Short summary

The iCARE project will investigate the effect of internet-based cognitive behavioral therapy as a stepped-care treatment for Mothers with symptoms of mild to moderate postpartum depression, aiming to reduce inequalities and barriers to treatment in Denmark.

Rationale

The iCARE project focuses on improving access to treatment for postpartum depression (PPD) in Denmark, where approximately 10-15% of new mothers are affected. PPD can have severe impacts on mothers, children, and families if untreated, and although systematic screening is conducted, treatment availability varies significantly between municipalities, leading to inconsistent and unequal support. Cognitive-behavioral therapy has been shown to effectively reduce depressive symptoms in postpartum women, though the availability of traditional face-to-face cognitive behavioral therapy is limited, with long wait times being a common barrier. Internet-based cognitive-behavioral therapy (iCBT) provides a scalable, accessible alternative that can be completed at home without requiring clinician time, offering both convenience and cost-effectiveness. Self-guided iCBT has demonstrated effectiveness in managing depressive symptoms, although it has also shown high dropout rates, and the potential adverse events remain unclear. International studies have had promising outcomes with iCBT for PPD, including programs in Norway, Portugal, Australia and the US. However, iCBT has yet to be tested within the Danish postnatal care system for mothers showing symptoms of postpartum depression. The iCARE project aims to address this gap by investigating the efficacy and safety of self-guided iCBT for new mothers with mild to moderate PPD, with a focus on evaluating dropout rates, potential adverse events, and overall treatment accessibility across Danish municipalities.

Description of the cohort

The research project is based on the existing screening procedures used by Danish municipalities, where all mothers are offered screening with the EPDS. We aim to integrate our study into the regular practices of health nurses across the 21 municipalities. Mothers who score between 11-18 on the EPDS during home visits by the nurse are encouraged to participate in our study. The inclusion criteria are: · Edinburgh Postnatal Depression Scale (EPDS) score 11-18 · ≥age 18 · Access to the internet Exclusion criteria are: · Thoughts of self harm ³2 on EPDS item 10 · Do not understand Danish language, · Substance abuse or dependence · Alcohol abuse, defined by a weekly consumption of alcohol exceeding 10 units, · Physical condition requiring frequent hospitalization like dialysis, chemotherapy, or blood transfusion, · A diagnosis of schizophrenia, or other psychotic disorders.

Data and biological material

Participants will complete an online survey to gather demographic and background information, including assessments for ADHD symptoms and childhood trauma. The primary outcome is symptoms of postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS). Additional assessments cover potential adverse effects of the intervention, negative thought patterns, emotion regulation, parental stress, anxiety severity, and general functioning. The survey also includes measures of children's social-emotional development. Questionnaire data will be linked to population registers to examine detailed short- and long-term outcomes following the intervention. Additionally, we will conduct semi-structured interviews with participants in the feasibility study.

Collaborating researchers and departments

Research Unit for Digital Psychiatry, Department of Clinical Research, University of Southern Denmark, Odense, Denmark

• Anja Friis Elliott

Center for Migration, Ethnicity and Health (MESU), Faculty Of Health Sciences, Department of Public Health /Section of Health Services Research

• Maria Marti Castaner
• Charlotte Thomsen
• Fiona Haustedt Mossman

National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark

• Kathrine Bang Madsen