Stephanie Nettleton

In 2023, it was estimated that 76.4% of adults (129 million) in the United States (US) were living with a chronic health condition (CHC) such as heart disease, diabetes, and chronic pain, among oth...

BACKGROUND Perinatal depression is a major public health concern, and internet-based interventions may increase access to empirically based interventions. Investigating the contributing components of internet-based interventions is critical to implementation research and sustainability efforts within healthcare systems. OBJECTIVE This randomized components trial investigated the impact of an internet-based cognitive behavioral therapy intervention for perinatal depression, comparing the online intervention alone to the online intervention plus phone coaching, assessed with quantitative and qualitative outcomes. METHODS Pregnant and postpartum Veterans (N = 51) were randomized to 1) MomMoodBooster (MMB) or 2) MomMoodBooster + phone coaching (MMBPC) and completed three study assessments (baseline, 3-month follow-up, 6-month follow-up). The intervention consisted of six weekly modules and two optional booster modules. Linear mixed-effects modeling was used to determine the impact of intervention condition over time on depressive symptoms, behavioral activation, and negative automatic thoughts. The impact of intervention condition throughout the intervention was assessed using the Patient Health Questionnaire-9 at weeks 1, 3, and 5 of the intervention. Qualitative analyses identified themes related to helpful aspects of the program and areas for improvement. RESULTS Veterans who completed the welcome call, required for login to the intervention, were included in the analyses (n = 46). Between-assessment analyses were limited by attrition observed across both conditions. Results indicated that significant improvements in depressive symptom severity (F(2, 54.28) = 6.16, P = .004), behavioral activation (F(2, 41.68) = 4.21, P = 0.02), and negative automatic thoughts (F(2, 39.77) = 4.10, P = 0.02) were observed over time but not by condition (ps > .05). Within-intervention change also indicated a significant main effect of time (F(2, 63.88) = 21.62, p < .001), but not condition (p > .05). Qualitative analyses indicated positivity about the intervention and desire for more interaction. CONCLUSIONS Perinatal Veterans experienced therapeutic benefit during and after the online CBT intervention. Despite value of, or desire for, interaction depending on condition, both conditions experienced improvements in the depression, the primary outcome, and the targeted therapeutic processes. Future work should continue to explore contributing components of empirically based interventions for implementation, dissemination, and scalability efforts. CLINICALTRIAL The study was pre-registered on ClinicalTrials.gov (NCT05196152).

Veterans are at increased risk of experiencing postpartum depression yet are understudied. Environmental factors like rurality and resource richness are associated with various health outcomes, although environmental relations to mental health outcomes, such as postpartum depression (PPD), have not been explored thoroughly. The current study aimed to examine the relation between living environment utilizing two indices (Area Deprivation Index and Rural Urban Commuting Area) and postpartum depressive symptom severity in postpartum Veterans. The study sample included postpartum Veterans that were recruited for an online CBT intervention. We utilized screening data from this recruitment effort. Depressive symptom severity was measured via the Patient Health Questionnaire-9. Individual Veteran-level administrative data included age, race, ethnicity, and residential address. Linear regression was used to determine whether resource richness and rurality were associated with depressive symptom severity when adjusting for race. Black Veterans had greater depressive symptom severity than White Veterans (β = 0.12, t = 3.39, p < .001). Rural-dwelling Veterans had lower depressive symptom severity than non-rural dwelling Veterans. Resource richness was not significantly associated with depressive symptom severity. There was not a significant interaction between race and rurality. The results of this study indicate that Black postpartum Veterans enrolled in VA care experienced greater depressive symptom severity. Additionally, rural-dwelling postpartum Veterans reported lower depressive symptom severity. Many postpartum Veterans in this sample were experiencing high symptom burden. Screenings for depressive symptom severity in the postpartum period should be provided to all childbearing individuals, but among Veterans, this may be particularly important.