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Original Investigation
September 8, 2021

Effect of Online 1-Day Cognitive Behavioral Therapy–Based Workshops Plus Usual Care vs Usual Care Alone for Postpartum Depression: A Randomized Clinical Trial

Author Affiliations
  • 1Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
  • 2Health Research Methodology Graduate Program, McMaster University, Hamilton, Ontario, Canada
  • 3Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
  • 4School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
  • 5Public Health and Emergency Services, Regional Municipality of Niagara, Thorold, Ontario, Canada
  • 6Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
JAMA Psychiatry. Published online September 8, 2021. doi:10.1001/jamapsychiatry.2021.2488
Key Points

Question  In women with postpartum depression (PPD), can an online 1-day cognitive behavioral therapy (CBT)–based workshop plus treatment as usual improve PPD and its comorbidities compared with treatment as usual alone?

Findings  In this randomized clinical trial of 403 mothers, online 1-day CBT-based workshops led to clinically and statistically significant improvements in PPD and anxiety, as well as improvements in social support, the mother-infant relationship, and positive affect in infants.

Meaning  These findings suggest that online 1-day CBT-based workshops provide the scope to treat large numbers of women with PPD effectively and efficiently, increasing access and supporting stepped care approaches.

Abstract

Importance  Postpartum depression (PPD) affects as many as 20% of mothers, yet just 1 in 10 of these women receives evidence-based treatment. The COVID-19 pandemic has increased PPD risk, reduced treatment access, and shifted preferences toward virtual care.

Objective  To determine whether an online 1-day cognitive behavioral therapy (CBT)–based workshop added to treatment as usual improves PPD, anxiety, social support, mother-infant relationship quality, and infant temperament more than treatment as usual alone.

Design, Setting, and Participants  This randomized clinical trial included 403 women with PPD who were recruited across Ontario, Canada, during the COVID-19 pandemic (April 20 to October 4, 2020). Women with Edinburgh Postnatal Depression Scale (EPDS) scores of at least 10 who were 18 years or older and had an infant younger than 12 months were eligible.

Interventions  Women were randomly assigned to receive a live, interactive online 1-day CBT-based workshop delivered by a registered psychotherapist, psychiatrist, or clinical psychology graduate student in addition to treatment as usual (n = 202) or to receive treatment as usual and wait-listed to receive the workshop 12 weeks later (n = 201).

Main Outcomes and Measures  The primary outcome was change in PPD (EPDS scores) in experimental and wait list control groups 12 weeks after baseline. Secondary outcomes included maternal anxiety (7-item Generalized Anxiety Disorder Questionnaire [GAD-7]), social support (Social Provisions Scale), quality of the mother-infant relationship (Postpartum Bonding Questionnaire), and infant temperament (Infant Behavior Questionnaire–Revised Very Short Form).

Results  Participants all identified as women with a mean (SD) age of 31.8 (4.4) years. The workshop led to significant mean (SD) reductions in EPDS scores (from 16.47 [4.41] to 11.65 [4.83]; B = −4.82; P < .001) and was associated with a higher odds of exhibiting a clinically significant decrease in EPDS scores (odds ratio, 4.15; 95% CI, 2.66-6.46). The mean (SD) GAD-7 scores decreased from 12.41 (5.12) to 7.97 (5.54) after the workshop (B = −4.44; 95% CI, −5.47 to −3.38; P < .001) and participants were more likely to experience a clinically significant change (odds ratio, 3.09; 95% CI, 1.99-4.81). Mothers also reported improvements in bonding (B = −3.22; 95% CI, −4.72 to −1.71; P < .001), infant-focused anxiety (B = −1.64; 95% CI, −2.25 to 1.00; P < .001), social support (B = 3.31; 95% CI, 1.04 to 5.57; P < .001), and positive affectivity/surgency in infants (B = 0.31; 95% CI, 0.05 to 0.56; P < .001).

Conclusions and Relevance  In this randomized clinical trial, an online 1-day CBT-based workshop for PPD provides an effective, brief option for mothers, reducing PPD and anxiety as well as improving social support, the mother-infant relationship, and positive affectivity/surgency in offspring.

Trial Registration  ClinicalTrials.gov Identifier: NCT04485000

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