Guided internet-based intervention for postpartum depression symptoms: Development and feasibility trial

Postpartum depression (PPD) represents a significant concern in Chile due to its high prevalence and considerable treatment gap. Amidst this challenge, the prevalent use of digital technologies and parenting applications offers new avenues for delivering Internet-based psychological interventions (IBIs), which have shown effectiveness in mitigating depression symptoms and hold potential for addressing PPD. This doctoral thesis project embarked on developing and assessing an IBI tailored for PPD, named “Mamá, te entiendo” (“Mom, I get you”). This 8-week guided intervention, aiming to diminish depressive symptoms among postpartum women, is rooted in cognitive-behavioral therapy, incorporating insights from mentalization and attachment theories, and delivered through a web app. Developed in line with the CeHRes Roadmap framework, this human-centered approach involved a systematic review, online surveys, focus groups, usability tests, interviews, and a technical pilot for its creation. To assess the intervention’s feasibility, acceptability, and preliminary efficacy, a pilot randomized controlled trial with 65 postpartum women diagnosed with minor to major depression was conducted. Participants were allocated to either the intervention or a waitlist control group, with assessments at the baseline, post-intervention (8 weeks), and one-month post-intervention (12 weeks). This mixed-methods approach combined quantitative and qualitative analyses to gain insights into participant experiences. Primary outcomes focused on feasibility and acceptability measures like recruitment rates, attrition, and participant satisfaction and engagement. Secondary outcomes examined depression symptoms, perceived social support, mother-infant bonding, and maternal self-efficacy. “Mamá, te entiendo” showed promising feasibility and acceptability, characterized by high satisfaction and engagement levels, although adherence posed a challenge. Participants highlighted several strengths: emotional support, beneficial content, practical exercises, empathetic e-coach feedback, and a user-friendly interface. However, some faced barriers like extensive texts, difficulty tracking progress, and time constraints. Initial efficacy findings indicated no significant differences across outcomes between the intervention and control groups. Nonetheless, both groups experienced improvements in PPD symptoms, mother-infant bonding, and maternal self-efficacy, which could be attributed to spontaneous recovery or concurrent mental health treatments. This study marks the first attempt in Chile to evaluate a psychological IBI for PPD symptoms, underscoring the potential and acceptability of technology-driven mental health solutions.