Internet-Based Cognitive Behavioral Therapy for Preventing Postpartum Depressive Symptoms Among Pregnant Individuals With Depression: Multicenter Randomized Controlled Trial in China
BackgroundWomen are particularly vulnerable to depression during pregnancy, which is one of the strongest risk factors for developing postpartum depression (PPD). Addressing antenatal depressive symptoms in these women is crucial for preventing PPD. However, little is known a...
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JMIR Publications
2025-03-01
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| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2025/1/e67386 |
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| author | Chen-Chi Duan Chen Zhang Hua-Lin Xu Jing Tao Jia-Le Yu Dan Zhang Shan Wu Xiu Zeng Wan-Ting Zeng Zhi-Yin Zhang Cindy-Lee Dennis Han Liu Jia-Ying Wu Ben Willem J Mol He-Feng Huang Yan-Ting Wu |
| author_facet | Chen-Chi Duan Chen Zhang Hua-Lin Xu Jing Tao Jia-Le Yu Dan Zhang Shan Wu Xiu Zeng Wan-Ting Zeng Zhi-Yin Zhang Cindy-Lee Dennis Han Liu Jia-Ying Wu Ben Willem J Mol He-Feng Huang Yan-Ting Wu |
| author_sort | Chen-Chi Duan |
| collection | DOAJ |
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BackgroundWomen are particularly vulnerable to depression during pregnancy, which is one of the strongest risk factors for developing postpartum depression (PPD). Addressing antenatal depressive symptoms in these women is crucial for preventing PPD. However, little is known about the effectiveness of internet-based cognitive behavioral therapy (ICBT) in preventing PPD in this high-risk group.
ObjectiveThis study aims to evaluate the short- and long-term effects of ICBT in preventing PPD among women with antenatal depressive symptoms.
MethodsParticipants were screened for antenatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) and randomly allocated (1:1) to either the ICBT group (receiving weekly online modules starting antenatally and continuing into early postpartum) or the control group (observed without treatment). Follow-up assessments were conducted up to 12 months postpartum, and data were analyzed using generalized estimating equations. The primary outcome was the prevalence of depressive symptoms at 6 weeks postpartum. A subgroup analysis based on the severity of antenatal depressive symptoms was also performed. The secondary outcomes included the long-term effects of ICBT on maternal depression, as well as its impact on anxiety, sleep quality, social support, parenting stress, co-parenting relationships, and infant development.
ResultsBetween August 2020 and September 2021, 300 pregnant individuals were recruited from 5 centers across China. No significant differences were observed in depressive symptoms at 6 weeks postpartum (P=.18) or at any longer-term follow-up time points (P=.18). However, a post hoc subgroup analysis showed that participants with antenatal EPDS scores of 10-12 in the ICBT group had a lower risk of developing depression during the first year postpartum (odds ratio 0.534, 95% CI 0.313-0.912; P=.02), but this was not observed for participants with more severe depression. Additionally, this subgroup demonstrated higher levels of co-parenting relationships (P=.02).
ConclusionsAmong individuals with antenatal depression, ICBT did not prevent the development of PPD. However, ICBT may be a preferable option for those with mild to moderate antenatal depressive symptoms. Future research is needed to explore modifications to ICBT to address more severe depressive symptoms.
Trial RegistrationChinese Clinical Trial Registry ChiCTR2000033433; https://www.chictr.org.cn/showproj.html?proj=54482
International Registered Report Identifier (IRRID)RR2-10.1186/s13063-022-06728-5 |
| format | Article |
| id | doaj-art-e1124468e0d34619a2a2d38a9143d25a |
| institution | DOAJ |
| issn | 1438-8871 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | JMIR Publications |
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| series | Journal of Medical Internet Research |
