Willkommen Mutterglück: Online CBT for Pregnant and Postpartum Women With Depression and Anxiety
NCT ID: NCT04183946
Last Updated: 2019-12-03
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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UNKNOWN
NA
300 participants
INTERVENTIONAL
2020-06-30
2024-01-31
Brief Summary
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After an initial screening to determine the eligibility to participate, all participants fulfilling the inclusion criteria will receive their personal access login in order to start the intervention.
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Detailed Description
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Previous research has shown that if a woman has high levels of depression or anxiety during pregnancy her child is at about double the risk for attention deficit hyperactivity disorder, conduct disorders, difficult temperament and behavioural problems later in development (O'Connor et al., 2002). High levels of prenatal anxiety and depression are frequently comorbid (Amiel Castro et al., 2016) and together with stress have been shown to increase risk for preterm delivery, low birth weight, impaired memory and cognitive function among others (Talge, Neal \& Glover, 2007). The important biopsychological changes brought by the perinatal period (Ehlert et al., 1990) require constant attention from health workers since they carry relevant risk factors for the mother's health and for the infant's neurodevelopment (Schetter \& Tanner, 2012).
Current depression interventions are not deliverable to a large number of individuals (Andersson \& Titov, 2014). As seen worldwide, the difficulty to receive proper treatment for depression and anxiety is also evident in Switzerland. About half of people suffering from depression and/or anxiety are not diagnosed and consequently do not receive any sort of psychological or pharmaceutical treatment (Baer et al., 2013).
The internet offers an opportunity to deliver tailored interventions such as those based on cognitive behavioural therapy (CBT) to a large audience, cost-effectively, while preserving intervention fidelity and anonymity. The potential effectiveness of the internet is indicated by research demonstrating the successful delivery of CBT by computer and the use of the internet in the delivery of CBT treatment (Andrews et al., 2010). Recent reviews of the evidence have recommended further research that includes long-term follow-up and evaluation of novel treatment modalities such as the ones provided by internet (Dennis et al., 2012). Moreover, online interventions have been widely explored for different mental health problems (Sourander et al., 2016) suggesting its potential to increase access to and uptake of services for women with a perinatal disorder.
The "Willkommen Mutterglück" program is an 8-session, interactive web-based cognitive behavioural intervention for prenatal and postpartum depression and anxiety.
Given the prevalence rates of depression and anxiety during the perinatal period and the rates of untreated patients, it is important to propose treatment alternatives. Several reviews on the area emphasize that topics such as type and amount of CBT material incorporated to the program, length and frequency of sessions, amount of homework given and frequency of minimal therapist intervention are related to effectivity of online interventions and warrant further research. Also, it is unclear whether therapist contact focusing on motivation to complete the program is more effective than non-therapist contact in the treatment of the disorders. Therefore, routine use of this online intervention for depressed and anxious mothers is only possible if this program/the effects are is scientifically evaluated with biomarkers.
The primary goal of this project is to investigate the effectiveness of an online cognitive behavioural intervention specifically tailored to pregnant and postpartum women in reducing depression and anxiety symptoms. The secondary goal is to assess the feasibility and usability of this intervention on the treatment of depression and anxiety.
Method: The investigators aim to recruit N=300 patients from the first gestational trimester to one year after birth. The eight intervention sessions are administered online via audio and video images. The participants are asked to actively participate during their weekly session through exercises and quizzes. Each weekly session has a duration of 40-50 minutes.
A SCID interview for screening will be conducted by a trained clinical psychologist and an experienced psychiatrist from a trusted Outpatient Clinic will verify the diagnosis. Screened and consented participants will then fill in some baseline questionnaires, provide sociodemographic information and receive a private login to access the program in order to start the intervention. After completing the second, fourth and eight intervention session participants will fill in the same and other psychological questionnaires.
Throughout the intervention, the investigators will frequently monitor patient's progress and potential worsening of depressive and anxiety symptoms. The investigating team will be particularly attentive to suicidal ideation. Patients identified with suicidal thoughts will be immediately contacted by the study team and advised to an appropriate course of action. Moreover, in all online pages of the "Willkommen Mutterglück" intervention participants can find an SOS button, providing contact information of emergency psychiatric units and suicide hotlines.
During the online intervention, participants will be contacted three times by telephone by coaches (psychotherapists in training). The content of coaching calls will adhere to a manualized script with defined aims of reviewing patient's progress, problem solving, encourage skill acquisition and introducing topics in upcoming sessions. Coaches will be trained with a specific manual developed by the investigation team. Training for the coaching role will involve reading the coach manual, knowledge of the program content and explanations from a senior researcher about the role and the tasks involved.
