Online screening for prenatal depression tested for impact on children’s and mothers’ health

Women’s health – Prenatal depression

Dawn KingstonOne in ten women suffers from depression or anxiety during pregnancy. The consequences can be devastating for both women and children, especially since prenatal depression and anxiety are largely undiagnosed and untreated. The focus has tended to be on post-partum depression.

“In terms of screening and treatment, it’s too little, too late,” says maternal and child health researcher Dr. Dawn Kingston. “We really need to be thinking of prenatal care.”

Recent advances in early development research show that the prenatal period is a particularly critical, vulnerable time for neurobiological development. Maternal depression and anxiety affect the growth and development of the fetus, and are associated with social, emotional and attentional problems and chronic illnesses in childhood and adulthood. Depressed, stressed out moms are more likely to experience preterm labour and deliver low-birth weight babies. Their depression, if left untreated, can continue and worsen after the birth, undermining their ability to bond with and care for their children.

Dr. Kingston, an assistant professor of nursing at the University of Alberta, aims to shift that 10 per cent statistic. She is heading the first — long overdue — large-scale study to evaluate the effectiveness of online prenatal screening and treatment on children’s development and long-term health and the health of their mothers. The four-year study will track 800 pregnant women and their children in Edmonton, Hamilton and Brantford for a year and perhaps longer, and test the performance and impact of an online screening and assessment system. The digital screening tool and therapy were developed for easy implementation in busy clinical settings.

Here’s how it works. A patient walks into her doctor’s office or into a hospital clinic. As part of her routine prenatal care, she fills out an online mental health questionnaire that includes symptoms and risk factors for depression and anxiety. Her responses are scored by a special software program. If the overall score indicates she may be at risk, a prompt is sent to her physician, along with recommendations for treatment options that are available in her community. Online therapy is also presented as an option — either alone or in combination with face-to-face counselling or medication.

The online tool was created by WCHRI’s data management and informatics team as part of a two-year Innovation Grant study, supported by the Royal Alexandra Hospital Foundation (RAHF). Another study (also funded by RAHF) enabled Dr. Kingston and her team to survey 500 pregnant women regarding their attitudes towards prenatal mental health screening. The overwhelming majority supported routine screening. The finding is significant, notes Dr. Kingston, given that routine prenatal mental health screening is not done in any province in Canada, although it’s standard practice in other countries such as the U.K. and Australia.

A minority of the respondents said they felt comfortable initiating discussions about mental health concerns, while 97 per cent preferred service-provider initiated screening. Surprisingly, most preferred online questionnaires rather than face-to-face interviews. The online screening tool was then developed in response to the women’s stated preferences and needs.

Dr. Kingston has also piloted an e-therapy, based on a cognitive behavioural therapy approach, for prenatal depression and stress. The initial response has been highly positive, she says. The online treatment is easily accessible unlike many more traditional therapies that can be expensive, hard to find and have long wait times.

Dr. Kingston anticipates that the full trial findings will improve prenatal mental health policies and care. “Alberta has the potential to become a leader in this regard,” she says.

A pilot trial for this study was funded by the Women and Children’s Health Research Institute and the Norlien Foundation.

Kingston’s research is funded by the generous support of the Lois Hole Hospital for Women, through WCHRI.

Lois Hole Hospital for Women