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Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression

  • H. A. O'Mahen (a1), D. A. Richards (a2), J. Woodford (a1), E. Wilkinson (a3), J. McGinley (a4), R. S. Taylor (a5) and F. C. Warren (a5)...

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)].


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.


A total of 249 women were recruited via a UK parenting site, 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.


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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The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence .
Corresponding author
* Address for correspondence: H. A. O'Mahen, Mood Disorders Centre, University of Exeter, Washington Singer Building, Exeter EX4 4QG, UK. (Email:
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Addis, ME, Martell, CR (2004). Overcoming Depression One Step at a Time: The New Behavioral Activation Approach to Getting Your Life Back. New Harbinger Press: New York.
Andersson, G, Cuijpers, P (2009). Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cognitive Behaviour Therapy 38, 196205.
Andrews, G, Cuijpers, P, Craske, MG, McEvoy, P, Titov, N (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One 5, e13196.
Beattie, A, Shaw, A, Kaur, S, Kessler, D (2009). Primary-care patients’ expectations and experiences of online cognitive behavioral therapy for depression: a qualitative study. Health Expectations 12, 4559.
Brockington, F, Oates, J, Georges, S, Turner, D, Vostanis, P, Sullivan, M, Lohr, C, Murdoh, C (2001). A screening questionnaire for mother–infant bonding disorders. Archives of Women's Mental Health 3, 133140.
Buist, A, Bilszta, J, Barnett, B, Milgrom, J, Ericksen, J, Condon, J, Hayes, B, Brooks, J (2005). Recognition and management of perinatal depression in general practice. Australian Family Physician 34, 787790.
Byford, S, McCrone, P, Barrett, B (2003). Developments in the quantity and quality of economic evaluations in mental health. Current Opinion in Psychiatry 16, 703707.
Christensen, H, Griffiths, KM, Farrer, L (2009). Adherence in Internet interventions for anxiety and depression: a systematic review. Journal of Medical Internet Research 11, e13.
Christensen, H, Griffiths, KM, Jorm, AF (2004). Delivering interventions for depression by using the Internet: randomised controlled trial. British Medical Journal 328, 265.
Cox, JL, Holden, JM, Sagovsky, R (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150, 782786.
Craig, P, Dieppe, P, Macintyre, S, Michie, S, Nazareth, I, Petticrew, M (2008). Developing and evaluating complex interventions: the new Medical Research Council guidance. British Medical Journal 337, a1655.
Crisp, A, Gelder, M, Goddard, E, Meltzer, H (2005). Stigmatization of people with mental illnesses: a follow-up study within the Changing Minds campaign of the Royal College of Psychiatrists. World Psychiatry 4, 106113.
Cuijpers, P, Donker, T, van Straten, A, Li, J, Andersson, G (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine 40, 19431957.
Cutrona, CE, Russell, D (1987). The provisions of social relationships and adaptation to stress. In Advances in Personal Relationships, vol. 1 (ed. Jones, H. and Perlman, D.), pp. 3767. JAI Press: Greenwich, CT.
Dennis, C-L, Chung-Lee, L (2006). Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth 33, 323331.
Dimidjian, S, Hollon, SD, Dobson, KS, Schmaling, KB, Kohlenberg, RJ, Addis, ME, Gallop, R, McGlinchey, JB, Markley, DK, Gollan, JK, Atkins, DC, Dunner, DL, Jacobson, NS (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology 74, 658670.
Etter, JF (2005). Comparing the efficacy of two Internet-based, computer-tailored smoking cessation programs: a randomized trial. Journal of Medical and Internet Research 7, e2.
Farvolden, P, Denisoff, E, Selby, P, Bagby, RM, Rudy, L (2005). Usage and longitudinal effectiveness of a web-based self-help cognitive behavioral therapy program for panic disorder. Journal of Medical and Internet Research 7, e7.
Gavin, NI, Gaynes, BN, Lohr, KN, Meltzer-Brody, S, Gartlhner, G, Swinson, T (2005). Perinatal depression: a systematic review of prevalence and incidence. Obstetrics and Gynecology 106, 10711083.
Goodman, JH (2009). Women's attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth 36, 6069.
Hind, D, O'Cathain, A, Cooper, CL, Parry, GD, Isaac, CL, Rose, A, Martin, L, Sharrack, B (2009). The acceptability of computerized cognitive behavioral therapy for the treatment of depression in people with chronic physical disease: a qualitative study of people with multiple sclerosis. Psychology and Health 25, 699712.
Jacobson, NS, Martell, CR, Dimidjian, S (2001). Behavioral activation treatment for depression: returning to contextual roots. Clinical Psychology: Science and Practice 8, 255270.
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 1219.
Julious, SA (2005). Sample size of 12 per group rule of thumb for a pilot study. Pharmaceutical Statistics 4, 287291.
Kaltenthaler, E, Brazier, J, De Nigris, E, Tumur, I, Ferriter, M, Beverley, C, Parry, G, Rooney, G, Sutcliffe, P (2006). Computerised cognitive behaviour therapy for depression and anxiety update: a systematic review and economic evaluation. Health Technology Assessment 10, 1168.
Kaltenthaler, E, Parry, G, Beverley, C, Ferriter, M (2008). Computerised cognitive–behavioral therapy for depression: systematic review. British Journal of Psychiatry 193, 181184.
