Oral Concurrent Session 9 - Medical Complications
Oral Concurrent Sessions
Emily S. Miller, MD, MPH (she/her/hers)
Associate Professor
Women & Infants Hospital of Rhode Island and Alpert Medical School of Brown University
Providence, Rhode Island, United States
David Mohr, PhD
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Dinah Williams, N/A
Women and Infants Hospital of Rhode Island
Providence, Rhode Island, United States
Melissa Shikany, N/A
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Tracy Walsh, N/A
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Nathan W. Winquist, MS
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Zara Mir, MS
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Elizabeth L. Gray, MS
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Shannon R. Smith, BS
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Charles Krause, MPH
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Lara M. Baez, PhD
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Madhu C. Reddy, PhD
University of California, Irvine
Irvine, California, United States
Myriad barriers obfuscate optimal care for perinatal mood and anxiety disorders (PMADs). Collaborative care models (CCMs) integrate mental health into primary care. While CCM offer a promising approach to improving PMAD care, implementation challenges persist, suggesting a need for innovative solutions such as technology-enabled services (TES) to optimize care delivery.
Study Design:
Randomized controlled trial (RCT) comparing the impact of a TES to treatment as usual within a CCM on PMAD symptoms. The TES included a cognitive behavioral therapy skills-based mobile app adapted to the perinatal context with adjunctive SMS-based coaching. Individuals were eligible to participate in the RCT if they were pregnant or within 3 months postpartum, experiencing ongoing symptoms of PMADs, enrolled in a CCM, and owned a smart phone. The primary and principal secondary outcomes were depression (PHQ9) and anxiety (GAD7) symptoms, respectively, measured serially over the 12-week intervention. PMAD symptom trajectories were analyzed via generalized linear mixed modeling and as symptom response (50% reduction in symptoms from baseline) and remission (PHQ9 and GAD7 < 4). Satisfaction and engagement with the TES were measured using the Satisfaction Index-Mental Health and TWente Engagement with Ehealth Technologies Scale, respectively.
Results:
Of the 75 women enrolled, 38 were randomized to the TES. Depression [β = -0.24 (95% CI -0.45, -0.03)] and anxiety [β = -0.24 (95% CI -0.46, -0.03)] symptom improvement were identified in the total study sample, but no differences were observed between groups in depression [β = -0.06 (95% CI -0.06, 0.17)] or anxiety [β = -0.06 (95% CI -0.30, 0.19)] symptoms (Figure 1). Response and remission analyses identified no differences across groups (Table 1). Satisfaction was high but not different between groups whereas participant engagement was higher in the TES group at the mid-point evaluation.
Conclusion:
Utilization of a TES to support CCM implementation led to increased engagement in perinatal mental health care but did not result in significant improvements in PMAD symptoms.