Importance: In view of the substantial challenge posed by the global burden of depression and anxiety, it is relevant to investigate how a disorder, which is a leading cause of disability worldwide, may affect mothers and mothers-to-be. Pregnant and postpartum women are often reluctant to take medication due to concerns about breast milk transmission or potential side effects. Therefore, non-pharmacologic interventions are a desirable first-line treatment option for this population. Given that despite frequent interactions with health workers during pregnancy and postpartum, rates of treatment for perinatal disorders are low, online therapy may be a viable treatment alternative. The planned longitudinal study is relevant in investigating the feasibility of an interactive CBT online intervention including minimal psychotherapist involvement and tailored specifically for this population. At the same time, it assesses the effectiveness of it in reducing depression and/or anxiety in pregnant and postpartum women. The results will help to better understand if an intervention (online program with coaching) with few barriers (e.g. no travel, no childcare costs, reduced stigma), may serve as an effective treatment option for pregnant and postpartum women who experience significant stigma or are underresourced in their local community.
Conditions
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Study Design
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NA
SINGLE_GROUP
TREATMENT
NONE
Study Groups
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Online Cognitive Behavioural Therapy
Screened participants diagnosed with minor to moderate anxiety and/or depression will receive online CBT therapy (8 interactive sessions) aiming to treat their symptomatology. Each session can be completed at one's own pace.
Online Cognitive Behavioural Therapy
The "Willkommen Mutterglück" program is an 8-session, interactive web-based CBT intervention for prenatal and postpartum depression and anxiety. The sessions are administered online via audio and video images. Each weekly session has a duration of 40-50 minutes during which the participants are asked to actively participate through exercises and quizzes.
A SCID interview for screening will be conducted by a trained clinical psychologist and an experienced psychiatrist from our outpatient clinic will verify the diagnosis. Screened and consented participants will answer baseline questionnaires, provide sociodemographic information and receive a private login to access the program. After completing the 2nd, 4th and 8th intervention session participants will fill in psychological questionnaires.
During the intervention, participants will be contacted three times by telephone by coaches (psychotherapists in training) who follow a manualized script.
Interventions
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Online Cognitive Behavioural Therapy
The "Willkommen Mutterglück" program is an 8-session, interactive web-based CBT intervention for prenatal and postpartum depression and anxiety. The sessions are administered online via audio and video images. Each weekly session has a duration of 40-50 minutes during which the participants are asked to actively participate through exercises and quizzes.
A SCID interview for screening will be conducted by a trained clinical psychologist and an experienced psychiatrist from our outpatient clinic will verify the diagnosis. Screened and consented participants will answer baseline questionnaires, provide sociodemographic information and receive a private login to access the program. After completing the 2nd, 4th and 8th intervention session participants will fill in psychological questionnaires.
During the intervention, participants will be contacted three times by telephone by coaches (psychotherapists in training) who follow a manualized script.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* between 18 and 45 years old
* minor to moderate depression and/or generalised anxiety disorder
* fluent in German
* having a computer, laptop or handheld device with internet access
Exclusion Criteria
* women taking psychotropic medication
* women with current suicidality
* women who are currently receiving psychological treatment for depression or anxiety
18 Years
45 Years
FEMALE
No
Sponsors
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Ambulatorium für kognitive Verhaltenstherapie und Verhaltensmedizin - UZH
UNKNOWN
Lamprecht AG
UNKNOWN
University of Zurich
OTHER
Responsible Party
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Principal Investigators
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Ulrike Ehlert, Prof. Dr.
Role: STUDY_CHAIR
University of Zurich, Department of Psychology - Clinical Psychology and Psychotherapy
Rita Amiel Castro, Dr. phil.
Role: PRINCIPAL_INVESTIGATOR
University of Zurich, Department of Psychology - Clinical Psychology and Psychotherapy
Locations
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University of Zurich, Department of Psychology - Clinical Psychology and Psychotherapy
Zurich, , Switzerland
Countries
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Central Contacts
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Facility Contacts
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References
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Amiel Castro RT, Pinard Anderman C, Glover V, O'Connor TG, Ehlert U, Kammerer M. Associated symptoms of depression: patterns of change during pregnancy. Arch Womens Ment Health. 2017 Aug;20(4):593-594. doi: 10.1007/s00737-017-0728-7. Epub 2017 May 25. No abstract available.
Andersson G, Titov N. Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry. 2014 Feb;13(1):4-11. doi: 10.1002/wps.20083.
Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One. 2010 Oct 13;5(10):e13196. doi: 10.1371/journal.pone.0013196.
Barnes M, Cox J, Doyle B, Reed R. Evaluation of a practice-development initiative to improve breastfeeding rates. J Perinat Educ. 2010 Fall;19(4):17-23. doi: 10.1624/105812410X530893.
Ehlert U, Patalla U, Kirschbaum C, Piedmont E, Hellhammer DH. Postpartum blues: salivary cortisol and psychological factors. J Psychosom Res. 1990;34(3):319-25. doi: 10.1016/0022-3999(90)90088-l.
