Comparing standard and technology-assisted peer-delivered CBT for perinatal depression: A causal mediation study

Area of Science:

• Mental Health
• Psychology
• Digital Health

Background:

• Perinatal depression affects many mothers globally.
• Traditional face-to-face interventions exist, but digital adaptations are emerging.
• Understanding the mechanisms of digital interventions is crucial for optimizing their effectiveness.

Purpose of the Study:

• To examine the mechanisms through which the Technology Assisted Thinking Healthy Programme-Technology Assisted Programme (THP-TAP) improved perinatal depression symptoms compared to a face-to-face approach.
• To decompose the total effect of THP-TAP into pre-specified indirect effects, including session attendance, behavioral activation, social support, problem-solving, cognitive restructuring, and peer empathy.

Main Methods:

• A counterfactual-based approach to mediation analysis was employed.
• Mediators were assessed at 3 months postpartum.
• Depressive symptoms were measured at 6 months postpartum using the Patient Health Questionnaire-9 (PHQ-9).

Main Results:

• Perceived social support in the THP-TAP group significantly mediated improvement in perinatal depression symptoms compared to the face-to-face THP group (adjusted mean difference in PHQ-9: -0.072).
• No significant indirect effects were found for other mediators, including session attendance, behavioral activation, problem-solving, cognitive restructuring, or peer empathy.
• The THP-TAP intervention did not demonstrate superiority over the face-to-face THP in overall symptom improvement.

Conclusions:

• Perceived social support emerged as a key mechanism through which the digital THP-TAP intervention improved perinatal depression symptoms.
• Findings underscore the importance of social connectedness in digital psychosocial interventions.
• Peer-delivered digital interventions can effectively foster relational components, contributing to improved mental health outcomes.