find the time to schedule trips outside of the home. The proposed research will provide a feasibility test of an alternative approach - a Web-based cognitive behavioral PPD treatment - designed to reduce depressive symptoms measured at a 6-week posttest and a 3-month follow-up.