Adjusting an Available Online Peer Support Platform in a Program to Supplement the Treatment of Perinatal Depression and Anxiety

“There were 8 items that assessed usability, usefulness, and intention to use and recommend 7Cups and were adapted from established measures including the USE [40], Behavioral Intention to Use [35], and Word of Mouth Communication [41,42].”

“There were 8 items that assessed usability, usefulness, and intention to use and recommend 7Cups and were adapted from established measures including the USE [40], Behavioral Intention to Use [35], and Word of Mouth Communication [41,42].”

“Depression and anxiety have comparable impacts on quality of life [4] and are associated with high levels of lost work productivity and increased medical costs [5,6].”

“Overcoming these barriers requires novel resources that expand potential models of delivery [18], which can offer a variety of services to meet each person’s individual needs and preferences.”

“Furthermore, Internet-based resources for perinatal depression and anxiety have demonstrated feasibility and efficacy [20-25].”

“Untreated perinatal depression and anxiety carry several additional risks, including obstetric complications, puerperal pathologies, and increased psychopathology in childhood or adolescents [7-9].”

“Attitudes toward the listeners were measured using four items that were used in a previous study on 7Cups [36], adapted from measures of therapeutic alliance [43-45].”

“More than 15% of women experience symptoms of depression and anxiety during this period [1-3].”

“Research has shown, for example, that low-income pregnant women with higher quality of social support tend to experience less postpartum depression [15], and that even brief interventions of postnatal support groups are effective in reducing the symptoms of postpartum depression [16].”

“Several barriers, however, to receiving such services present during the perinatal period including lack of time, stigma, and childcare [17].”

“Untreated perinatal depression and anxiety carry several additional risks, including obstetric complications, puerperal pathologies, and increased psychopathology in childhood or adolescents [7-9].”

“For example, studies have demonstrated that online group support can be beneficial for women experiencing postpartum depression [49], and depressive symptoms following breast cancer diagnosis [50].”

“…that have demonstrated that peer support is an effective tool to prevent perinatal depression via phone [56] and is generally acceptable by women who suffer from postpartum depression [57,58], 7Cups could meet several of the needs of women seeking treatment for perinatal depression or anxiety.”

“Overall, psychosocial treatments appear to be preferred to pharmacotherapy [10-12].”

“Depression and anxiety have comparable impacts on quality of life [4] and are associated with high levels of lost work productivity and increased medical costs [5,6].”

“Along with other studies that have demonstrated that peer support is an effective tool to prevent perinatal depression via phone [56] and is generally acceptable by women who suffer from postpartum depression [57,58], 7Cups could meet several of the needs of women seeking treatment for perinatal…”

“Overall, psychosocial treatments appear to be preferred to pharmacotherapy [10-12].”

“Despite the large number of apps available, very few have empirical support [25,26], and many health apps lack basis in empirically supported principles [27,28].”

“Digital tools such as mindfulness training exist [52,53] and could be impactful if provided to users.”

“Despite the large number of apps available, very few have empirical support [25,26], and many health apps lack basis in empirically supported principles [27,28].”

“More than 15% of women experience symptoms of depression and anxiety during this period [1-3].”

“These treatments do not confer any exposure risks to the babies, for example, [13,14], and the availability of emotional and social support during perinatal period has a significant role in the prevention and recovery from perinatal mood disorders.”

“We follow existing guidelines on key processes and factors to evaluate when considering existing eHealth products [30,31].”

“Depression and anxiety have comparable impacts on quality of life [4] and are associated with high levels of lost work productivity and increased medical costs [5,6].”

“This approach could also ensure that the resultant product or program can stay relevant to the current technological environment, which is a major challenge in this field [32].”

“For example, studies have demonstrated that online group support can be beneficial for women experiencing postpartum depression [49], and depressive symptoms following breast cancer diagnosis [50].”

“More than 15% of women experience symptoms of depression and anxiety during this period [1-3].”

“In fact, it is likely we could have trained more listeners, as the training is an automated and nonconsumable [51] resource.”

“For the purposes of patient recruitment and referral, and in accordance with Internet-based intervention studies that relate to safety concerns [38,39] the following guidelines were created: 1.”

“Given the consistently changing nature of software and the technological environment, it has been suggested that behavior change principles are the more important unit of analysis than the apps themselves [29].”

“It might also be worth exploring methods that allow people to receive and provide support at the same time, making the platform more scalable as additional users join, for example, [48].”

“…controlled trial comparing computerized behavioral activation for postpartum depression to treatment as usual (limited access to the Internet website), medium to large effect sizes favored women who received the computerized treatment on scores of depression ( d =0.87) and anxiety ( d =0.59) [21].”

“Research has shown, for example, that low-income pregnant women with higher quality of social support tend to experience less postpartum depression [15], and that even brief interventions of postnatal support groups are effective in reducing the symptoms of postpartum depression [16].”

“perinatal depression and anxiety carry several additional risks, including obstetric complications, puerperal pathologies, and increased psychopathology in childhood or adolescents [7-9].”

“We follow existing guidelines on key processes and factors to evaluate when considering existing eHealth products [30,31].”

“Overall, psychosocial treatments appear to be preferred to pharmacotherapy [10-12].”

“Furthermore, Internet-based resources for perinatal depression and anxiety have demonstrated feasibility and efficacy [20-25].”

“Despite the large number of apps available, very few have empirical support [25,26], and many health apps lack basis in empirically supported principles [27,28].”

