Relieve Maternal Perinatal Depression with Smartphone-Based Mindfulness Training
By John M. de Castro, Ph.D.
“the ideal treatment plan for perinatal depression and anxiety often includes mindfulness techniques.” – Edith Gettes
The period of pregnancy is a time of intense physiological and psychological change. Anxiety, depression, and fear are quite common during pregnancy. More than 20 percent of pregnant women have an anxiety disorder, depressive symptoms, or both during pregnancy. The psychological health of pregnant women has consequences for fetal development, birthing, and consequently, child outcomes. Depression during pregnancy is associated with premature delivery and low birth weight.
In addition, immediately after birth it is common for the mother to experience mood swings including what has been termed “baby blues,” a sadness that may last for as much as a couple of weeks. But some women experience a more intense and long-lasting negative mood called postpartum depression. This occurs usually 4-6 weeks after birth in about 15% of births; about 600,000 women in the U.S. every year. For 50% of the women the depression lasts for about a year while about 30% are still depressed 3 years later.
Hence, it is clear that there is a need for methods to treat depression, and anxiety during the perinatal period. Since the fetus can be negatively impacted by drugs, it would be preferable to find a treatment that did not require drugs. Mindfulness training has been shown to improve anxiety and depression normally and to relieve maternal anxiety and depression during pregnancy and to relieve postpartum depression.
The vast majority of the mindfulness training techniques, however, require a trained teacher. The participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with busy employee schedules and at locations that may not be convenient. As an alternative, apps for smartphones have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. But the question arises as to the effectiveness of these apps and their ability to relieve depression during the perinatal period.
In today’s Research News article “Effectiveness of Smartphone-Based Mindfulness Training on Maternal Perinatal Depression: Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875700/ ) Sun and colleagues recruited pregnant women who were diagnosed with depression and randomly assigned them to receive 8-weeks of either health consultation or mindfulness training. Mindfulness training occurred in 8 weekly sessions delivered on a smartphone app. The training was Mindfulness-Based Cognitive Therapy (MBCT) modified for pregnant women. Health consultation also occurred via smartphone app. They were measured before during, and after training, 10 weeks later, and 6-months after delivery for depression, anxiety symptoms, perceived stress, positive and negative emotions, sleep-related problems, fatigue, memory, and fear of childbirth. There was a 52% completion rate for the trainings.
They found that after training the mindfulness group had significantly lower levels of depression and anxiety and significantly higher levels of positive emotions but these were not maintained 6 months after delivery. The mindfulness group also had a significantly higher rate of depression symptom remission. Hence the smartphone-based mindfulness training improved the psychological health of the pregnant women.
These findings replicate previous findings that mindfulness training reduces anxiety and depression in non-pregnant individuals and relieves maternal anxiety and depression during pregnancy. The strength of the current study was that these effects were produced by mindfulness training with a smartphone app. This is important as this training is highly scalable at minimal cost and so can be made available to virtually all pregnant women who want it. Hence, it may be able to reduce the psychological misery that occurs in many women during the perinatal period, making pregnancy a happier time for the women and produce better outcoms for the infant.
So, relieve maternal perinatal depression with smartphone-based mindfulness training.
“the risk of having moderate depressive symptoms was reduced by nearly 90% in participants receiving the MMT [Mindfulness] intervention.” – Ruta Nonacs
CMCS – Center for Mindfulness and Contemplative Studies
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Sun, Y., Li, Y., Wang, J., Chen, Q., Bazzano, A. N., & Cao, F. (2021). Effectiveness of Smartphone-Based Mindfulness Training on Maternal Perinatal Depression: Randomized Controlled Trial. Journal of medical Internet research, 23(1), e23410. https://doi.org/10.2196/23410
Despite potential for benefit, mindfulness remains an emergent area in perinatal mental health care, and evidence of smartphone-based mindfulness training for perinatal depression is especially limited.
The objective of this study was to evaluate the effectiveness of a smartphone-based mindfulness training intervention during pregnancy on perinatal depression and other mental health problems with a randomized controlled design.
Pregnant adult women who were potentially at risk of perinatal depression were recruited from an obstetrics clinic and randomized to a self-guided 8-week smartphone-based mindfulness training during pregnancy group or attention control group. Mental health indicators were surveyed over five time points through the postpartum period by online self-assessment. The assessor who collected the follow-up data was blind to the assignment. The primary outcome was depression as measured by symptoms, and secondary outcomes were anxiety, stress, affect, sleep, fatigue, memory, and fear.
A total of 168 participants were randomly allocated to the mindfulness training (n=84) or attention control (n=84) group. The overall dropout rate was 34.5%, and 52.4% of the participants completed the intervention. Mindfulness training participants reported significant improvement of depression (group × time interaction χ24=16.2, P=.003) and secondary outcomes (χ24=13.1, P=.01 for anxiety; χ24=8.4, P=.04 for positive affect) compared to attention control group participants. Medium between-group effect sizes were found on depression and positive affect at postintervention, and on anxiety in late pregnancy (Cohen d=0.47, –0.49, and 0.46, respectively). Mindfulness training participants reported a decreased risk of positive depressive symptom (Edinburgh Postnatal Depression Scale [EPDS] score>9) compared to attention control participants postintervention (odds ratio [OR] 0.391, 95% CI 0.164-0.930) and significantly higher depression symptom remission with different EPDS reduction scores from preintervention to postintervention (OR 3.471-27.986). Parity did not show a significant moderating effect; however, for nulliparous women, mindfulness training participants had significantly improved depression symptoms compared to nulliparous attention control group participants (group × time interaction χ24=18.1, P=.001).
Smartphone-based mindfulness training is an effective intervention in improving maternal perinatal depression for those who are potentially at risk of perinatal depression in early pregnancy. Nulliparous women are a promising subgroup who may benefit more from mindfulness training.