Alan W. Gemmill

Background: Up to 1 in 10 fathers experience postnatal depression. Fathers are less likely to seek help and receive adequate treatment than depressed mothers. Digital treatments hold significant potential for engaging and supporting fathers, but no effective program exists. Objective: The aim of the study is to evaluate the efficacy of an online cognitive behavioral therapy program, DadBooster, for treating postnatal depression in fathers. Methods: A parallel, 2-group randomized controlled trial (N=50) was conducted to test the superiority of DadBooster over waitlist control who received routine care. Randomization was computer-generated, with allocation concealment maintained through central, computer-automated administration. Participating fathers were aged 18 years or older, had a baby younger than 12 months, had a depression diagnosis using the Quick Structured Clinical Interview for DSM-5 (QuickSCID-5), were not receiving depression treatment, and did not meet criteria for other mental health disorders. They were recruited Australia-wide and completed questionnaires online and assessments by telephone. Primary outcomes were depression symptom severity (Depression Anxiety Stress Scales-21 [DASS-21]) and depressive episode remission (QuickSCID-5) 12 weeks after enrollment. Participants were not blinded. Assessments (QuickSCID-5) and data analysis were conducted blind to allocation. Results: Participants (N=50) were randomized (DadBooster: n=25; waitlist control: n=25) and analyzed as assigned; the trial is complete. Mean depression symptoms (DASS-21) at 12 weeks were significantly lower for DadBooster than waitlist control (adjusted mean difference −7.26, 95% CI −11.34 to −3.18; F _1,47 =12.81; P <.001; η _p ² =0.21); average scores reduced by 72% (compared to 40% in waitlist control) and dropped to the “normal” range at 12 weeks. Of the DadBooster participants assessed, 2 of 23 (9%) still met diagnostic criteria (QuickSCID-5) at 12 weeks compared with 7 of 24 (29%) waitlist controls; not significant (Fisher exact test: P =.14). Significant differences were found for stress (adjusted mean difference −6.55, 95% CI −11.01 to −2.09; F _1,47 =8.73; P =.005; η _p ² =0.16), parenting self-efficacy (adjusted mean difference 4.06, 95% CI 1.16-6.95; F _1,47 =7.93; P =.007; η _p ² =0.14), and negative automatic thoughts (adjusted mean difference −18.10, 95% CI −29.79 to −6.42; F _1,47 =9.71; P =.003; η _p ² =0.17). Participants engaged well with the intervention—80% (20/25) visited 4 or more sessions—and attrition was low. No adverse events were identified. Conclusions: This randomized controlled trial demonstrates the efficacy of DadBooster, the first online treatment targeting clinically diagnosed postnatal depression in fathers, addressing a critical gap in the treatment of postnatal depression, an area that has until recently been primarily focused on mothers. By providing evidence for an intervention specifically designed for fathers with potential for broader scalability, this study advances the limited literature on treatment approaches for postnatal depression in fathers. Given its accessibility, privacy, and convenience, DadBooster is a promising and potentially impactful intervention for supporting fathers.

Perinatal mental health remains a critical global challenge, with maternal mortality, preterm birth, and persistent disparities in care contributing to adverse outcomes for mothers. In addition, mental health difficulties in the perinatal period are associated with poorer developmental outcomes for young children and impose an economic burden on societies. Addressing these issues requires innovative approaches that can complement traditional clinical practices. Artificial intelligence (AI) has emerged as a powerful tool with the potential to transform perinatal care by enabling early risk prediction, personalised interventions, and scalable support systems. However, there are no existing reviews on use of AI across different stages of perinatal mental health. We conclude with a call to action for clinicians, researchers, policymakers, and technology developers to collaborate on a consensus framework that ensures ethical, safe, and equitable integration of AI into perinatal care.