“Finally, a study investigating the feasibility of an Internet-facilitated intervention for disadvantaged mothers with elevated symptoms of depression found greater reduction in depressive symptoms for participants in the intervention group compared to waiting list condition [23].”

“Safety practices draw from recommendations for Internet-based intervention research and cover areas of system security, online safety, and clinical safety [37].”

“These treatments do not confer any exposure risks to the babies, for example, [13,14], and the availability of emotional and social support during perinatal period has a significant role in the prevention and recovery from perinatal mood disorders.”

“These findings are also congruent with the Griffiths et al study [59] showing that peer support delivered online is perceived to provide a useful support for those who suffer from depression.”

“This finding converges with the Pugh et al study [47] showing that one of the main perceived advantages of a therapist assisted online program for women who suffer from postpartum depression revolves around the program flexibility and accessibility, due to the mothers’ need to manage themselves…”

“For the purposes of patient recruitment and referral, and in accordance with Internet-based intervention studies that relate to safety concerns [38,39] the following guidelines were created: 1.”

“Attitudes toward the listeners were measured using four items that were used in a previous study on 7Cups [36], adapted from measures of therapeutic alliance [43-45].”

“More research needs to address implementation into practice and evaluate efficacy and feasibility in real-world settings [55].”

“Indeed, many women express interest in the use of Internet-based health care resources during the perinatal period [19].”

“As seen in Multimedia Appendix 2, the 208 articles included in this review [27-237] reported on 2 types of user studies: (1) 69 studies were needs assessments that aimed to understand user needs and attitudes toward DMHIs without or before engaging with a specific intervention as part of a study and (2) 135 studies we…”

“For patients who seek face-to-face help first, mental health apps may still be recommended by mental health professionals as a supplement to therapy, 3 or as a form of intermediate support while on the waiting list.”

“Baumel and Schueller [65] presented similar results showing that women with perinatal mood disorders preferred to receive services late at night, when clinicians were not available, due to the fact that they were awake and had pockets of availability at that time.”

“These techniques have also been adapted for specific peer populations, such as mothers with postpartum depression [8].”

“Description of 7Cups The adaptation of 7Cups as part of the program to supplement treatment for perinatal mood disorders was described in a previous paper [22].”

“A recent study aimed to design a program to help implement an online technological platform into existing treatment resources for perinatal depression and anxiety for a given healthcare system (Baumel and Schueller, 2016).”

“Sanvello Moberg et al (2019)[96] 500 Randomized control trial Effectiveness Compared to waitlist Sanvello Broglia et al (2019)[97] 38 Two-arm, parallel, nonrandomized Effectiveness Compared to receiving face-toface treatment 7 Cups Baumel et al (2015)[98] 866 One-time assessment Qualitative evaluation Compared to sati…”

“Another handful of web-based peer support platforms train nondistressed volunteer listeners, but unlike our program, these platforms generally do not use evidence-based behavioral teaching techniques, and it is unknown if these trainings improve listeners’ behavioral adherence to guidelines [60-62].”

“Others guide peers to focus on conveying emotional support, such as through listening to and affirming recipients’ experiences without offering advice.(14,81) In face-to-face recovery, Alcoholics Anonymous has similar norms of avoiding direct advice.”

“to understand how clinicians and nurses can better support new mothers’ needs [8, 10].”

“Some technology-based interventions (eg, short message service text messages, Web-based peer support, and internet therapy) have been tested in perinatal and postpartum women with depression and have been shown to be effective in reducing their depressive symptoms [60-63].”

“Moreover, some users desired to receive support from individuals who have personal experience with mental health issues (Baumel and Schueller 2016).”

“The clinical outcomes method is currently being utilized in a project to adapt an available online platform to enhance care for people with mental disorders (Baumel et al. 2016; Baumel and Schueller 2016).”

“There are two major challenges to the effectiveness and sustainability of these peer-support platforms: volunteer turnover and lack of professional training are well reported by prior literature [10, 48, 50, 65].”

“Les profession - nels de sant é peuvent d’ailleurs avoir une certaine r é ticence à r é f é rer leurs patients à un espace de soutien en ligne si celle-ci n’est pas modérée par un professionnel [23, 61, 67].”

“For example, in research conducted by Baumel and Schueller, users believed that peer emotional support in an online psychological talking cure platform was more effective than drug therapy [12], so they were more willing to share their feelings and seek help on the platform.”

“29 Parents with infants in the NICU reported a preference for accessing the internet with their smartphone when seeking information about their infant ’ s health.”

“For the 7 Cups of Tea program from the USA, we included a formative [Baumel and Schueller, 2016] and a feasibility study [Baumel et al., 2018].”

“Moreover, smart phone applications have shown good sensitivity and specificity for postpartum depression screening, which indicates that health services using smart phones are effective.(27,28) The decision-making aids booklet is mainly in the form of pictures or charts, which can be placed in the waiting area for pat…”

“…among youth, the feasibility and acceptability of peer support through online chats has been shown among adults with e.g. lived experience of mental disorders (Fortuna et al., 2020), perinatal depression/anxiety (Baumel and Schueller, 2016) or schizophrenia-spectrum disorders (Baumel et al., 2016).”

“That partnership led to several published studies (Baumel, 2015; Baumel et al., 2016, 2018; Baumel & Schueller, 2016; Hsu et al., 2025; Liu et al., 2024; Loveys et al., 2018; Pendse et al., 2019; Stapleton et al., 2024; Wang et al., 2025; Yang et al., 2024).”