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Use of text messages to screen for postpartum depression holds promise
Using text messages to screen for and educate about postpartum depression was well-accepted, sensitive and feasible in a study of almost 1,000 women.
“Postpartum depression is a very serious illness, with negative consequences for both mother and baby,” Andrea Lawson, PhD, from the department of psychiatry at Mount Sinai Hospital and the University of Toronto, told Healio Psychiatry. “Despite being the most common postpartum mental health issue, only 18% to 25% of postpartum depression cases are detected without screening.”
Text messaging has been used to provide information, support and self-monitoring for some mental health conditions, like substance use disorders, schizophrenia, and affective disorders, according to Lawson and colleagues.
“In the perinatal population, text messaging has been used for information provision and an adjunct to treatment,” they wrote in Psychiatric Services. “To date, there are no reports on the use of text messaging for mental health screening in the perinatal population.”
Researchers examined the feasibility of using text messages to improve postpartum depression screening and education for women in the immediate postpartum period.
For the first 12 weeks postpartum, 937 women received a text message containing a two-question screen for postpartum depression every 2 weeks and three messages each week about postpartum mental health.
Lawson and colleagues used the Edinburgh Postnatal Depression Scale to evaluate those who screened positive for depression via text messaging. All participants received an online survey at 12 to 13 weeks postpartum to report their satisfaction with the text messages.
In total, 126 women screened positive for postpartum depression. The results showed moderate agreement between the text messaging screen and the Edinburgh Postnatal Depression Scale (k = 0.45), with good sensitivity (0.9; 95% CI, 0.81-0.96) and specificity (0.82; 95% CI, 0.79-0.85). In addition, the positive predictive value was 0.32 (95% CI, 0.29-0.36), while the negative predictive value was 0.99 (95% CI, 0.98-0.99), according to the findings.
Overall, 930 participants responded to at least one of the text message screens and 632 responded to all six. The investigators reported that 589 participants responded to the satisfaction survey, with most (n = 459) recommending that all women receive screening for postpartum depression via text messaging.
Most survey respondents reported that they read the educational texts about postpartum mental health (n = 554) and more than half of them found the information helpful. Furthermore, 91% of the survey respondents would recommend that all women in the postpartum period receive educational texts about postpartum depression.
“The take-home message is that screening for postpartum depression and providing information on postpartum mental health via text message is sensitive and feasible and circumvents many common barriers women experience when accessing screening and treatment (e.g., stigma, childcare, transportation),” Lawson told Healio Psychiatry. “This cost-effective technology has excellent potential to be used in mental health care for universal screening purposes and as a first step in the pathway to treatment.” – by Savannah Demko
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Postpartum depression is one of the most common complications of childbirth with well documented adverse consequences to mother, baby and family if not appropriately diagnosed and treated. Although screening for postpartum depression (PPD) is recommended by most medical organizations including the US Preventive Services Task Force, the actual practice of screening remains inconsistent in many places.
The use of smart phones to conduct screening for PPD is a very promising way to connect with women who have given birth and a recent study reported great satisfaction by women who participated in a screening program using mobile devices. The high rates of participation are consistent with other recent work demonstrating robust rates of participation by postpartum women in a smart phone genetic research study.
In this new study, of the 930 women who were screened at least once, approximately 13.5% had a positive screen that showed moderate agreement with the Edinburgh Postnatal Depression Scale. This prevalence is consistent with current estimates of the 10% to 15% prevalence of PPD in the general population.
Importantly, this study demonstrated that almost all women who were sent a text message for screening responded at least once to the prompt and participated in screening. Moreover, the screening via smart phone was favorably reviewed.
These findings demonstrate that mobile technology shows great promise for implementing population level screening; thereby removing barriers to screening for PPD. Future work should examine how to expand this work to the general population and connect women needing further evaluation and treatment with appropriate resources.