Background/Objectives: Postnatal depression imposes a substantial burden on wellbeing as well as costs estimated to exceed $7 billion for every one-year cohort of births in Australia. Despite this, most cases go untreated, a major barrier being the poor rate of treatment uptake. We developed and pilot tested an integrated screening and clinical decision support system (PIRIMID) to assist maternal and child health nurses (MCHNs) to create individualised management plans, with specific referral pathways, for women depressed postnatally. We assessed the feasibility of PIRIMID by examining acceptability for both nurses and women, ease of implementation, and referral rates, and we monitored treatment uptake and depression. Methods: An extensive co-design and consultation process was used to develop PIRIMID. A pilot cluster randomised controlled trial (RCT) was conducted comparing PIRIMID to Routine care, with partial crossover (PIRIMID followed by crossover to Routine care and Routine care followed by continued Routine care). A state-wide survey of MCHNs in Victoria, Australia, explored perceived benefits and barriers of PIRIMID from a consumer perspective. Results: Twelve MCHNs (PIRIMID: n = 6; Routine care: n = 6) and 229 women (conditions: PIRIMID, n = 52; Crossover Routine care, n = 42; Routine care, n = 57; Continued Routine care, n = 78) were recruited to the RCT. Median scores for depression, anxiety and stress symptoms were low and similar at all timepoints and conditions. PIRIMID was acceptable and helpful to MCHNs and women, and most MCHNs rated integration into their existing clinical systems as easy. There were trends in favour of higher referral rates by PIRIMID MCHNs (18%, 95% CI: 5–40) compared with other conditions (10–15%, 95% CIs: 6–29, 2–27, 6–26), but treatment uptake appeared similar across conditions. The statewide survey (n = 292) revealed that 84% of MCHNs would use PIRIMID, and the main potential barriers to use would be time constraints and technical issues. Conclusions: This pilot work indicates that PIRIMID shows promise as a feasible and acceptable tool to assist MCHNs to develop management plans for women depressed postnatally. Further research with adequate statistical power is needed to explore effects on treatment uptake with larger samples of postnatally depressed women.

Perinatal depression is highly prevalent, yet there is a very low rate of treatment uptake and help-seeking. The MumSpace Initiative was funded by the Australian government to invest in digital stepped-care treatments and support for perinatal depression, to improve mental health outcomes and national access. This paper describes the reach of the MumSpace initiative as a one-stop shop offering perinatal depression treatments with a solid evidence base (MumMoodBooster programmes), supported by a prevention programme addressing modifiable risk factors through a smartphone application (MindMum) as well as evidence-based universal prevention programmes. We have brought together multi-skilled teams and a Perinatal Depression Consortium to deliver the programmes and address changing technology. The effectiveness of MumSpace was evaluated through systematic monitoring of consumer reach: data analysis of website traffic and resource uptake. MumSpace has successfully sustained engagement, attracting over 275,000 visits since its launch in 2017, with the number of visitors to the website increasing year on year. The central treatment tools, MumMoodBooster and Mum2BMoodBooster, have reached over 10,000 Australian women, largely through self-referral. Despite the development of a portal for direct clinician referral and monitoring, continuing challenges for implementation involve integrating digital treatments into traditional services and recruiting professionals to directly engage mothers.

Background: Substantial evidence indicates that maternal depression during pregnancy (i.e., antenatal depression) is associated not only with maternal wellbeing but also with child emotional and behavioural development. Children of antenatally depressed women are at risk of emotional and behavioural problems, including internalising problems (e.g., anxiety and depression) and externalising problems (e.g., attention problems), that may last at least to adolescence. These enduring effects also constitute an enormous economic cost. Despite the seriousness of this problem, until recently there existed very few controlled studies evaluating whether active psychological treatment for antenatal depression can prevent adverse child outcomes. Our previous pilot randomised controlled trial (RCT) exploring the effect of cognitive behavioural therapy (CBT) for antenatal depression on child outcomes showed promising results. We aim to assess whether treating antenatal depression with an evidence-based 8-week structured CBT program can prevent or ameliorate adverse child developmental outcomes at 2 years of age. Methods: Pregnant women ≤ 30 weeks gestation diagnosed with a depressive disorder are recruited and randomised to CBT or treatment as usual (TAU). The target sample size is 230 and the primary outcome measure is the infant Internalising scale of the Child Behaviour Checklist (CBCL) at 24 months of age. Secondary infant outcome measures at 24 months are the Externalising scale of the CBCL and the motor and cognitive development subscales of the Ages & Stages Questionnaire (ASQ-3). Additional secondary outcome measures are subscales of the Revised Infant Behaviour Questionnaire (IBQ-R), ASQ-3 and the ASQ-Socio-Emotional (ASQ-SE) at 3 and 12 months of age and the quality of mother-infant interaction at 3 and 24 months. Maternal measures, including demographic data, depression diagnosis, depressive and anxiety symptoms, perceived stress and parenting stress, are collected across all time points. Discussion: The trial is ongoing and recruitment was slowed due to the COVID-19 pandemic. If results suggest a beneficial effect of antenatal depression treatment on infant outcomes, the project could have repercussions for standard antenatal care, for maternal and infant health services and for preventing the intergenerational transmission of mental health disorders. Trial registration: Australia and New Zealand Clinical Trials Register: ACTRN12618001925235 Date Registered: 27 November 2018.

