A web-based cognitive-behavioural intervention to prevent postpartum depression

Postpartum Depression [PPD] is a significant public health problem, given its prevalence and the adverse consequences that entail the whole family (Kingston, Tough, & Whitfield, 2012). Despite extensive research on this topic, there are some gaps we intend to address in this research project.

Firstly, despite the extensive knowledge about the risk factors for PPD, in particular the recognition of the important role of marital relationship as a risk and maintenance factor for PPD symptoms (Pilkington, Milne, Cairns, Lewis, & Whelan, 2015), it remains to be understood the dyadic mechanisms (e.g., dyadic coping, communication) involved in the occurrence and maintenance of depression in the postpartum period. Moreover, it is also important to better understand the role of other variables (e.g., cognitive variables, such as dysfunctional attitudes towards motherhood; psychological resources/skills, such as self-compassion or psychological flexibility) in the development and maintenance of this clinical condition.

Secondly, there are also gaps in the prevention of PPD and in the promotion of postpartum mental health. Although this clinical condition is amenable to preventive efforts (due to its well-defined timeframe and clearly identified risk factors), there are some limitations: first, regarding the identification of women at risk for developing PPD; second, with regard to the provision of effective PPD prevention programs that increase the Portuguese population’s access to mental healthcare. In addition, even women who are not at risk of developing PPD face a number of challenges and concerns (e.g., baby care, changes in social/marital relationships, return to work) that put them in a more vulnerable position. Research has shown that mental health is more than the absence of psychopathology and that, although related, they constitute distinct dimensions. In this sense, the promotion of positive mental health is a significant component that should be considered in the postpartum period. In this context, the development of e-mental health tools, namely web-based psychological interventions, seem to be a feasible way to increase the women’s access to preventive approaches for PPD and mental health promotion that may enable women with skills and resources to face future adversities.

Thirdly, there are also research gaps concerning the process of seeking professional help for perinatal distress problems, as well as concerning the usefulness and effectiveness of e-mental health tools in the treatment of PPD, particularly by combining the web-based component with face-to-face sessions (blended format).

Specifically, this research project has the following main goals: 1) to examine the mechanisms (e.g., dyadic, cognitive, emotion regulation) involved in the development and maintenance of postpartum depressive symptoms, as well as in the promotion of positive mental health in the postpartum period; 2) to adapt a risk index for Postpartum Depression (Postpartum Depression Predictors Inventory – Revised; Beck, 2002) and a measure of positive mental health (Mental Health Continuum Short Form) for the Portuguese population, and to examine their psychometric properties; 3) to develop a web-based psychological intervention to prevent PPD and promote women’s mental health (Be a Mom) in the postpartum period, and to examine its effectiveness, acceptability, usability and cost-effectiveness in the Portuguese population; 4) to examine the process of seeking professional help to address PPD symptoms, as well as the role of individual (e.g., stigma) and interpersonal (e.g., peer support) variables in this process; and 5) to develop and evaluate the effectiveness of a blended intervention (bBe a Mom) for the treatment of PPD, as well as its acceptability, usability and cost effectiveness.