Award Title: Digital Assessment of Wellbeing in New Parents (DAWN-P): a feasibility study of digital screening for postnatal depression
Funder: Department of Health and Social Care

Abstract: Epidemiological studies show that 17% of mothers (and 9% of fathers) suffer an episode of major depression (postnatal depression: PND) in the year following childbirth and that suicide is the leading cause of maternal death in this period. The consequences and costs of PND are particularly high due to its impact on infants as well as parents. If detected, PND usually responds well to psychological treatment and/or medication. Hence, improving access to perinatal mental health care for both parents is a priority in the NHS Long Term Plan. The main barrier to access in NHS practice is inefficient PND screening. Recommended practice is for health visitors to administer a well-validated PND screening scale at postnatal visits, usually the 10-item Edinburgh Postnatal Depression Scale (EPDS). However, our audit of 14,200 mothers found that only 41% were screened, resulting in a whole sample rate of caseness of just 3%, consistent with national reports that >50% of cases go undetected.  To improve access, we developed a new smartphone app (ClinTouch DAWN-P) that allows parents to monitor their mood with EPDS on a daily basis from 36 weeks  gestation, uploading real-time responses to a secure server. A proof-of-concept study, over 8 weeks perinatally, in 15 mothers and 8 partners showed the app to be easy, acceptable, safe, and valid against the standard EPDS. This solution addresses existing screening barriers: (i) limited staff time for screening, (ii) parental unwillingness to disclose difficulties to a professional, (iii) language barriers and (iv) no partner/father screening.   The current proposal addresses specific uncertainties in preparation for a full-scale RCT, which will test whether digital screening: identifies more true positives than usual practice; leads to better mental health 6 months postpartum; is safe, acceptable and cost-effective. The full-scale RCT design will be informed by the current proposal which aims to (i) refine the DAWN-P digital screening, in collaboration with key stakeholders; (ii) evaluate feasibility/acceptability of delivering a full-scale, single-blind RCT within NHS services; (iii) optimise RCT design, parameters and procedures.   The design will be a single-blind pilot RCT of digital screening vs. standard practice in a randomised sample of n=80 antenatal mothers, recruited from two maternity services, with a partner/father (n=20) sub-study. Participants randomised to the experimental arm will use DAWN-P app daily from ≥36 weeks  pregnancy until 8 weeks postpartum, in addition to usual care. Participants scoring above threshold on screening (digital or conventional) will have diagnosis confirmed at interview. This sample is sufficient to assess feasibility outcomes and estimate key parameters with adequate precision to inform definitive trial sample size. Qualitative interviews will be conducted with n=30 participating mothers and with n=30 health professionals. Using Framework Analysis, relevant overarching themes will be identified to explore any acceptability and implementation issues.   We have involved parents, health visitors and Greater Manchester commissioners of mental health and maternity services in the study design and the dissemination plan. We will produce a range of outputs for mixed audiences: peer-reviewed papers, conference/seminar presentations, and participant newsletters/blogs/videos published on our website and social media.

Lay Abstract: Postnatal depression is hugely disruptive for parents and their children. Around 17 mothers and 9 fathers in every 100 experience depression in the year after their baby s birth. Parental depression can affect parents  wellbeing, the parent-infant bond and children s development. It can also affect parents  and children s long-term physical and mental health. If postnatal depression remains untreated, it has a heavy economic burden for society – around £74,000 for each case.   Medication or talking therapy can be used to successfully treat postnatal depression, but identifying who needs treatment is difficult. Around half of cases of postnatal depression are currently missed. Our study seeks to improve this vital step.   Most people of childbearing age (94%) own a smartphone. We have developed a smartphone app that asks questions about parents  daily mood to help identify postnatal depression quickly and efficiently. Last year, we ran a small study and found this  digital screening  accurately identified parents needing postnatal depression treatment.   Now we want to gather more information about our digital screening app compared to usual NHS care. For example:    How much do parents use the app and what do they think about it?   What are the main costs of digital screening compared to usual care?  Are parents happy to complete all the assessments we plan to use?   This information will help us design and run a much larger study in future.  To gather this information, we will invite 80 women in the late stages of pregnancy (after 36 weeks) to participate in the current study. We will divide participants, by chance, into two groups of 40 women. The first group will receive usual NHS care. The second group will receive usual NHS care plus the digital screening app.  We will gather information using questionnaires and phone interviews when participants start the study, when their babies are 8 weeks old and again at 6 months old. Assessments will ask about mood, NHS resource use and app acceptability. If a parent from either group has possible postnatal depression, they will receive an extra phone call assessment and signposting.  Over the past 18 months, we have discussed this research with Patient and Public Involvement (PPI) contributors many times. Their ideas fed directly into the study design. During the study, two people with experience of postnatal depression will lead a diverse, 8-person PPI group. The PPI group will meet every 2-3 months using a video-conferencing platform (e.g. Zoom). They will provide regular guidance on the research (e.g., recruitment strategies, app design) and will receive support/training as needed throughout.  We will communicate research findings to the public via local engagement events, plus blogs/newsletters/videos. We will present findings to health professionals and researchers via research conferences and research journals.

Research Activity Codes: 4.4 POPULATION SCREENING
Health Categories: REPRODUCTIVE HEALTH AND CHILDBIRTH;MENTAL HEALTH