Grant KA, McMahon C, Austin MP. Maternal anxiety during the transition to parenthood: a prospective study. J Affect Disord. 2008 May;108(1-2):101-11. doi: 10.1016/j.jad.2007.10.002. Epub 2007 Nov 14.
Griffiths KM, Farrer L, Christensen H. The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials. Med J Aust. 2010 Jun 7;192(S11):S4-11. doi: 10.5694/j.1326-5377.2010.tb03685.x.
Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res. 2012 Oct 1;36(5):427-440. doi: 10.1007/s10608-012-9476-1. Epub 2012 Jul 31.
O'Connor TG, Heron J, Glover V; Alspac Study Team. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. J Am Acad Child Adolesc Psychiatry. 2002 Dec;41(12):1470-7. doi: 10.1097/00004583-200212000-00019.
Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012 Jun;32(4):329-42. doi: 10.1016/j.cpr.2012.02.004. Epub 2012 Feb 28.
Dunkel Schetter C, Tanner L. Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry. 2012 Mar;25(2):141-8. doi: 10.1097/YCO.0b013e3283503680.
Sourander A, McGrath PJ, Ristkari T, Cunningham C, Huttunen J, Lingley-Pottie P, Hinkka-Yli-Salomaki S, Kinnunen M, Vuorio J, Sinokki A, Fossum S, Unruh A. Internet-Assisted Parent Training Intervention for Disruptive Behavior in 4-Year-Old Children: A Randomized Clinical Trial. JAMA Psychiatry. 2016 Apr;73(4):378-87. doi: 10.1001/jamapsychiatry.2015.3411.
Talge NM, Neal C, Glover V; Early Stress, Translational Research and Prevention Science Network: Fetal and Neonatal Experience on Child and Adolescent Mental Health. Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? J Child Psychol Psychiatry. 2007 Mar-Apr;48(3-4):245-61. doi: 10.1111/j.1469-7610.2006.01714.x.
Zaers S, Waschke M, Ehlert U. Depressive symptoms and symptoms of post-traumatic stress disorder in women after childbirth. J Psychosom Obstet Gynaecol. 2008 Mar;29(1):61-71. doi: 10.1080/01674820701804324.
Alder J, Urech C. Angststörungen in der Schwangerschaft. In: Riecher-Rössler A, eds. Psychische Erkrankungen in Schwangerschaft und Stillzeit. Basel, Switzerland: Karger; 2014.
Amiel Castro R, Glover V, Kammerer M, Ehlert U. Associations between maternal symptoms of depression, coping strategies and infant temperament: A longitudinal study from pregnancy to postpartum, Manuscript submitted for publication.
Baer N, Schuler D, Moreau-gruet F. Depressionen in der Schweizer Bevölkerung Daten zur Epidemiologie, Behandlung und sozial-beruflichen Integration. Obsan Bericht 56, 2013.
Bergant AM, Nguyen T, Heim K, Ulmer H, Dapunt O. [German language version and validation of the Edinburgh postnatal depression scale]. Dtsch Med Wochenschr. 1998 Jan 16;123(3):35-40. doi: 10.1055/s-2007-1023895. German.
Carter D, Kostaras X. Psychiatric disorders in pregnancy. British Columbia Medical Journal 47(2): 96-100, 2005.
Gast U, Oswald T, Zündorf F, Hofmann A. SKID-D- Strukturiertes Klinisches Interview für DSM-IV. Dissoziative Störungen Manual. Göttingen, Germany: Hogrefe; 2000.
Hautzunger M, Keller F, Kühner C. Beck Depressions-Inventar Revision. Manual. München, Germany: Pearson; 2009.
Löwe B, Zipfel S, Herzog W. Deutsche Übersetzung und Validierung des Brief Patient Health Questionnaire (Brief PHQ). Medizinische Universitätsklinik Heidelberg, Germany: AOK, no date.
Margraf J, Ehlers A. Beck-Angst-Inventar. Manual. München, Germany: Pearson; 2007.
Oates MR. Perinatal psychiatric syndromes: clinical features. Psychiatry, 5(1): 5-9, 2006.
O'Hara MW, Swain AM. Rates and risk of postpartum depression-a meta-analysis. International Review of Psychiatry 8(1): 37-54, 1996.
Pössel P, Seemann S, Hautzinger M. Evaluation eines deutschsprachigen Instrumentes zur Erfassung positiver und negativer automatischer Gedanken. Evaluation of a German-language instrument for assessing positive and negative automatic thoughts. Zeitschrift Für Klinische Psychologie Und Psychotherapie: Forschung Und Praxis 34(1): 27-34, 2005.
Rummel B, Ruegenhagen E, Reinhardt W. Fragebogen zur System-Gebrauchstauglichkeit; 2013.
Related Links
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Pregnancy related research by the University of Zurich
Other Identifiers
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Willkommen Mutterglück Program
Identifier Type: -
Identifier Source: org_study_id
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