Increasing access to treatment: Where does technology fit? RCT of a blended treatment for Postnatal depression Heather O’Mahen, Ph.D. Mood Disorders Centre

The Burden of Mental Health  30% of individuals will suffer from at least one mental health disorder.  Most common: depression, anxiety, substance abuse  Mental illness and chronic pain are leading causes of disability. Mental illness = 23% of “years lived with disability,” low back pain = 11%.  10% of new mums will suffer from depression during pregnancy or postnatally  75% of people who suffer from mental illness won’t receive it (up to 85% of women with perinatal depression)

Mental Health Parity?

What’s going on?  Our treatment models are often incorrect. We treat mental illness as if it is an acute, rather than chronic illness.  We prescribe treatments that don’t fit with what patients want (e.g., medication versus therapy)  Patients struggle with stigma  Perinatal depression – double stigma

How does technology fit?  Internet  Apps  Watches  SKYPE  Telephone  Health monitoring systems  Virtual reality  Accessible, portable, convenient  Can be personalised  Used within individual’s environment (generalize skills outside the therapy room)  Economical (for patient and for health care system)  De-stigmatizing  Can beat-out post-code lotteries and deliver specialized, high quality, national care.

Netmums Postnatal Depression Forum

Minding the Gap Women with diagnosable “Mild/Moderate” and Moderate/Severe” Mental Illness

What do Women Want? Skills The ability to do it in a time that’s convenient for me Choice A mentor : someone who knows what they’re talking about and who can keep me motivated to do the treatment Treatment specific to motherhood To have a personal approach Easy to understand O’Mahen,H.A. Henshaw, E., Fedock, G., Himle, J., Forman, J., & Flynn, H. (2012). Modifying CBT for perinatal depression: What do women want? A qualitative study. Cognitive and Behavioural Psychotherapy, 19,2, Approaches that overcome stigma

MumiBA: an online Behavioural Activation (BA) treatment for Postnatal depression

Adapting and updating the MUMiBA programme  12 sessions of Behavioural Activation, supported by PWP via telephone (20-30 minute sessions).  Feedback: Relevance  Solution: A modular approach  Development and choice of modules – Service User Involvement.  Modules  BA – 5 core sessions  2 individualized modules:  Rumination “Sticky Thinking”  Sleep  Communication  “Being a Good Enough Mum”  Changing roles and relationships  Anxiety O’Mahen, H.A., Woodford, J., Richards, D., Wilkinson, E., McKinley, J., Warren, F., & Taylor, R.S. (2013). Netmums: A Phase II Randomized Controlled Trial of a Guided Internet Behavioral Activation Treatment for Postpartum Depression, Psychological Medicine

F (1,80) = 9.46, p =.003, Cohen’s d = -.88, 95% CI: -.42 to month follow-up; Cohen’s d = -0.78, 95% CI: to 0.10 Reliable and clinically significant improvement: OR 62.2% (n = 23/37) NetmumsHWD, 29.4% (10/34) TAU, 0.26 (95% CI 0.10 to 0.71).

F (1,58) = 5.07, p =.028; (95% CI to -0.07)

F(1,58) = 4.58, P = 0.04; (95% CI to 1.11)

Conclusions  Acceptable: Trial and treatment adherence rates good.  Feasible – average sessions time 29 minutes – may be cost-effective and accessible alternative for PND  Effect sizes similar to other online supported CBT programs, and similar to face-to-face treatments for PND