Digital screening for postnatal depression: mixed methods proof-of-concept study
Abstract Background Depression during the postnatal year is prevalent in mothers (17%) and fathers (9%), and suicide is the leading cause of maternal death in this period. Lifelong costs and consequences of untreated postnatal depression (PND) are high due to impacts on infants as well as parents. W...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-022-04756-2 |
| _version_ | 1829105339837972480 |
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| author | Emily Eisner Shôn Lewis Charlotte Stockton-Powdrell Ria Agass Pauline Whelan Clare Tower |
| author_facet | Emily Eisner Shôn Lewis Charlotte Stockton-Powdrell Ria Agass Pauline Whelan Clare Tower |
| author_sort | Emily Eisner |
| collection | DOAJ |
| description | Abstract Background Depression during the postnatal year is prevalent in mothers (17%) and fathers (9%), and suicide is the leading cause of maternal death in this period. Lifelong costs and consequences of untreated postnatal depression (PND) are high due to impacts on infants as well as parents. We aimed to improve access to PND treatment using digital screening. We developed a smartphone app (ClinTouch DAWN-P) that allows parents to monitor their mood daily with the Edinburgh Postnatal Depression Scale (EPDS), uploading responses in real-time to a secure server. We evaluated the app’s feasibility, acceptability, validity and safety in a proof-of-concept study. Methods Pregnant women (≥ 36 weeks gestation) and partners were recruited from antenatal services and invited to complete daily EPDS assessments via the ClinTouch DAWN-P app until 6 weeks postpartum. Participants completed standard paper-based EPDS at two time points for validity comparisons. We examined app acceptability and usability at 6 weeks postpartum with qualitative interviews, examined using framework analysis, and the abridged Mobile App Rating Scale (convergent mixed methods design). Results Most (96%) eligible pregnant women approached were keen to try the app. Participating mothers (n = 15) and partners/fathers (n = 8) found the app easy to use, and 91% continued to use it for the full study period. Overall, 67% of daily app-based assessments were completed, with a history of depression predicting lower app usage. Participants suggested modifications to the app and its deployment to improve usability (e.g., extending the response window and including feedback and parenting advice). The validity of app-based responses was confirmed by high agreement with standard EPDS. App-based and paper-based ratings showed perfect agreement in identifying cases of likely PND. There were no serious adverse events relating to app use. Conclusions Digital PND screening appears feasible, acceptable, valid and safe. It also benefits from being remotely delivered: we enrolled all participants remotely during the first COVID-19 lockdown. Use of digital screening could address known shortcomings of conventional health visitor-delivered screening such as limited staff time, parental unwillingness to disclose difficulties to a professional, lack of partner/father screening, and language barriers. Trial registration The study was prospectively registered (Clinicaltrials.gov: NCT04279093 ). |
| first_indexed | 2024-12-12T06:04:58Z |
| format | Article |
| id | doaj.art-00d7d7652ace491eb51be5f9d40e3b21 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-12T06:04:58Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-00d7d7652ace491eb51be5f9d40e3b212022-12-22T00:35:18ZengBMCBMC Pregnancy and Childbirth1471-23932022-05-0122111210.1186/s12884-022-04756-2Digital screening for postnatal depression: mixed methods proof-of-concept studyEmily Eisner0Shôn Lewis1Charlotte Stockton-Powdrell2Ria Agass3Pauline Whelan4Clare Tower5Division of Psychology and Mental Health, University of ManchesterDivision of Psychology and Mental Health, University of ManchesterDivision of Informatics, Imaging & Data Sciences, University of ManchesterSt Helens and Knowsley Teaching Hospitals NHS TrustGreater Manchester Mental Health NHS Foundation TrustManchester University NHS Foundation TrustAbstract Background Depression during the postnatal year is prevalent in mothers (17%) and fathers (9%), and suicide is the leading cause of maternal death in this period. Lifelong costs and consequences of untreated postnatal depression (PND) are high due to impacts on infants as well as parents. We aimed to improve access to PND treatment using digital screening. We developed a smartphone app (ClinTouch DAWN-P) that allows parents to monitor their mood daily with the Edinburgh Postnatal Depression Scale (EPDS), uploading responses in real-time to a secure server. We evaluated the app’s feasibility, acceptability, validity and safety in a proof-of-concept study. Methods Pregnant women (≥ 36 weeks gestation) and partners were recruited from antenatal services and invited to complete daily EPDS assessments via the ClinTouch DAWN-P app until 6 weeks postpartum. Participants completed standard paper-based EPDS at two time points for validity comparisons. We examined app acceptability and usability at 6 weeks postpartum with qualitative interviews, examined using framework analysis, and the abridged Mobile App Rating Scale (convergent mixed methods design). Results Most (96%) eligible pregnant women approached were keen to try the app. Participating mothers (n = 15) and partners/fathers (n = 8) found the app easy to use, and 91% continued to use it for the full study period. Overall, 67% of daily app-based assessments were completed, with a history of depression predicting lower app usage. Participants suggested modifications to the app and its deployment to improve usability (e.g., extending the response window and including feedback and parenting advice). The validity of app-based responses was confirmed by high agreement with standard EPDS. App-based and paper-based ratings showed perfect agreement in identifying cases of likely PND. There were no serious adverse events relating to app use. Conclusions Digital PND screening appears feasible, acceptable, valid and safe. It also benefits from being remotely delivered: we enrolled all participants remotely during the first COVID-19 lockdown. Use of digital screening could address known shortcomings of conventional health visitor-delivered screening such as limited staff time, parental unwillingness to disclose difficulties to a professional, lack of partner/father screening, and language barriers. Trial registration The study was prospectively registered (Clinicaltrials.gov: NCT04279093 ).https://doi.org/10.1186/s12884-022-04756-2Postnatal depressionDigital mental healthmHealthSmartphoneMaternal mental healthScreening |
| spellingShingle | Emily Eisner Shôn Lewis Charlotte Stockton-Powdrell Ria Agass Pauline Whelan Clare Tower Digital screening for postnatal depression: mixed methods proof-of-concept study BMC Pregnancy and Childbirth Postnatal depression Digital mental health mHealth Smartphone Maternal mental health Screening |
| title | Digital screening for postnatal depression: mixed methods proof-of-concept study |
| title_full | Digital screening for postnatal depression: mixed methods proof-of-concept study |
| title_fullStr | Digital screening for postnatal depression: mixed methods proof-of-concept study |
| title_full_unstemmed | Digital screening for postnatal depression: mixed methods proof-of-concept study |
| title_short | Digital screening for postnatal depression: mixed methods proof-of-concept study |
| title_sort | digital screening for postnatal depression mixed methods proof of concept study |
| topic | Postnatal depression Digital mental health mHealth Smartphone Maternal mental health Screening |
| url | https://doi.org/10.1186/s12884-022-04756-2 |
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