mHealth for Antenatal Mental Health

NCT ID: NCT02516982

Last Updated: 2019-09-23

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

946 participants

Study Classification

OBSERVATIONAL

Study Start Date

2015-10-31

Study Completion Date

2018-08-31

Brief Summary

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The aim of this study is to determine the feasibility of using mobile technology for:

1. Implementing the recommendations of the Antenatal and postnatal mental health: clinical management and service guidance NICE guideline for recognising depression (i.e., Whooley questions followed by a validated screening instrument such as the Edinburgh Postnatal Depression Scale) during pregnancy using iPad Air tablets in the waiting area of general practices, midwifery services, or hospitals during antenatal clinics; and
2. Using a bespoke app running on pregnant women's own smartphones to monitor mood and symptoms of depression throughout pregnancy.

Detailed Description

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As part of our first aim, we will assess the psychometric properties of the Whooley questions, by comparing the answers given to these questions against the scores obtained on the Edinburgh Postnatal Depression Scale, and we will manipulate the survey questionnaire layout of the Whooley Questions and the Edinburgh Postnatal Depression Scale in order to ensure that this survey design choice does not affect data quality. As part of our second aim, we will compare two prospective sampling protocols on patient compliance and engagement with the app.

We will use a parallel, randomised control trial study design. Participation in each part of the study (i.e., iPads in antenatal clinics, or app running on own handset) will be independent from each other. Those participants consenting to get involved in the part of the study assessing the use of iPads in antenatal clinics will be randomly assigned to complete (i) an app version of the Whooley questions and the Edinburgh Postnatal Depression Scale in which the questionnaires are presented using a scrolling layout (i.e., App screening - Scrolling), or (ii) an app version of the Whooley questions and the Edinburgh Postnatal Depression Scale in which the questionnaires are presented using a paging layout (i.e., App screening - Paging).

Participants consenting to get involved in the part of the study assessing the use of an app running on participants' own devices will be randomly allocated to one of two sampling protocols: (i) a prospective sampling protocol of 6 months consisting of the Edinburgh Postnatal Depression Scale and 5 momentary questions related to mood; or (ii) a prospective sampling protocol of 6 months consisting of the Edinburgh Postnatal Depression Scale.

We will utilise a block randomisation procedure (with blocks of 4) to generate our allocation sequence. Random numbers will be generated using Stata 13.0. Researchers conducting participant recruitment will not be involved in this randomisation procedure in order to avoid recruitment bias.

Conditions

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Depression Pregnancy

Study Design

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Observational Model Type

OTHER

Study Time Perspective

PROSPECTIVE

Study Groups

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Screening - Scrolling layout

Participants will be asked to complete a survey consisting of three sections using an iPad Air tablet:

* Section 1: Demographic information survey
* Section 2: Whooley questions
* Section 3: Edinburgh Postnatal Depression Scale

All questions will be presented on a single screen. This means that participants will have to scroll vertically in order to answer all the questions.

Whooley Questions

Intervention Type OTHER

The Whooley questions are a case-finding instrument for depression in primary care. This 2-question instrument screens for depressed mood and anhedonia that have been present during the past month. Respondents are required to answer Yes or No to each of these questions. An affirmative answer to any of them should be followed by further assessment, including the use of a validated screening instrument or referral to a general practitioner or a mental health practitioner.

Edinburgh Postnatal Depression Scale

Intervention Type OTHER

The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-administered survey that screens for symptoms such as feelings of guilt, sleep disturbance, reduced energy levels, anhedonia and suicidal ideation that have been present during the 7 days preceding its administration. Each question is scored on a 4-point scale ranging from 0 to 3 points. Overall scores between 10 and 12 points suggest increased risk for depression; scores of 13 points or above indicate that the diagnostic criteria for major depression disorder have probably been met. In addition, item 10 deals with suicidal thoughts. The EPDS is a valid and reliable tool for identifying women at risk of depression, both during pregnancy and postpartum, and is sensitive to changes in the severity of depression over time.

Screening - Paging layout

Participants will be asked to complete a survey consisting of three sections using an iPad Air tablet:

* Section 1: Demographic information survey
* Section 2: Whooley questions
* Section 3: Edinburgh Postnatal Depression Scale

Only one question will be presented at any given time. This means that participants will have to navigate through multiple pages in order to answer all the questions.