Background Substantial evidence indicates that maternal depression during pregnancy (i.e., antenatal depression) is associated not only with maternal wellbeing but also with child emotional and behavioural development. Children of antenatally depressed women are at risk of emotional and behavioural problems, including internalising problems (e.g., anxiety and depression) and externalising problems (e.g., attention problems), that may last at least to adolescence. These enduring effects also constitute an enormous economic cost. Despite the seriousness of this problem, until recently there existed very few controlled studies evaluating whether active psychological treatment for antenatal depression can prevent adverse child outcomes. Our previous pilot randomised controlled trial (RCT) exploring the effect of cognitive behavioural therapy (CBT) for antenatal depression on child outcomes showed promising results. We aim to assess whether treating antenatal depression with an evidence-based 8-week structured CBT program can prevent or ameliorate adverse child developmental outcomes at 2 years of age.Methods Pregnant women ≤ 30 weeks gestation diagnosed with a depressive disorder are recruited and randomised to CBT or treatment as usual (TAU). The target sample size is 230 and the primary outcome measure is the infant Internalising scale of the Child Behaviour Checklist (CBCL) at 24 months of age. Secondary infant outcome measures at 24 months are the Externalising scale of the CBCL and the motor and cognitive development subscales of the Ages & Stages Questionnaire (ASQ-3). Additional secondary outcome measures are subscales of the Revised Infant Behaviour Questionnaire (IBQ-R), ASQ-3 and the ASQ-Socio-Emotional (ASQ-SE) at 3 and 12 months of age and the quality of mother-infant interaction at 3 and 24 months. Maternal measures, including demographic data, depression diagnosis, depressive and anxiety symptoms, perceived stress and parenting stress, are collected across all time points.Discussion The trial is ongoing and recruitment was slowed due to the COVID-19 pandemic. If results suggest a beneficial effect of antenatal depression treatment on infant outcomes, the project could have repercussions for standard antenatal care, for maternal and infant health services and for preventing the intergenerational transmission of mental health disorders.Trial registration: Australia and New Zealand Clinical Trials Register: ACTRN12618001925235 Date Registered: 27 November 2018.

Background: Depression in pregnancy is prevalent, under-treated, and has serious impacts on the wellbeing of women and on child development. Internet programs can reach women who may not access traditional treatments due to distance, stigma or concern about taking medication. We adapted our online postnatal depression program, MumMoodBooster, for antenatal use. We aimed to trial feasibility, acceptability, and potential efficacy of the new Mum2BMoodBooster intervention with depressed pregnant women. Methods: Twenty-seven pregnant women with Edinburgh Postnatal Depression Scale score > 11 used the program in a feasibility trial. Twenty-one had current diagnoses of major or minor depression on the Structured Clinical Interview for the DSM-IV. Assessment of symptoms occurred at screening/baseline, post-test (8 weeks post-enrollment), and at follow-up (3 months postpartum) using the Patient Health Questionnaire (PHQ-9) and the Depression Anxiety Stress Scales (DASS-21). Results: In this feasibility trial, depression scores on both the PHQ-9 and the DASS-21, showed significant reductions representing large effects, with average symptom scores reduced by > 50%, and maintained in the ‘minimal or no depression’ range at 3 month follow-up. Anxiety scores also decreased significantly. Program usage was high with 74% of women visiting all six sessions. Program acceptability ratings were moderate to high. Conclusions: Findings paralleled the magnitude of symptom reductions seen in randomised trials of the postnatal MumMoodBooster program, suggesting that Mum2BMoodBooster is an effective treatment for depressed pregnant women. Effective internet therapies are likely to become increasingly important as the COVID-19 pandemic continues to make face-to-face access to health care problematic during ‘lockdowns’.

