A Randomized Controlled Trial of a Therapist- Assisted Internet Cognitive Behaviour Therapy Program for Women with Postpartum Depression

Abstract

Postpartum depression (PPD) impacts up to 15% of Canadian women following childbirth. The debilitating disorder not only impacts the woman, but also is related to short- and long-term consequences of her infant‘s development. A systematic review of psychological treatments for PPD demonstrated symptomatic improvements from pre- to post-treatment and superiority to control conditions (Sockol, Epperson, & Barber, 2011). Remarkably, many women suffering from PPD do not receive appropriate treatment. Internet and computer-based delivery formats are an innovative way to improve access to psychological treatment. While therapist-assisted Internet cognitive behaviour therapy (TAICBT) has proven more efficacious than a controlled waitlist condition to treat depressive symptoms reported by mothers of young children (Sheeber et al., 2012), research has not investigated TAICBT for PPD. The current study examined the efficacy of TAICBT for the treatment of PPD reported by Saskatchewan women who have a child less than one year of age. Using a randomized control design, women (N = 50) scoring above 10 on the Edinburgh Postnatal Depression Scale (EPDS) were randomly assigned to receive either TAICBT or waitlist control (WLC). The efficacy of the treatment was investigated at baseline and at sevento 10-week follow-up. Treatment satisfaction, therapeutic alliance, and open-ended questions regarding participant experiences with the program were explored at posttreatment. For a longer-term follow-up, TAICBT participants were contacted four-weeks following treatment completion. Analyses included multi-level mixed models, clinical significance testing, multiple regressions, and thematic content analysis of the openended responses. Results indicated that symptoms of PPD tended to decrease more quickly over time for participants in the TAICBT group compared to those in the WLC group, and these results were clinically significant, reliable, and maintained at four-week follow-up. Secondary analyses indicated that TAICBT participants demonstrated a greater reduction in symptoms of postnatal anxiety, general stress, and parental distress and an increase in psychological and environmental quality of life when compared to the WLC participants. Study implications, limitations, and future research directions are discussed.