Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression
Open accessAbstract
Background: Despite the high prevalence of postnatal depression (PND), few women seek help. Internet interventions may overcome many of the barriers to PND treatment use. We report a phase II evaluation of a 12-session, modular, guided Internet behavioural activation (BA) treatment modified to address postnatal-specific concerns [Netmums Helping With Depression (NetmumsHWD)]. Method: To assess feasibility, we measured recruitment and attrition to the trial and examined telephone session support and treatment adherence. We investigated sociodemographic and psychological predictors of treatment adherence. Effectiveness outcomes were estimated with the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder-7, Work and Social Adjustment Scale, Postnatal Bonding Questionnaire, and Social Provisions Scale. Results: A total of 249 women were recruited via a UK parenting site, Netmums.com. A total of 83 women meeting DSM-IV criteria for major depressive disorder were randomized to NetmumsHWD (n = 41) or treatment-as-usual (TAU; n = 42). Of the 83 women, 71 (86%) completed the EPDS at post-treatment, and 71% (59/83) at the 6-month follow-up. Women completed an average of eight out of 12 telephone support sessions and five out of 12 modules. Working women and those with less support completed fewer modules. There was a large effect size favouring women who received NetmumsHWD on depression, work and social impairment, and anxiety scores at post-treatment compared with women in the TAU group, and a large effect size on depression at 6 months post-treatment. There were small effect sizes for postnatal bonding and perceived social support. Conclusions: A supported, modular, Internet BA programme can be feasibly delivered to postpartum women, offering promise to improve depression, anxiety and functioning.
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Most other web-based interventions for postpartum depression relied exclusively on classic cognitive behavioral therapy principles and neglected concepts emphasized by third wave cognitive behavioral therapy.
“and they relied exclusively on classic cognitive behavioral therapy (CBT) principles [10,11], thus neglecting various concepts emphasized by third wave CBT”
From The Efficacy of Be a Mom, a Web-Based Intervention to Prevent Postpartum Depression: Examining Mechanisms of Change in a Randomized Controlled Trial (2023) · cites this paper as [11]
The Introduction ('Why create a new online treatment for postpartum depression?'; page unavailable) describes prior online CBT programmes, supporting the claim that such interventions existed. It does not establish that most relied exclusively on classic CBT or neglected third-wave concepts. Instead, it describes this paper’s own online treatment as behavioural activation using functional analysis without CBT’s cognitive components. (LLM, conf=0.83)
Experimental — accuracy not yet measuredMost web-based interventions for PPD were not specifically designed or tested for preventive purposes and relied exclusively on classic CBT.
“It bears recalling that most web-based interventions for PPD were not specifically designed or tested for preventive purposes and that they relied exclusively on classic CBT [7,10,11];”
From The Efficacy of Be a Mom, a Web-Based Intervention to Prevent Postpartum Depression: Examining Mechanisms of Change in a Randomized Controlled Trial (2023) · cites this paper as [11]
The Method (Participants; page unavailable) enrolled women who met criteria for major depressive disorder, so this web-based intervention tested treatment, not prevention. But the Introduction (‘Why create a new online treatment for postpartum depression?’; page unavailable) describes its approach as behavioural activation without CBT’s cognitive components. The paper does not establish that most web-based PPD interventions relied exclusively on classic CBT. (LLM, conf=0.85)
Experimental — accuracy not yet measuredExtending iCBT support through additional weekly telephone calls has been found to improve treatment adherence.
“Indeed, extending iCBT support through additional weekly telephone calls has been found to improve treatment adherence [39].”
From Internet-based cognitive behavioral therapy for symptoms of depression and anxiety among patients with a recent myocardial infarction: The u-care heart randomized Controlled trial (2018) · cites this paper as [39]
The Methods describe weekly telephone support, and the Discussion and Implications report higher adherence and less attrition in the guided trial than in an earlier unsupported trial. But this trial did not isolate the effect of the calls: the Implications say it is unclear whether outcomes were due to the online content, telephone support, or both. The source therefore supports an association, not a finding that additional calls improved adherence. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPsychotherapeutic programs aimed at depression are not always effective in improving mother-infant bonding.
“Psychotherapeutic programs aimed at depression are not always effective in improving mother-infant bonding (O'Mahen et al., 2014), however, combined programs specifically targeting both mood and bonding problems have shown some success (Holt et al., 2021).”
From Associations between maternal psychological distress and mother-infant bonding: a systematic review and meta-analysis (2023) · cites this paper as O'Mahen et al., 2014
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Computer-assisted cognitive behavioral therapy for pregnant women with major depressive disorder
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- Authors
- O'Mahen, H. A., Richards, D. A., Woodford, J., Wilkinson, E., McGinley, J., Taylor, R. S., & Warren, F. C.
- Affiliations
- University of Exeter (GB)
- Imperial College London (GB)
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2013-10-09
- Volume
- 44
- Issue
- 8
- Pages
- 1675-1689
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC4005035
- OpenAlex
- W2146301370
- Cited by
- 201
- References
- 56
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 16 · 2023: 26 · 2022: 23 · 2021: 26 · 2020: 13 · 2019: 14 · 2018: 21 · 2017: 15 · 2016: 18 · 2015: 9 · 2014: 5
- FWCI
- 10.88
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Open Research Exeter (University of Exeter) (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- Figshare (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0611-10203)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- postpartum depression, behavioral activation, online intervention, guided self-help, medication adherence, telephone support, social support, anxiety, work and social functioning, maternal mental health
- MeSH terms
- Adult, Behavior Therapy, Feasibility Studies, Female, Humans, Treatment Outcome, Depression, Postpartum, Internet
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