Whooley Questions

Intervention Type OTHER

The Whooley questions are a case-finding instrument for depression in primary care. This 2-question instrument screens for depressed mood and anhedonia that have been present during the past month. Respondents are required to answer Yes or No to each of these questions. An affirmative answer to any of them should be followed by further assessment, including the use of a validated screening instrument or referral to a general practitioner or a mental health practitioner.

Edinburgh Postnatal Depression Scale

Intervention Type OTHER

The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-administered survey that screens for symptoms such as feelings of guilt, sleep disturbance, reduced energy levels, anhedonia and suicidal ideation that have been present during the 7 days preceding its administration. Each question is scored on a 4-point scale ranging from 0 to 3 points. Overall scores between 10 and 12 points suggest increased risk for depression; scores of 13 points or above indicate that the diagnostic criteria for major depression disorder have probably been met. In addition, item 10 deals with suicidal thoughts. The EPDS is a valid and reliable tool for identifying women at risk of depression, both during pregnancy and postpartum, and is sensitive to changes in the severity of depression over time.

Retrospective plus momentary assessment

Participants in this group will be asked to download and install an app onto their own smartphones. After that, they will be asked to complete a sampling protocol consisting of 6 consecutive days, once a month for 6 months. During the 6 assessment days, participants will be required to complete the Edinburgh Postnatal Depression Scale, 5 momentary questions on a 5-point pictorial scale, and 2 contextual questions.

Edinburgh Postnatal Depression Scale

Intervention Type OTHER

The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-administered survey that screens for symptoms such as feelings of guilt, sleep disturbance, reduced energy levels, anhedonia and suicidal ideation that have been present during the 7 days preceding its administration. Each question is scored on a 4-point scale ranging from 0 to 3 points. Overall scores between 10 and 12 points suggest increased risk for depression; scores of 13 points or above indicate that the diagnostic criteria for major depression disorder have probably been met. In addition, item 10 deals with suicidal thoughts. The EPDS is a valid and reliable tool for identifying women at risk of depression, both during pregnancy and postpartum, and is sensitive to changes in the severity of depression over time.

Momentary questions

Intervention Type OTHER

These will consist of 5 questions on a 5-point pictorial scales, assessing participants' mood, sleep, energy, enjoyment and worry.

Contextual questions

Intervention Type OTHER

Two questions asking for participants' location and activity at the time they were asked to complete the momentary questions.

Retrospective assessment

Participants in this group will be asked to download and install an app onto their own smartphones. After that, they will be asked to complete a sampling protocol consisting of one day a month for 6 months. The assessment days will consist of a single administration of the Edinburgh Postnatal Depression Scale.

Edinburgh Postnatal Depression Scale

Intervention Type OTHER

The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-administered survey that screens for symptoms such as feelings of guilt, sleep disturbance, reduced energy levels, anhedonia and suicidal ideation that have been present during the 7 days preceding its administration. Each question is scored on a 4-point scale ranging from 0 to 3 points. Overall scores between 10 and 12 points suggest increased risk for depression; scores of 13 points or above indicate that the diagnostic criteria for major depression disorder have probably been met. In addition, item 10 deals with suicidal thoughts. The EPDS is a valid and reliable tool for identifying women at risk of depression, both during pregnancy and postpartum, and is sensitive to changes in the severity of depression over time.

Interventions

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Whooley Questions

The Whooley questions are a case-finding instrument for depression in primary care. This 2-question instrument screens for depressed mood and anhedonia that have been present during the past month. Respondents are required to answer Yes or No to each of these questions. An affirmative answer to any of them should be followed by further assessment, including the use of a validated screening instrument or referral to a general practitioner or a mental health practitioner.

Intervention Type OTHER

Edinburgh Postnatal Depression Scale

The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-administered survey that screens for symptoms such as feelings of guilt, sleep disturbance, reduced energy levels, anhedonia and suicidal ideation that have been present during the 7 days preceding its administration. Each question is scored on a 4-point scale ranging from 0 to 3 points. Overall scores between 10 and 12 points suggest increased risk for depression; scores of 13 points or above indicate that the diagnostic criteria for major depression disorder have probably been met. In addition, item 10 deals with suicidal thoughts. The EPDS is a valid and reliable tool for identifying women at risk of depression, both during pregnancy and postpartum, and is sensitive to changes in the severity of depression over time.

