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Digital screening for postnatal depression: mixed methods proof-of-concept study
Emily Eisner1,2, Shôn Lewis3, Charlotte Stockton-Powdrell4
1Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK. emily.eisner@manchester.ac.uk.
Insights
A new smartphone app for postnatal depression (PND) screening is feasible, acceptable, valid, and safe for parents. This digital tool improves access to PND assessment and treatment, overcoming barriers of traditional methods.
Area of Science:
- Digital health interventions
- Mental health screening
- Perinatal mental health
Background:
- Postnatal depression (PND) affects 17% of mothers and 9% of fathers, with significant long-term consequences.
- Suicide is the leading cause of maternal death in the postnatal year.
- Improving access to PND screening and treatment is crucial for parental and infant well-being.
Purpose of the Study:
- To develop and evaluate a smartphone application (ClinTouch DAWN-P) for digital screening of PND.
- To assess the feasibility, acceptability, validity, and safety of the app in a proof-of-concept study.
- To enhance accessibility of PND screening through a digital platform.
Main Methods:
- Recruited pregnant women (≥36 weeks gestation) and partners for daily mood monitoring using the Edinburgh Postnatal Depression Scale (EPDS) via the ClinTouch DAWN-P app.
- Compared app-based EPDS data with standard paper-based EPDS for validity assessment.
- Evaluated app acceptability and usability through qualitative interviews and the abridged Mobile App Rating Scale.
Main Results:
- High maternal interest (96%) and sustained app usage (91%) were observed.
- App-based EPDS showed high agreement with paper-based assessments, accurately identifying likely PND cases.
- No serious adverse events were reported, indicating the app's safety.
Conclusions:
- Digital PND screening via smartphone apps is a feasible, acceptable, valid, and safe approach.
- Remote delivery of digital screening, as demonstrated during the COVID-19 lockdown, enhances accessibility.
- Digital tools can overcome limitations of traditional health visitor-delivered screening, including staff time constraints and parental reluctance to disclose issues.
Background:
Depression during the postnatal year is prevalent in mothers (17%) and fathers (9%), and suicide is the leading cause of maternal death in this period. Lifelong costs and consequences of untreated postnatal depression (PND) are high due to impacts on infants as well as parents. We aimed to improve access to PND treatment using digital screening. We developed a smartphone app (ClinTouch DAWN-P) that allows parents to monitor their mood daily with the Edinburgh Postnatal Depression Scale (EPDS), uploading responses in real-time to a secure server. We evaluated the app's feasibility, acceptability, validity and safety in a proof-of-concept study.
Methods:
Pregnant women (≥ 36 weeks gestation) and partners were recruited from antenatal services and invited to complete daily EPDS assessments via the ClinTouch DAWN-P app until 6 weeks postpartum. Participants completed standard paper-based EPDS at two time points for validity comparisons. We examined app acceptability and usability at 6 weeks postpartum with qualitative interviews, examined using framework analysis, and the abridged Mobile App Rating Scale (convergent mixed methods design).
Results:
Most (96%) eligible pregnant women approached were keen to try the app. Participating mothers (n = 15) and partners/fathers (n = 8) found the app easy to use, and 91% continued to use it for the full study period. Overall, 67% of daily app-based assessments were completed, with a history of depression predicting lower app usage. Participants suggested modifications to the app and its deployment to improve usability (e.g., extending the response window and including feedback and parenting advice). The validity of app-based responses was confirmed by high agreement with standard EPDS. App-based and paper-based ratings showed perfect agreement in identifying cases of likely PND. There were no serious adverse events relating to app use.
Conclusions:
Digital PND screening appears feasible, acceptable, valid and safe. It also benefits from being remotely delivered: we enrolled all participants remotely during the first COVID-19 lockdown. Use of digital screening could address known shortcomings of conventional health visitor-delivered screening such as limited staff time, parental unwillingness to disclose difficulties to a professional, lack of partner/father screening, and language barriers.
Trial Registration:
The study was prospectively registered (Clinicaltrials.gov: NCT04279093 ).