| spelling | doaj-art-e1124468e0d34619a2a2d38a9143d25a2025-08-20T03:00:05ZengJMIR PublicationsJournal of Medical Internet Research1438-88712025-03-0127e6738610.2196/67386Internet-Based Cognitive Behavioral Therapy for Preventing Postpartum Depressive Symptoms Among Pregnant Individuals With Depression: Multicenter Randomized Controlled Trial in ChinaChen-Chi Duanhttps://orcid.org/0000-0002-3771-5419Chen Zhanghttps://orcid.org/0000-0003-3556-6752Hua-Lin Xuhttps://orcid.org/0009-0007-8921-6623Jing Taohttps://orcid.org/0009-0006-4661-3939Jia-Le Yuhttps://orcid.org/0000-0002-9926-0958Dan Zhanghttps://orcid.org/0000-0003-1295-4795Shan Wuhttps://orcid.org/0000-0002-5449-7580Xiu Zenghttps://orcid.org/0000-0002-7791-5386Wan-Ting Zenghttps://orcid.org/0009-0001-3161-9207Zhi-Yin Zhanghttps://orcid.org/0009-0005-3554-7481Cindy-Lee Dennishttps://orcid.org/0000-0002-0135-7242Han Liuhttps://orcid.org/0000-0001-6714-7793Jia-Ying Wuhttps://orcid.org/0009-0008-3020-4772Ben Willem J Molhttps://orcid.org/0000-0001-8337-550XHe-Feng Huanghttps://orcid.org/0000-0003-4344-8019Yan-Ting Wuhttps://orcid.org/0000-0002-2293-1792 BackgroundWomen are particularly vulnerable to depression during pregnancy, which is one of the strongest risk factors for developing postpartum depression (PPD). Addressing antenatal depressive symptoms in these women is crucial for preventing PPD. However, little is known about the effectiveness of internet-based cognitive behavioral therapy (ICBT) in preventing PPD in this high-risk group. ObjectiveThis study aims to evaluate the short- and long-term effects of ICBT in preventing PPD among women with antenatal depressive symptoms. MethodsParticipants were screened for antenatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) and randomly allocated (1:1) to either the ICBT group (receiving weekly online modules starting antenatally and continuing into early postpartum) or the control group (observed without treatment). Follow-up assessments were conducted up to 12 months postpartum, and data were analyzed using generalized estimating equations. The primary outcome was the prevalence of depressive symptoms at 6 weeks postpartum. A subgroup analysis based on the severity of antenatal depressive symptoms was also performed. The secondary outcomes included the long-term effects of ICBT on maternal depression, as well as its impact on anxiety, sleep quality, social support, parenting stress, co-parenting relationships, and infant development. ResultsBetween August 2020 and September 2021, 300 pregnant individuals were recruited from 5 centers across China. No significant differences were observed in depressive symptoms at 6 weeks postpartum (P=.18) or at any longer-term follow-up time points (P=.18). However, a post hoc subgroup analysis showed that participants with antenatal EPDS scores of 10-12 in the ICBT group had a lower risk of developing depression during the first year postpartum (odds ratio 0.534, 95% CI 0.313-0.912; P=.02), but this was not observed for participants with more severe depression. Additionally, this subgroup demonstrated higher levels of co-parenting relationships (P=.02). ConclusionsAmong individuals with antenatal depression, ICBT did not prevent the development of PPD. However, ICBT may be a preferable option for those with mild to moderate antenatal depressive symptoms. Future research is needed to explore modifications to ICBT to address more severe depressive symptoms. Trial RegistrationChinese Clinical Trial Registry ChiCTR2000033433; https://www.chictr.org.cn/showproj.html?proj=54482 International Registered Report Identifier (IRRID)RR2-10.1186/s13063-022-06728-5https://www.jmir.org/2025/1/e67386 |
| spellingShingle | Chen-Chi Duan Chen Zhang Hua-Lin Xu Jing Tao Jia-Le Yu Dan Zhang Shan Wu Xiu Zeng Wan-Ting Zeng Zhi-Yin Zhang Cindy-Lee Dennis Han Liu Jia-Ying Wu Ben Willem J Mol He-Feng Huang Yan-Ting Wu Internet-Based Cognitive Behavioral Therapy for Preventing Postpartum Depressive Symptoms Among Pregnant Individuals With Depression: Multicenter Randomized Controlled Trial in China Journal of Medical Internet Research |
| title | Internet-Based Cognitive Behavioral Therapy for Preventing Postpartum Depressive Symptoms Among Pregnant Individuals With Depression: Multicenter Randomized Controlled Trial in China |
| title_full | Internet-Based Cognitive Behavioral Therapy for Preventing Postpartum Depressive Symptoms Among Pregnant Individuals With Depression: Multicenter Randomized Controlled Trial in China |
| title_fullStr | Internet-Based Cognitive Behavioral Therapy for Preventing Postpartum Depressive Symptoms Among Pregnant Individuals With Depression: Multicenter Randomized Controlled Trial in China |
| title_full_unstemmed | Internet-Based Cognitive Behavioral Therapy for Preventing Postpartum Depressive Symptoms Among Pregnant Individuals With Depression: Multicenter Randomized Controlled Trial in China |
| title_short | Internet-Based Cognitive Behavioral Therapy for Preventing Postpartum Depressive Symptoms Among Pregnant Individuals With Depression: Multicenter Randomized Controlled Trial in China |
| title_sort | internet based cognitive behavioral therapy for preventing postpartum depressive symptoms among pregnant individuals with depression multicenter randomized controlled trial in china |
| url | https://www.jmir.org/2025/1/e67386 |
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