How might mobile technology aid maternal mental health?

By Jose Marcano, Research Assistant and PhD Candidate and the Department of Primary Care and Public Health at Imperial College London

The impact of maternal mental health problems on families is far reaching. The consequences extend beyond mothers, having lasting effects on their children and families. 

For this reason, maternal mental health should be a key public health priority. One solution to improving the screening for, and responses to, mental health needs could lie in the use of mobile technology.

The problem

Research has shown that maternal mental health problems have lasting effects on life outcomes for the child, such as emotional and behavioural development.1-5 

Maternal mental health problems also have a considerable impact on health and social care systems, the economy and society in general.6 Recent UK figures show that mental health problems (including depression, anxiety, psychoses, post-traumatic stress disorder, and other disorders) can affect up to 20% of women during pregnancy or immediately after childbirth.5,7-8 

Worryingly, these problems often go undiagnosed and untreated: approximately half of all cases of perinatal depression and anxiety fail to be recognised. Barriers such as insufficient information about expected changes in mood during pregnancy, the characteristics of the healthcare providers, lack of reassurance that mental healthcare is a normal part of antenatal care, insufficient time, and stigma can often delay diagnosis and prevent access to treatment.9-10

We must identify innovative ways of tackling these barriers, particularly in light of recent findings that highlight the benefits of screening for depression during pregnancy and after childbirth.11 

The potential of mobile health

Recent innovations in interventions have used mobile technology to promote and support maternal mental health, within a field known as mobile health. Mobile health, or mHealth, refers to the support of medical or public health practice through the use of mobile devices, such as mobile phones, tablets, or wearable devices.12

A key perceived advantage of mobile health is its potential reach given the uptake of mobile technology in the general population. The increase in popularity, versatility and quality of these devices means mobile health has genuine potential to address some of the barriers that prevent perinatal mental health problems from being diagnosed, and increase access to treatment.

In addition, mobile technology could be used to support women to better understand their mood and communicate their problems within existing antenatal care pathways. 

The research so far

A number of mobile health initiatives are currently being implemented worldwide. 

For example, in the US, researchers at the University of Illinois and Champaign-Urbanara Public Health District are evaluating the use of tablet computers to screen for depression during antenatal appointments.13 This project was informed by focus groups aimed at identifying staff perceptions and concerns regarding the implementation of this practice,14 which is an essential step to the effective roll out of mobile health interventions. 

In the UK, the charity Best Beginnings is currently working on a number of films to support maternal mental health, which will be included in their Baby Buddy app. This app provides parents and parents-to-be with personalised, evidence-based content about pregnancy and the first six months after childbirth.

Best Beginnings have commissioned academic evaluations to assess the impact of their Baby Buddy app,15 and they operate a bespoke embedding service to facilitate the incorporation of their resources into local healthcare services.16

Here at Imperial College London’s Global eHealth Unit we are evaluating the feasibility of using tablet computers to facilitate the screening of low mood and depressive symptoms in the waiting area of antenatal clinics across NHS facilities in England.17-18 We are working with the NHS sites involved in the project to ensure that this process complements their local mental health care pathways.

We are also working with researchers at Trinity College Dublin to evaluate the use of women’s own devices to monitor these symptoms at home throughout pregnancy. This will be preceded by a series of co-design sessions to ensure that we capture the perceptions and concerns of all relevant stakeholders (e.g., mother, mothers-to-be, midwives, clinicians). 

These initiatives provide a glimpse of the new opportunities that this field can offer in terms of delivering maternal mental health services and for gathering data. They also highlight important issues around the current state of the evidence base for this emerging field. In order to facilitate the incorporation of mobile health interventions into existing healthcare services, it is important to capture the views and concerns of those front-line practitioners, who will be responsible for offering these interventions. More importantly, it is key that these concerns are addressed appropriately.

The majority of the evidence in support of mobile health interventions comes from small scale feasibility or pilot studies. These studies are important to capture implementation issues that could influence the successful deployment of mobile health interventions in clinical settings.

However, in order to build a strong evidence base for mobile health, we need to ensure that these initiatives are designed with the potential to be easily scaled up, integrated into existing care pathways within health systems, and with appropriate built-in evaluation processes.

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References

  1. Capron LE, Glover V, Pearson RM, Evans J, O’Connor TG, Stein A, Murphy SE, Ramchandani PG (2015). Associations of maternal and paternal mood with offspring anxiety disorder at age 18 years. Journal of affective disorders; 15( 187): 20 – 6. 
  2. Pearson RM, Evans J, Kounali D, Lewis G, Heron J, Ramchandani PG, O’Connor TG, Stein A (2013). Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years. JAMA Psychiatry; 70(12): 1312 – 9. 
  3. Canadian Paediatric Society (2004). Maternal depression and child development. Paediatric Child Health; 9(8): 575 – 583. 
  4. Stein A, Malmberg LE, Sylvia K, Barnes J, Leach P (2008). The influence of maternal depression, caregiving, and socioeconomic status in the post-natal year on children’s language development. Child: care, health and development; 34(5): 603 – 12. 
  5. Mental Health Foundation (2015). Fundamental Facts About Mental Health. UK: Mental Health Foundation. 
  6. Bauer A, Parsonage M, Knapp M, Iemmi V, Adelaja B (2014). The costs of perinatal mental health problems. London: Centre for Mental Health and London School of Economics. 
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  8. Royal College of Psychiatrists (2012). Mental health in pregnancy [Online]. Available on: http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/mentalhealthinpr... [Accessed 09 March 2016]. 
  9. Kingston D, Austin MP, Heaman M, McDonald S, Lasiuk G, Sword W, Giallo R, Hegadoren K, Vermeyden L, van Zanten SV, Kingston J, Jarema K, Biringer A (2015). Barriers and facilitators of mental health screening in pregnancy. Journal of affective disorders; 186: 350 – 7. 
  10. Goodman JH (2009). Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth; 36(1): 60 – 9. 
  11. Siu AL, USPSTF (2016). Screening for Depression in Adults – US Preventive Services Task Force Recommendation Statement. JAMA; 315(4): 380 – 387. 
  12. The World Health Organization (2011). mHealth: New horizons for health through mobile technologies – Global Observatory for eHealth series – Volume 3. Switzerland: World Health Organization. 
  13. Illinois New Bureau (2015). Project to use tablets to screen women for perinatal depression [Online]. Available on: https://news.illinois.edu/blog/view/6367/204390 [Accessed 09 March 2016].  
  14. Pineros-Leano M, Tabb KM, Sears H, Meline B, Huang H (2015). Clinical staff attitudes towards the use of mHealth technology to conduct perinatal depression screenings: a qualitative study. Family Practice; 32(2): 211 – 5. 
  15. Best Beginnings. Evidence, impact and evaluation [Online]. Available on: http://www.bestbeginnings.org.uk/evidence-impact-and-evaluation [Accessed 09 March 2016]. 
  16. Best Beginnings. Commissioning & Resources [Online]. Available on: http://www.bestbeginnings.org.uk/commissioning-resources [Accessed 09 March 2016]. 
  17. Marcano Belisario JS, Gupta AK, O’Donoghue J, Morrison C, Car J (2016). Tablet computers for implementing NICE antenatal mental health guidelines: protocol of a feasibility study. BMJ Open; 6: e009930. 
  18. Global eHealth Unit (2016). mHealth for Antenatal Mental Health [Online]. Available on: https://www1.imperial.ac.uk/ehealth/gehu_research/gehu_mamh/ [Accessed 09 March 2016].