以患者为导向的电子健康项目改善围产期抑郁症的试验:MomMoodBooster2的实际有效性研究

IF 4.3 4区 医学 Q1 OBSTETRICS & GYNECOLOGY Obstetrical & Gynecological Survey Pub Date : 2023-10-01 DOI:10.1097/ogx.0000000000001213
Brian G. Danaher, John R. Seeley, Richard K. Silver, Milagra S. Tyler, J. Jo Kim, Laura M. La Porte, Emily Cleveland, David R. Smith, Jeannette Milgrom, Jeff M. Gau
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引用次数: 0

摘要

围产期抑郁症和产后抑郁症对患者来说是一种沉重的负担,与早产、低出生体重、产后住院、母子关系减少、后代发育迟缓以及其他重要的健康和幸福指标有关。特别是围产期抑郁症,未被充分识别,因此治疗不足。本研究旨在评估MMB电子健康计划(MomMoodBooster2 [MMB2]),该计划针对围产期抑郁症,旨在评估该工具的智能手机版本的有效性。主要结局的目标是分析MMB2在一般情况下缓解焦虑和抑郁症状严重程度的程度(使用围产期和产后工具);次要结果侧重于使用趋势以及可用性和有用性评级。参与者从北岸大学健康系统的围产期抑郁症项目(PDP)中招募。入选标准包括孕妇和产后不到一年的妇女,年龄大于18岁,无主动自杀意念,能上网,英语熟练程度。REDCap(田纳西州纳什维尔范德比尔特大学)用于入组和随机化。最终分析包括191例患者,随机分为两组,一组采用MMB2和PDP方案,一组仅采用PDP方案。项目完成后,93%的患者完成了相关的后测。各组间的初步筛查无显著差异,基线特征也同样一致。控制围产期状态,后测显示抑郁严重程度、焦虑、压力和自动思维显著降低(P≤0.001),行为激活和自我效能增加。进一步分析显示,MMB2组在压力(P = 0.019)和抑郁严重程度(P = 0.003)方面从基线到测试后均有较大的下降。两组比较无其他显著影响。MMB2的使用情况各不相同,但通常表明患者在收到第一次邀请后不久就访问了该计划,然后在他们第一次和最后一次访问医疗保健提供者之间的多个不同天数定期访问该计划(平均[SD]访问次数为49.4[30.2]个不同天数)。41%的参与者使用围产期工具,43%的参与者使用产后工具,10%的参与者同时使用这两种工具,因为在最初招募时怀孕,但在研究过程中分娩。该计划包括在前12周发送短信,但没有直接评估短信的影响。在提供的评分中,96%的人认为该程序“有点”到“非常”容易使用,83%的参与者认为它“有点”到“非常”有用。两组中的许多参与者报告使用了其他管理策略,如药物治疗、治疗会议和医生建议,但这些干预措施的使用在两组之间没有差异。这些结果表明MMB2在减轻焦虑和抑郁严重程度以及提高自我效能方面是有效的。在临床上,这种电子保健工具可能是补贴妇女护理的适当方式,因为面对面的选择有限或无法获得其他选择。它也可以用来增加对抑郁症状管理的面对面选择。进一步的研究应该集中在更大、更多样化的人群上,以了解这些发现是否可以推广到这个小群体之外。此外,应优化可持续性和采用策略,以使该计划尽可能深入。更多的研究还可以检查这种治疗的长期随访和效果的持久性。
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Trial of a Patient-Directed eHealth Program to Ameliorate Perinatal Depression: The MomMoodBooster2 Practical Effectiveness Study
ABSTRACT Perinatal depression and postpartum depression represent a significant burden for those who experience them and are associated with preterm birth, low birth weight, postpartum hospitalization, diminished mother-child relationships, offspring developmental delay, and other important markers of health and well-being. Perinatal depression, in particular, is underidentified and thus undertreated. This study was designed to assess the MMB eHealth program (MomMoodBooster2 [MMB2]), which is targeted toward perinatal depression, with an aim to assess the effectiveness of the smartphone version of this tool. Primary outcomes were targeted toward analyzing the extent to which MMB2 relieved the severity of anxiety and depression symptoms in general (using both perinatal and postpartum tools); secondary outcomes focused on usage trends along with ratings of usability and helpfulness. Participants were recruited from the Perinatal Depression Program (PDP) in the NorthShore University HealthSystem. Eligibility criteria included pregnant women and women less than a year postpartum, age older than 18 years, no active suicidal ideation, access to internet, and English language proficiency. REDCap (Vanderbilt University Nashville, Tenn) was used for onboarding and randomization. Final analyses included 191 patients randomized into 2 groups, one with MMB2 and the PDP protocol and one with only PDP. After program completion, 93% of patients completed an associated posttest. Primary screenings were not significantly different between groups, and baseline characteristics were likewise consistent. Controlling for perinatal status, posttests showed a significant decrease in depression severity, anxiety, stress, and automatic thoughts ( P ≤ 0.001), as well as an increase in behavioral activation and self-efficacy. Further analysis showed that the MMB2 group showed greater decreases from baseline to posttest in both stress ( P = 0.019) and depression severity ( P = 0.003). No other significant effects were found when comparing the 2 groups. Usage of MMB2 varied, but generally showed that patients visited the program shortly after receiving the first invitation and then periodically on multiple distinct days between their first and last visit to their health care provider (mean [SD] visits, 49.4 [30.2] distinct days). Perinatal tools were used by 41% of participants, and 43% used postpartum tools, with 10% using both tools because of being pregnant at initial recruitment but delivering over the course of the study. The program included text messages for the first 12 weeks, and impact of these was not directly assessed. Of ratings provided, 96% rated the program as “somewhat” to “extremely” easy to use, and 83% of participants rated it as “somewhat” to “extremely” helpful. Many participants in both groups reported using other management strategies such as medication, therapy sessions, and physician advice, but use of these interventions did not differ between groups. These results indicate that MMB2 is effective at reducing anxiety and depression severity, as well as improving self-efficacy. Clinically, this eHealth tool may be an appropriate way to subsidize care for women where in-person options are limited or other options are unavailable. It could also be used to augment in-person options for management of depressive symptoms. Further research should focus on larger and more diverse populations, to understand if the findings are generalizable beyond this small population. In addition, the sustainability and adoption strategies should be optimized to allow this program to be as far reaching as possible. More research could also examine long-term follow-up and durability of the effects of this treatment.
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来源期刊
CiteScore
2.70
自引率
3.20%
发文量
245
审稿时长
>12 weeks
期刊介绍: ​Each monthly issue of Obstetrical & Gynecological Survey presents summaries of the most timely and clinically relevant research being published worldwide. These concise, easy-to-read summaries provide expert insight into how to apply the latest research to patient care. The accompanying editorial commentary puts the studies into perspective and supplies authoritative guidance. The result is a valuable, time-saving resource for busy clinicians.
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