Kohn, R, Saxena, S, Levav, I, Saraceno, B (2004). The treatment gap in mental health care. Bulletin of the World Health Organization 82, 858866.
Le, H-N, Perry, DF, Sheng, X (2009). Using the Internet to screen for postpartum depression. Maternal and Child Health Journal 13, 213221.
Löwe, B, Decker, O, Müller, S, Brähler, E, Schellberg, D, Herzog, W, Herzberg, PY (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care 46, 266274.
Matthey, S (2004). Calculating clinically significant change in postnatal depression studies using the Edinburgh Postnatal Depression Scale. Journal of Affective Disorders 78, 269272.
Meyer, B, Berger, T, Caspar, F, Beevers, CG, Andersson, G, Weiss, M (2009). Effectiveness of a novel integrative online treatment for depression (Deprexis): randomized controlled trial. Journal of Medical Internet Research 11, e15.
Mundt, JC, Marks, IM, Greist, JH, Shear, K (2002). The Work and Social Adjustment Scale: a simple accurate measure of impairment in functioning. British Journal of Psychiatry 180, 461464.
Murray, L, Arteche, A, Fearon, P, Halligan, S, Croudace, T, Cooper, P (2010). The effects of maternal postnatal depression and child sex on academic performance at age 16 years: a developmental approach. Journal of Child Psychology and Psychiatry 51, 11501159.
Murray, L, Woolgar, M, Cooper, P (2004). Detection and treatment of postpartum depression. Community Practitioner 77, 1317.
National Institute for Health and Clinical Excellence (2007). Antenatal and Postnatal Mental Health. National Institute for Health and Clinical Excellence: London.
National Research Council and Institute of Medicine (2009). Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention. Committee on Depression, Parenting Practices, and the Healthy Development of Children. Board on Children, Youth, and Families. Division of Behavioral and Social Sciences and Education. The National Academies Press: Washington, DC.
O'Mahen, HA, Fedock, G, Henshaw, E, Himle, J, Forman, J, Flynn, HA (2012). Modifying CBT for perinatal depression: what do women want? A qualitative study. Cognitive and Behavioral Practice 19, 359371.
O'Mahen, HA, Flynn, HA (2008). Preferences and perceived barriers to treatment for depression during the perinatal period. Journal of Women's Health 17, 13011309.
O'Mahen, HA, Himle, J, Fedock, G, Henshaw, E, Flynn, HA (2013 a). A pilot randomized controlled trial of cognitive behavioral therapy for perinatal depression for women with low income. Depression and Anxiety 30, 679687.
O'Mahen, HA, Woodford, J, McKinley, J, Taylor, R, Lynch, T, Warren, F (2013 b). A randomized controlled trial of an unsupported Internet-based behavioral activation treatment for postnatal depression: a feasibility study. Journal of Affective Disorders. Published online: 17 April 2013. doi:10.1016/j.jad.2013.03.005.
Pawlby, S, Sharp, D, Hay, D, O'Keane, V (2008). Postnatal depression and child outcome at 11 years: the importance of accurate diagnosis. Journal of Affective Disorders 107, 241245.
Payne, KA, Myhr, G (2010). Increasing access to cognitive–behavioral therapy (CBT) for the treatment of mental illness in Canada: a research framework and call for action. Health Care Policy 5, e173e175.
Perini, S, Titov, N, Andrews, G (2009). Clinician-assisted Internet-based treatment is effective for depression: randomized controlled trial. Australian and New Zealand Journal of Psychiatry 43, 571578.
Poobalan, AS, Aucott, LS, Ross, L, Smith, WC, Helms, PJ, Williams, JH (2007). Effects of treating postnatal depression on mother–infant interaction and child development: systematic review. British Journal of Psychiatry 191, 378386.
Reay, R, Fisher, Y, Robertson, M, Adams, E, Owen, C, Kumar, R (2006). Group interpersonal psychotherapy for postnatal depression: a pilot study. Archives of Women's Mental Health 9, 3139.
Rosenthal, R, Rosnow, RL (2008). Essentials of Behavioral Research: Methods and Data Analysis, 3rd edn. McGraw-Hill: New York.
Sheeber, LB, Seeley, JR, Feil, EG, Davis, B, Sorensen, E, Kosty, DB, Lewinsohn, PM (2012). Development and pilot evaluation of an internet-facilitated cognitive-behavioural intervention for maternal depression. Journal of Consulting and Clinical Psychology 80, 739749.
Sockol, LE, Epperson, CN, Barber, JP (2011). A meta-analysis of treatments for perinatal depression. Clinical Psychology Review 31, 839849.
Spek, V, Cuijpers, P, Nyklíček Riper, H, Keyzer, J, Pop, V (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychological Medicine 37, 319328.
Spitzer, RL, Kroenke, K, Williams, JBW, Löwe, B (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine 166, 10921097.
Swinson, RP (2006). The GAD-7 scale was accurate for diagnosing generalized anxiety disorder. Evidence Based Medicine 11, 184.
Tharner, A, Lujik, MP, van Ijzendoorn, MH, Bakermans-Kranenburg, MJ, Jaddoe, VW, Hofman, A, Verhulst, FC, Tiemejer, H (2012). Maternal lifetime history of depression and depressive symptoms in the prenatal and early postnatal period do not predict infant–mother attachment quality in a large, population-based Dutch cohort study. Attachment and Human Development 14, 6381.
Warmerdam, L, van Straten, A, Twisk, J, Riper, H, Cuijpers, P (2008). Internet-based treatment for adults with depressive symptoms: randomized controlled trial. Journal of Medical Internet Research 10, e44.
White, IR, Royston, P, Wood, AM (2011). Multiple imputation using chained equations: issues and guidance for practice. Statistics in Medicine 30, 377399.
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