Mobile Phone Based Peer Support to Prevent Postpartum Depression Among Adolescent Mothers
Condition: Postpartum Depression
MeSH terms: Depression, Postpartum; Depression; Depressive Disorder
Study type: Interventional

Summary: 
      This pilot study will evaluate the feasibility and acceptability of a mobile phone based peer
      support intervention among adolescent mothers. Half of the participants will receive usual
      care plus the peer support intervention and the other half of the participants will receive
      usual care only.
    

Detailed description: 
      Postpartum depression (PPD) is one of several postpartum mood disorders and is classified as
      a major depressive disorder. It has the highest inception rate during the first 12 weeks
      postpartum and is frequently comorbid with anxiety disorders or significant anxiety symptoms.
      PPD is the most frequent form of maternal morbidity following childbirth and has serious
      negative consequences including maternal suffering, impaired maternal-infant interactions and
      cognitive, behavioural and emotional problems in infants and children. As a result of these
      negative consequences, PPD has been deemed a major public health concern warranting
      preventive intervention. Adolescent mothers are a particularly vulnerable maternal population
      who are at approximately three times greater risk for developing postpartum depression (PPD)
      compared to adult mothers, with an estimated prevalence of 38%. In 2011, over 65,000 live
      births were recorded to adolescents between 15-24 years of age in Canada, which represents a
      significant number of mothers at risk for developing PPD.

      Several variables have been identified as predictors for PPD among adolescent mothers;
      however, the one variable which has been consistently identified in studies is a lack of
      social support. A detailed analysis of social support variables in predictive studies among
      adolescent mothers clearly identifies not having someone to talk with about their problems as
      a major deficiency in social support. These findings are not surprising as the relationship
      between lack of social support and reduced psychological well-being has been well
      established. Evidence shows that decreased social network size, fewer close relationships,
      and lower perceived adequacy of social support are all linked to depressive symptomatology.

      Peer to peer support, a form of social support, has been shown to improve health outcomes in
      various age groups including adolescents. Peers are lay individuals who have similar
      characteristics and experiences as a target population and can share pragmatic knowledge and
      empathic understanding. The provision of peer support includes (a) informational support
      (knowledge, facts, and suggestions), (b) emotional support (attentive listening, caring and
      reassurance) and (c) appraisal support (motivation, encouragement and positive communication)
      which is delivered by a peer.

      The purpose of this study is to evaluate the feasibility and acceptability of a mobile
      phone-based peer support intervention and adherence with the trial protocol to inform a
      future definitive full-scale randomized controlled trial.

      The design is a pilot randomized controlled trial. Forty eligible and consenting pregnant
      adolescents age 16-24 years will be randomized into an intervention or control group.
      Adolescents in the control group will receive standard prenatal and postpartum in-hospital
      and community care. Adolescents in the intervention group will receive the same standard care
      as the control group plus a mobile phone-based peer support intervention. Mobile phone-based
      peer support will consist of support provided by a trained peer mentor starting in the
      participant's last trimester of pregnancy and continuing for 12 weeks postpartum. Peer
      mentors are young mothers between 16-24 years of age who will receive 12 hours of training to
      learn how to provide support to new young mothers. Peer support will be provided either via
      voice calling or text messaging depending on the participant's preference. Additionally,
      acceptability by participants the intervention group will be evaluated via questionnaire and
      semi-structured interview to determine likes/dislikes and areas for improvement. Preliminary
      effectiveness will be a secondary outcome with depressive and anxiety symptoms measured using
      the Edinburgh Postnatal Depression Scale and the Speilberger State Anxiety Inventory at 12
      weeks postpartum. Social support and health services utilization will also be measured at 12
      weeks postpartum.

      This study will provide evidence about a novel approach to preventing PPD among adolescent
      mothers. Results will reveal which components of peer support (informational, emotional or
      appraisal support) and which aspects of mobile phone technology (voice-calling, text
      messaging or a combination of both) are most acceptable for adolescent mothers. Based on the
      results of this current study, new knowledge will be gained in relation to the provision of
      peer support among adolescent mothers using mobile technology. This trial will provide
      valuable information to address a major public health concern (PPD) in a highly vulnerable
      population (adolescent mothers).
    

Intervention name(s): Mobile Phone Based Peer Support; Usual Care
Intervention type(s): Other; Other
Intervention description(s): Adolescents allocated to the experimental group will have access to all standard prenatal and postpartum community supports. In addition, mobile phone-based peer support (MPPS), which consists of support provided by a peer mentor via mobile phone (with both voice calling and Short Message Service text message capabilities) will be provided during pregnancy and for 12 weeks postpartum. Peer support is defined as a specific type of social support (informational, appraisal, and emotional support) that is provided by a peer mentor who possesses experiential knowledge of adolescent motherhood and is of similar age to the participant.; Participants allocated to the usual care group will not receive the peer support intervention but will have access to all standard community prenatal and postpartum support services such as 1) the Canada Prenatal Nutrition Program; 2) postpartum home visits / telephone support from a public health nurse; 3) postpartum appointments with midwives, obstetrician, family physician, and / or pediatricians, and 4) prenatal and postpartum support as needed from psychiatrists, psychologists, social workers, breastfeeding clinics, and community resources.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Peer support; Postpartum Depression; Adolescent Pregnancy