Effectiveness of mHealth consultation services for preventing postpartum depressive symptoms: a randomized clinical trial

BMC Medicine

Research Article

Hideki Hashimoto¹  Yuki Arakawa²  Daisuke Nishi³  Shiho Kino⁴  Kosuke Inoue⁵  Maho Haseda⁵  Daisuke Nishioka⁶  Naoki Kondo⁷ 

[1] Department of Health and Social Behavior, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;Department of Health and Social Behavior, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan;Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan;Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan;Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan;Department of Medical Statistics, Research & Development Center, Osaka Medical and Pharmaceutical University, Osaka, Japan;Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan;Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan;

关键词: Postpartum depression;    mHealth;    Prevention;    Randomized controlled trial;    Health consultation services;    eHealth;    Mental health;   

DOI  :  10.1186/s12916-023-02918-3

 received in 2022-12-27, accepted in 2023-06-01,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAlthough many conventional healthcare services to prevent postpartum depression are provided face-to-face, physical and psychosocial barriers remain. These barriers may be overcome by using mobile health services (mHealth). To examine the effectiveness of mHealth professional consultation services in preventing postpartum depressive symptoms in real-world settings, we conducted this randomized controlled trial in Japan, where universal free face-to-face perinatal care is available.MethodsThis study included 734 pregnant women living in Yokohama city who could communicate in Japanese, recruited at public offices and childcare support facilities. The participants were randomized to the mHealth group (intervention, n = 365), where they could use a free app-based mHealth consultation service with gynecologists/obstetricians, pediatricians, and midwives whenever and as many times as they wanted between 6 p.m. and 10 p.m. on weekdays throughout their pregnancy and postpartum periods (funded by the City of Yokohama government) or the usual care group (control, n = 369). The primary outcome was the risk of elevated postpartum depressive symptoms, defined as Edinburgh Postnatal Depression Scale score ≥ 9. Secondary outcomes were self-efficacy, loneliness, perceived barriers to healthcare access, number of clinic visits, and ambulance usage. All outcomes were collected three months post-delivery. We also conducted subgroup analyses assessing the differences in the treatment effect by sociodemographic status.ResultsMost women completed all questionnaires (n = 639 of 734, response rate: 87%). The mean baseline age was 32.9 ± 4.2 years, and 62% were primipara. Three months post-delivery, women in the mHealth group had a lower risk of elevated postpartum depressive symptoms (47/310 [15.2%]) compared to the usual care group (75/329 [22.8%], risk ratio: 0.67 [95% confidence interval: 0.48–0.93]). Compared with the usual care group, women in the mHealth group had higher self-efficacy, less loneliness, and fewer perceived barriers to healthcare access. No differences were observed in the frequency of clinic visits or ambulance usage. Furthermore, in the subgroup analyses, we did not find differences in the treatment effect by sociodemographic status.ConclusionsLocal government-funded mHealth consultation services have a preventive effect on postpartum depressive symptoms, removing physical and psychological barriers to healthcare access in real-world settings.Trial registrationUMIN-CTR identifier: UMIN000041611. Registered 31 August 2021.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 3