Online CBT workshop improves postpartum depression during COVID-19 pandemic

An online 1-day cognitive behavioral therapy-based workshop improved outcomes among women with postpartum depression during the COVID-19 pandemic, according to results of a randomized clinical trial published in JAMA Psychiatry.

“Postpartum depression affects up to 20% of mothers, but as few as just one in 10 are able to access evidence-based treatment,” Ryan J. Van Lieshout, MD, PhD, associate professor in the department of psychiatry and behavioral neurosciences at McMaster University in Canada, told Healio Psychiatry. “This can be due to a variety of factors, ranging from a preference for psychotherapy over other treatments to a lack of time. More recently, the COVID-19 pandemic has made accessing care safely even more difficult, so we wanted to develop an intervention that overcame as many of these barriers as possible and test its effectiveness during the pandemic.”

Specifically, Van Lieshout and colleagues sought to determine whether the online 1-day CBT-based workshop combined with treatment as usual improved postpartum depression (PPD), anxiety, social support, mother-infant relationship quality and infant temperament more than solely treatment as usual. They analyzed data of 403 women with PPD recruited from Ontario, Canada, during the COVID-19 pandemic between April 20, 2020, and Oct. 4, 2020. They included women who scored 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS) and who were 18 years or older (mean age, 31.8 years) with an infant younger than 12 months.

The researchers randomly assigned 202 participants to a live, interactive online 1-day CBT-based workshop conducted by a registered psychotherapist, psychiatrist or clinical psychology graduate student combined with treatment as usual and 201 to treatment as usual who were wait-listed to receive the workshop 12 weeks later. Change in PPD among experimental and wait list control groups 12 weeks after baseline served as the primary outcome. Maternal anxiety according to the seven-item Generalized Anxiety Disorder Questionnaire (GAD-7), social support according to the Social Provisions Scale, quality of the mother-infant relationship according to the Postpartum Bonding Questionnaire and infant temperament according to the Infant Behavior Questionnaire-Revised Very Short Form served as secondary outcomes.

Results showed an association between the workshop and a significant mean reduction in EPDS scores from 16.47 to 11.65 (P < .001). The workshop also correlated with higher odds of showing a clinically significant decrease in EPDS scores (OR = 4.15; 95% CI, 2.66-6.46). Mean GAD-7 scores decreased from 12,41 to 7.97 following the workshop (P < .001). Participants had a higher likelihood of exhibiting a clinically significant change (OR = 3.09; 95% CI, 1.99-4.81), and they noted improvements in bonding (P < .001), infant-focused anxiety (P < .001), social support (P < .001) and positive affectivity/surgency in infants (P < .001).

“These workshops have the potential to significantly increase access to treatment and could represent an important first step in stepped care treatment pathways for postpartum depression, helping many mothers while identifying those in need of additional treatment,” Van Lieshout said.