Intervention Type OTHER

Momentary questions

These will consist of 5 questions on a 5-point pictorial scales, assessing participants' mood, sleep, energy, enjoyment and worry.

Intervention Type OTHER

Contextual questions

Two questions asking for participants' location and activity at the time they were asked to complete the momentary questions.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Pregnant women attending antenatal clinics

Exclusion Criteria

* Diagnosis of any common mental health disorder (i.e., depression or anxiety disorders) as specified in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
* Receiving treatment for any common mental health disorder
* Recent personal history of any common mental health disorder (i.e., within the past 12 months)
* Not comfortable reading and writing in English

Participants enrolled in the study assessing an app for the monitoring of mood and symptoms of depression need to own an iPhone or any Android-compatible smartphone.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Imperial College London

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jose S Marcano Belisario

Role: PRINCIPAL_INVESTIGATOR

Imperial College London

Josip Car

Role: PRINCIPAL_INVESTIGATOR

Imperial College London

Cecily Morrison

Role: PRINCIPAL_INVESTIGATOR

Imperial College London

John O'Donoghue

Role: PRINCIPAL_INVESTIGATOR

Imperial College London

Ajay Gupta

Role: STUDY_CHAIR

Imperial College London

Paul Ramchandani

Role: STUDY_CHAIR

Imperial College London

Gavin Doherty

Role: PRINCIPAL_INVESTIGATOR

University of Dublin, Trinity College

Kevin Doherty

Role: PRINCIPAL_INVESTIGATOR

University of Dublin, Trinity College

Locations

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East Lancashire

Blackburn, , United Kingdom

Site Status

Royal Bolton Hospital

Bolton, , United Kingdom

Site Status

Burton Hospitals

Burton, , United Kingdom

Site Status

The Pennine Acute Hospitals

Crumpsall, , United Kingdom

Site Status

Hinchinbrooke Hospital

Huntingdon, , United Kingdom

Site Status

East Midlands CRN

Lincoln, , United Kingdom

Site Status

Chelsea & Westminster Hospital

London, , United Kingdom

Site Status

Hillingdon Hospitals

London, , United Kingdom

Site Status

Northwick Park Hospital

London, , United Kingdom

Site Status

West Middlesex Hospital

London, , United Kingdom

Site Status

North of England

Newcastle, , United Kingdom

Site Status

Shrewsburty & Telford Hospital

Shrewsbury, , United Kingdom

Site Status

University Hospitals of North Midlands

Stoke-on-Trent, , United Kingdom

Site Status

Wrightington, Wigan and Leigh NHS

Wigan, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Marcano-Belisario JS, Gupta AK, O'Donoghue J, Morrison C, Car J. Tablet computers for implementing NICE antenatal mental health guidelines: protocol of a feasibility study. BMJ Open. 2016 Jan 22;6(1):e009930. doi: 10.1136/bmjopen-2015-009930.

Reference Type BACKGROUND
PMID: 26801468 (View on PubMed)

Marcano Belisario JS, Doherty K, O'Donoghue J, Ramchandani P, Majeed A, Doherty G, Morrison C, Car J. A bespoke mobile application for the longitudinal assessment of depression and mood during pregnancy: protocol of a feasibility study. BMJ Open. 2017 May 29;7(5):e014469. doi: 10.1136/bmjopen-2016-014469.

Reference Type BACKGROUND
PMID: 28554914 (View on PubMed)

Marcano-Belisario JS, Gupta AK, O'Donoghue J, Ramchandani P, Morrison C, Car J. Implementation of depression screening in antenatal clinics through tablet computers: results of a feasibility study. BMC Med Inform Decis Mak. 2017 May 10;17(1):59. doi: 10.1186/s12911-017-0459-8.

Reference Type RESULT
PMID: 28490353 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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15IC2687

Identifier Type: -

Identifier Source: org_study_id

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