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J Affect Disord. 2017 Oct 15;221:56-64. doi: 10.1016/j.jad.2017.06.013. Epub 2017 Jun 13.

Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial.

Author information

1
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden. Electronic address: erik.forsell@ki.se.
2
Department of Clinical Sciences, Psychiatry, Umeå University, Sweden.
3
University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Sweden.
4
Department of Children and Women, Karolinska University Hospital, Huddinge, Sweden.
5
Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Obstetrics and Gynecology, Karolinska Institutet, Sweden.
6
Psychiatry Southwest, Stockholms Läns Sjuvårdsområde (SLSO), Stockholm, Sweden.
7
Department of Psychology, Uppsala University, Sweden.
8
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Clinical Sciences, Psychiatry, Umeå University, Sweden.
9
Department of Clinical Science, Intervention and Technology (CLINTEC), Department of Pediatrics, Karolinska Institutet, Sweden.
10
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.

Abstract

Major depression occurs in 5-10% of pregnancies and is associated with many negative effects for mother and child, yet treatment options are scarce. To our knowledge, this is the first published randomised controlled trial on Internet delivered Cognitive Behavior Therapy (ICBT) for this group.

OBJECTIVE:

To test the efficacy of a pregnancy adapted version of an existing 10-week ICBT-program for depression as well as assessing acceptability and adherence DESIGN: Randomised controlled trial.

SETTING:

Online and telephone.

POPULATION OR SAMPLE:

Self-referred pregnant women (gestational week 10-28 at intake) currently suffering from major depressive disorder.

METHODS:

42 pregnant women (gestational week 12-28) with major depression were randomised to either treatment as usual (TAU) provided at their antenatal clinic or to ICBT as an add-on to usual care.

MAIN OUTCOME MEASURES:

The primary outcome was depressive symptoms measured with the Montgomery-Åsberg depression rating scale-self report (MADRS-S). The Edinburgh Postnatal Depression Scale and measures of anxiety and sleep were used. Credibility, satisfaction, adherence and utilization were also assessed.

RESULTS:

The ICBT group had significantly lower levels of depressive symptoms post treatment (p < 0.001, Hedges g =1.21) and were more likely to be responders (i.e. achieve a statistically reliable improvement) (RR = 0.36; p = 0.004). Measures of treatment credibility, satisfaction, utilization, and adherence were comparable to implemented ICBT for depression.

LIMITATIONS:

Small sample size and no long-term evaluation.

CONCLUSION:

Pregnancy adapted ICBT for antenatal depression is feasible, acceptable and efficacious. These results need to be replicated in larger trials to validate these promising findings.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02366429.

KEYWORDS:

Antenatal depression; Cognitive behavior therapy; Depression; Internet; Online; Perinatal mental health; Pregnancy; Psychotherapy; ehealth

PMID:
28628768
DOI:
10.1016/j.jad.2017.06.013
[Indexed for MEDLINE]
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