Social Media-Based Parenting Program for Women With Postpartum Depressive Symptoms

The Parent Child Early Relational Assessment (PCERA) is a validated 65-item videotape assessment designed to measure the quality of affect and behavior in parent-infant interactions. The PCERA uses ratings that are based on observations of 5-minute videotaped interactions with parent-infant dyads engaged in free play. The PCERA has been shown to possess good interrater reliability, internal consistency, discriminant and concurrent validity, and sensitivity to change. The PCERA contains 8 subscales of which 3 parenting subscales will be the focus: 1) Parental Positive Affective Involvement and Verbalization, 2) Parental Negative Affect and Behavior, and 3) Parental Intrusiveness, Insensitivity, and Inconsistency. Each individual subscale is scored between 0-5, with higher scores indicating more responsive parenting. A subscale score of 1-2 indicates an area of concern, a score of 3 indicates some concern, and a score of 4-5 indicates an area of strength.

Time frame: Baseline and 3 Months

Population: Participants who completed both a Baseline and 3-month follow-up Parent Child Early Relational Assessment (PCERA) videotape measure were included in the overall analysis. At Baseline, 73 (36 control and 37 intervention) of the 75 total enrolled participants completed a PCERA videotape measure, and 66 (34 control and 32 intervention) of the 75 total enrolled participants completed a PCERA videotape measure at 3-month follow-up.

The Acceptability survey is a 10-item scaled with 3 additional open ended questions that will be used to assess feasibility of the parenting program. The total score (range: 9-45) will be used and the open ended questions will be qualitatively analyzed to help inform the acceptability scores. Higher scores on the acceptability survey indicate greater satisfaction and feasibility of the parenting program. The acceptability survey will be administered at the 3-month visit to the intervention, only.

Time frame: 3 months

Population: Participants in the Parenting Program + MoodGym (Intervention arm), only. At the 3-month time point, there were several participants who had been lost to follow-up and did not complete the Acceptability Survey measure. This is the reason for the drop in number of participants.

The MoodGym Acceptability survey will be used to assess feasibility of the online depression treatment program, MoodGym. The survey includes two qualitative open-ended questions and an additional question that asks, It is \_\_\_\_\_\_\_\_\_\_\_ that I will use MoodGym compared to going to a health care provider for depression treatment. The response is a 5-point likert-scale from Much More Likely to Much Less Likely. The open ended questions will be qualitatively analyzed to help inform the acceptability scores. The MoodGym Acceptability survey will be administered at the 3-month visit to both the intervention and control group.

Time frame: 3 months

Population: Participants who completed a 3-month MoodGym Acceptability Survey measure were included in the overall analysis. At the 3-month time point, there were several participants who had been lost to follow-up and did not complete the MoodGym Acceptability Survey measure. This is the reason for the drop in number of participants.

The Multi-dimensional Scale of Perceived Social Support (MSPSS) is a 12-item scale that assesses perceived social support from family, friends, and a significant other. Response categories are on a 7-point likert-scale from 1=very strongly disagree to 7=very strongly agree. The total score will be used (range: 12-84).

Time frame: Baseline

Population: Participants who completed a Baseline Multi-dimensional Scale of Perceived Social Support (MSPSS) measure were included in the overall analysis. At Baseline, 74 (37 control and 37 intervention) of the 75 total enrolled participants completed the MSPSS measure.

The Beck Depression Inventory (BDI-II) is a 21-item self-report tool that measures the severity of depression and includes two subscales: cognitive and somatic. It has been well validated, and widely used, with scores 14-19 indicating mild depression, 20-28 moderate depression, and 29-63 severe depression. The total score (range: 0-63) will be used, with higher scores indicating higher levels of depression. These outcomes will assess changes in BDI-II from baseline to 3 months.

Time frame: Baseline and 3-months

Population: Participants who completed the Beck Depression Inventory (BDI-II) measure at each time point were included in the analysis. At baseline there was one participant, of the 75 total enrolled, who did not complete any baseline measures, including the BDI-II. Over the 3-month time frame there were several participants who were lost to follow-up and did not complete the BDI-II measure. This is the reason for the drop in number of participants analyzed between groups over the 3-month period.