In an increasingly connected world and in the midst of a global pandemic, digital trials offer numerous advantages over traditional trials that rely on physical study sites. Digital trials have the potential to improve access to research and clinical treatments for the most vulnerable and minoritized, including pregnant and postpartum individuals. However, digital trials are underutilized in maternal and child health research, and there is limited evidence to inform the design and conduct of digital trials. Our research collaborative, consisting of 5 research teams in the U.S. and Australia, aimed to address this gap. We collaborated to share lessons learned from our experiences recruiting and retaining pregnant and postpartum individuals in digital trials of social and behavioral interventions. We first discuss the promise of digital trials in improving participation in research during the perinatal period, as well as the unique challenges they pose. Second, we present lessons learned from 12 completed and ongoing digital trials that have used platforms such as Ovia, Facebook, and Instagram for recruitment. Our trials evaluated interventions for breastfeeding, prenatal and postpartum depression, insomnia, decision making, and chronic pain. We focus on challenges and lessons learned in 3 key areas: (1) rapid recruitment of large samples with a diversity of minoritized identities, (2) retention of study participants in longitudinal studies, and (3) prevention of fraudulent enrollment. We offer concrete strategies that we pilot-tested to address these challenges. Strategies presented in this commentary can be incorporated, as well as formally evaluated, in future studies.

Background: Previous research has confirmed that symptoms of postnatal depression (PND) can be ameliorated through internet-delivered psychological interventions. Advantages of internet-delivered treatment include anonymity, convenience, and catering to women who are unable to access face-to-face (FTF) treatments. To date, no research has examined the efficacy of such interventions compared directly with FTF treatments in women clinically diagnosed with PND.Objective: This study aims to compare the efficacy of one of the first web-based cognitive behavioral therapy (CBT) interventions (internet CBT+coach calls) for PND (MumMoodBooster [MMB]) with FTF-CBT in a randomized controlled trial (RCT).Methods: In this study, 116 postnatal women with a Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) diagnosis of major or minor depression were randomized to MMB (39/116, 33.6%), FTF-CBT (39/116, 33.6%), or a treatment-as-usual (TAU) control condition (38/116, 32.8%). Diagnostic status was determined at baseline and at 21-week follow-up using the Structured Clinical Interview for the DSM-IV. Severity of anxiety and depressive symptoms was evaluated using the Depression Anxiety Stress Scales and the revised Beck Depression Inventory at baseline, 12-week follow-up (after treatment), and 21-week follow-up.Results: Of the 116 participants, 107 (92.2%) had a diagnosis of major depression at baseline. Rates of remission from a major or minor depressive episode at 21 weeks in both the FTF-CBT and MMB groups were superior to that of the TAU group (56.6% and 47.7% less likely to be depressed, respectively) and they were not significantly different from each other. Although remission rates differed between TAU and FTF-CBT, growth models showed that, in terms of symptom reduction across time, the FTF-CBT treatment was not significantly better than TAU. By comparison, MMB was statistically superior to both TAU and FTF-CBT in reducing symptoms of depression, anxiety, and stress from baseline to the 21-week follow-up (large and moderate effect sizes). Thus, after 21 weeks, the average symptom scores for depression and anxiety of women receiving MMB were approximately half those of women in both the TAU and FTF-CBT groups.Conclusions: In this RCT, MMB was at least as effective as FTF-CBT in achieving remission from a diagnosed PND episode. MMB was superior to TAU and FTF-CBT in encouraging and maintaining reduction of symptom severity over the 21-week follow-up for depressed postnatal women. These findings replicate results of prior studies on MMB that showed clinically significant improvements in depressive symptoms, and they provide direct empirical support that internet-delivered treatment for depressed postnatal women is a viable alternative to FTF treatment. The generalizability of the results needs to be examined in future research, as RCTs of internet-based versus FTF treatments necessarily involve a subset of people who are willing to undertake either modality of treatment.Trial Registration: Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000881730; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364683&isReview=true