moodup in improving psychological outcomes among perinatal women

Conditions: Anxiety; Pregnancy Related; Perinatal Depression; Prenatal Stress; Sleep Disturbance

Summary: dramatic physiological, psychological, and social changes during the antenatal period may significantly affect a woman's psychosocial and physical conditions, thereby resulting in stress, anxiety, and depressive symptoms. cognitive behavior therapy (cbt) is a well-established effective psychotherapy to modify thoughts, beliefs, and perceptions, as well as change the behavioral patterns under numerous conditions. however, at-risk women that need access to cbt are challenged by many issues, such as insufficient therapists, stigmatization, long waiting times, and high costs. preventive strategies may offer a more acceptable means of addressing the problem. internet-based cbt can help overcome some barriers to improve psychological well-being by providing a timely and efficacious intervention that is customizable, cost-effective, and flexible in terms of time and geography. hypotheses compared with the control group, 1. women who completed an internet-based cbt (moodup) will have significantly lower scores for stress, anxiety, and depressive symptoms immediately post-intervention and at 12 weeks post-intervention; 2. women who completed moodup will reduce the frequency of negative automatic thoughts, achieve a better sleep quality, life satisfaction, and mental health immediately post-intervention and at 12 weeks post-intervention; 3. women who completed moodup will have better client satisfaction. approach a two-stage research design will be used for 3 years. stage i will consist of the development and validation of moodup based on theoretical and empirical rationales. the development of moodup will be guided by a combination of the basic principles from behavioral and cognitive psychology. essential components, teaching strategies, and technical elements of moodup will be established according to literature review and a meta-analysis by the principal investigator and her team. ethical and quality standards will be assessed using the health on the net code of conduct and the health-related website evaluation form, respectively. stage ii will be used to evaluate the efficacy of moodup among 143 antenatal women using a randomized controlled trial, two-armed parallel group pretest, and repeated post-test following the consolidated standards of report trials guidelines for an internet-based intervention. primary outcomes will be the presence and severity of antenatal stress, anxiety, and depressive symptoms using the 21-item depression anxiety stress scale. secondary outcomes will be automatic thoughts, sleep disturbance, life satisfaction, mental well-being, and client satisfaction, as determined by the 30-item automatic thoughts questionnaires, four-item sleep disturbance subscale of the medical outcomes study sleep scale, the five-item satisfaction with life scale, the who five-item well-being index, and the seven-item client satisfaction questionnaire, respectively. multivariate analysis of variance with repeated measures will be used to compare the mean difference of scores in the three-time points through wilks's lambda test. the data will be analyzed according to the intention-to-treat principle with baseline values imputed for missing follow-up data.


Eligibility criteria:
inclusion criteria: * \< 18 weeks of gestation (the upper limit of \< 18 weeks allows time to complete six sessions and follow-up questionnaires prior to delivery) * 21 years of age or older * ability to speak and read english * plan to deliver baby in singapore * can access the internet. exclusion criteria: * severe psychiatric illness * severe medical complications * severe obstetric complications * fetal abnormality.

Keywords: psychological outcomes internet-based cognitive behavioural therapy perinatal women