Targeted health care information and internet-CBT to prevent postpartum depression, and the importance of personalized care - a two-step randomized study

About 15% of mothers suffer from postpartum depression, which besides their suffering often affects the relation to the child and partner negatively.

Depression during pregnancy constitutes a high risk for postpartum depression, and better screening and access to treatment is needed.Mom2B is a mobile application aimed towards all pregnant individuals, and includes screening for depression. If detected, general information regarding health care for depression is presented.

We want to randomize half of these indicated risk users to instead receive targeted information about guided, internet-based CBT (ICBT) for depression during pregnancy.Our hypothesis is that more of these will start our evidence-based ICBT and lower their symptom levels and risk for postpartum depression 8-10 weeks after delivery, measured with structured interview and registry data.

We also expect the strategy with targeted information and ICBT to be beneficial from a health economic perspective.

ICBT is preceded by an assessment, and during the 12-week treatment the participant works with a self-help material while actively supported by a psychologist via text messages.

We have evaluated the ICBT-program used in this study with positive results, but in line with other research on ICBT we have seen that more support and adjustments are often asked for.

In line with Personalized Care, we will thus randomize some of those seeking ICBT, via Mom2B or other channels, to receive more personalized care by letting them choose type of visits (physical/video/telephone) and get extra visits with a midwife with the purpose of better adjusting the care to their needs.

Others will receive no extra visits and are randomized to type of visit.

For sub-analyses, some also choose type of visit but receive no extra visits, and vice versa.Our hypothesis is that personalized ICBT will lead to increased treatment engagement and patient empowerment, as well as reduced symptoms and risk for postpartum depression.