Program for Perinatal Mental Health Promotion and Work-Life Balance

The MAternal Mental Health in the WORKplace (MAMH@WORK) intervention will address maternal mental health and well-being protection and promotion during late pregnancy, postpartum and return to work. More specifically, it will target women’s psychosocial adjustment and resilience during this life stage, while promoting several strategic skills: recognition of signals and symptoms of mental disorders; reduction of stigma against mental disorders; coping skills for stressful situations, with a special focus on e-training of mindfulness; enhancement of help-seeking efficacy; and strengthening of emotional and cognitive self-regulation. Health education sessions will be conducted by trained psychologists and psychiatrists experienced in cognitive-behavioural therapy-based psychoeducation interventions, prevention and treatment of depression and anxiety disorders. The intervention will be either conducted on-site (Instituto de Saúde Ambiental da Faculdade de Medicina da Universidade de Lisboa) or live streaming online. The format, setting and contents of the intervention will be fully defined after scoping literature reviews and Delphi technique, which will assure its adequacy as a short-term and sustainable intervention. Still, the intervention is planned as follows (slight changes are anticipated as a consequence of the scoping literature reviews and Delphi technique for consensus-building): - Modules: mental health literacy, self- and perceived stigma towards mental illness, work-life balance, early signs of mental disorders, mother-child interaction and promotion of secure attachment, social support, information about biofeedback (including technical details about the wearable devices), and mindfulness concepts and exercises. - Materials: a standardized operating procedure manual (with training and implementation material for facilitators); each participant will be provided with a booklet with mental health literacy contents and access to (online) e-mental health tools (i.e., easy-to-follow, short videos). - Procedures: discussion of vignettes, discussion of illustrative cases (i.e., cases of postpartum depression, poor and adequate mother-child interaction), emotional and cognitive expression exercises, video demonstration, roleplay of mother-child interactions, and demonstration followed by practical exercises on how to use biofeedback devices (i.e., smartwatch and a sleep banner analyzer) and interpret biofeedback outputs. - Intervention providers: trained psychologists and psychiatrists - Mode of delivery: either face-to-face or live streaming online - Number of sessions: short-term group intervention of 20h (4h/session) to be delivered in two blocks, one at pregnancy month 7, immediately after recruitment (block 1, two sessions) and the other at postpartum month 5 (block 2, three sessions). E-mental health tools are freely available to the participants, who can access them through their mobile phones or computer, at any time. Participants will be invited to access this content regularly (e.g., 10 minutes every other day) from allocation to arms until study close-out. - Group size: group size per session should be =15 - Location: Instituto de Saúde Ambiental da Faculdade de Medicina da Universidade de Lisboa Data collection will be performed by members of the research team through self-administered questionnaires, wearable devices for monitoring physiological signals (in association with a smartphone app), and direct observations of mother-child interactions. It will be conducted on five different moments: baseline (t0; 28–30 gestation weeks), one week after enrollment (t1; 29–31 gestation weeks), two weeks postpartum (t2), five months postpartum (t3), and twelve months postpartum (t4). Women in the intervention group with biofeedback will be provided with a smartwatch and a sleep analyzer device (free of charge for the participants). Participants will be instructed to wear the smartwatch every day, all day long (waterproof devices), and the sleep analyser during the night, when they go to bed. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework will be used to assess the potential for translation and public health impact of this intervention as follows: - Reach dimension: the participation rate given as the proportion of invited pregnant women that accepted to participate in the intervention will be calculated. - Effectiveness dimension: a three-arm randomized controlled trial will be implemented to assess this dimension. The intervention arm 1 will go through cognitive-behavioural therapy-based (CBT-based) psychoeducation sessions (including mindfulness e-training) by formally trained psychiatrists and psychologists; the intervention arm 2 will benefit from the same CBT-based psychoeducation sessions (with mindfulness e-training) in addition to a biofeedback intervention; the control arm will receive the care-as-usual from their health units. - Adoption dimension: does not apply, because the intervention will be delivered by members of the research team. - Implementation dimension: adequacy of the syllabus and the monitoring of a set of progress objectives (e.g., number of the psychoeducation intervention hours delivered, sessions attendance, costs associated, and number of hours of online mindfulness exercises completed, health app analytics). - Maintenance dimension: at both individual and setting levels will be measured at the last moment of data collection, respectively, by (a) the extent to which attendees maintain behavioural change after participating in the intervention and (b) the willingness of health unit managers to provide their users with this intervention.