The Edinburgh Postnatal Depression Scale (EPDS) is a validated 10-item self-report measure of depressive symptoms with strong evidence for reliability, validity, and utility in varying populations. It has been used extensively in mental health research and provides cutpoints to determine the severity of depressive symptoms. It includes a question on suicidal thoughts and wishes (#10) that will be used to monitor for suicidality. The total score (range: 0-30) will be used with scores of 10 or higher representing minor or moderate depression and scores of 20 or greater representing severe depression.These outcomes will assess changes in EPDS from baseline to 3 months.

Time frame: Baseline, 1-month, 2-month, 3-month

Population: Participants who completed the Edinburgh Postnatal Depression Scale (EPDS) measure at each time point were included in the analysis. Over the 3-month time frame there were several participants who were lost to follow-up and did not complete the subsequent EPDS measures. This is the reason for the drop in number of participants analyzed between groups over the 3-month period.

The National Comorbidity Survey (NCS) provides data on mental health treatment in the United States. We will include a question from the NCS on prior mental health services use in the past month: In the past month, did you receive treatment for problems with your emotions or nerves, or your use of alcohol or drugs? We will consider mental health service use to have occurred in the past month if a mother responds Yes to this question. The results indicate the number of participants from each group who received mental health services/treatment at each time point. Additionally, if a mother responds Yes to the initial NCS item, a follow-up question will be asked to determine the specific types of services that were accessed: If yes, what type of treatment did you receive?

Time frame: 1-month, 2-month, 3-month

Population: Participants who completed the National Comorbidity Survey (NCS) measure at each time point were included in the analysis. Over the 3-month time frame there were several participants who were lost to follow-up and did not complete the NCSmeasure. This is the reason for the drop in number of participants analyzed between groups over the 3-month period.

The Parenting Sense of Competence Scale (PSOC) is a validated 17-item self-report measure of parenting self-esteem and competence and consists of two factors: satisfaction and efficacy. Response categories are on a 6-point likert-scale from strongly disagree to strongly agree. The total score (range: 17-102), which includes the sum of the two factors, will be used. A higher score indicates a higher parenting sense of competency. There are no average scores or 'cut-off's' for this tool. These outcomes will assess changes in PSOC from baseline to 3 months.

Time frame: Baseline and 3 months

Population: Participants who completed the Parenting Sense of Competence Scale (PSOC) measure at each time point were included in the analysis. At baseline there was one participant, of the 75 total enrolled, who did not complete any baseline measures, including the PSOC. Over the 3-month time frame there were several participants who were lost to follow-up and did not complete the PSOC measure. This is the reason for the drop in number of participants analyzed between groups over the 3-month period.

The Parenting Stress Index-Short Form (PSI-SF) is a validated 36-item scale that measures parenting stress. The PSI-SF is a direct derivative of the full-length test (PSI) and it has been shown to have excellent internal consistency and to be positively associated with maternal psychological distress. Scores on the PSI-SF correlate well with the full-length PSI. It yields a Total Stress score from three scales: Parental Distress, Parent-Child Dysfunctional Interaction, and Difficult Child. The total score (range: 36-180) will be used, with higher scores indicating higher levels of stress.These outcomes will assess changes in PSI-SF from baseline to 3 months.

Time frame: Baseline and 3 months

Population: Participants who completed the Parenting Stress Index-Short Form (PSI-SF) measure at each time point were included in the analysis. At baseline there was one participant, of the 75 total enrolled, who did not complete any baseline measures, including the PSI-SF. Over the 3-month time frame there were several participants who were lost to follow-up and did not complete the PSI-SF measure. This is the reason for the drop in number of participants analyzed between groups over the 3-month period.

The TFI-8 is a validated 8-item scale that is used to measure cohesion and is continuous process monitoring for therapy groups. Scores on the TFI-8 correlate well with the full TFI. The total score (range: 8-56) will be used, with higher scores indicating greater cohesion within the group. The TFI-8 will be administered at the 3-month visit to the intervention group, only.

Time frame: 3 months

Population: Participants in the Parenting Program + MoodGym (Intervention arm), only. At the 3-month time point, there were several participants who had been lost to follow-up and did not complete the TFI-8 measure. This is the reason for the drop in number of participants.