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Prevention of postpartum depression via a digital acceptance and commitment therapy-based intervention: protocol for
Silvia Rizzi1, Anna Elena Nicoletti1, Chiara De Luca2
1Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler, Trento, Italy.
Introduction:
The perinatal period - encompassing pregnancy and the first months after childbirth - is a time of increased psychological vulnerability. It is often associated with high levels of anxiety, stress and depression. Access to psychological support is frequently limited by stigma, geographical barriers, and a shortage of services. Digital health interventions offer promising solutions to overcome these obstacles.
Methods:
This study evaluates the acceptability, feasibility, and user experience of REA, a virtual coach based on Acceptance and Commitment Therapy (ACT), to promote psychological well-being and prevent postpartum depression (PPD). Fifty pregnant women (25-30 weeks of gestation) will be recruited. The 8-week intervention delivers psychoeducational content via text, audio, and video, and collects steps, sleep, and heart rate via smartwatches for triangulation with self-reported measures. User Experience (UX) and User Engagement (UE) will be assessed with the System Usability Scale (SUS), the User Engagement Scale-Short Form (UES-SF), the Italian Chatbot Usability Scale, version B (ITA BUS B), and the User Version of the Mobile Application Rating Scale (uMARS), alongside semi-structured interviews. Psychological outcomes will be assessed pre-post with the two Whooley Questions, the Center for Epidemiological Studies Depression Scale (CES-D), the Multidimensional Psychological Flexibility Inventory (MPFI), and the 12-Item Short Form Health Survey (SF-12).
Expected Results:
The intervention is expected to demonstrate high levels of user satisfaction and engagement (SUS ≥ 68, UES-SF ≥ 3,5/5; ITA BUS B ≥ 44/55 (≈4,0/5); uMARS ≥ 4,0/5), resulting in improvements in psychological flexibility, perceived well-being, and overall quality of life, recognizing that preventive efficacy will be evaluated in subsequent studies with controlled designs and postpartum outcome measures.
Discussion:
REA represents a scalable and accessible tool to support perinatal mental health, offering an innovative approach to the early prevention of postpartum distress.
Trial Registration:
This study was approved by the ethics committee of the APSS (Provincial Health Services Authority) under number 12090 (May 15, 2025).
