title: Internet-based behavioral activation--treatment for postnatal depression (Netmums): a randomized controlled trial.
abstract: BACKGROUND
  Despite the high prevalence of postnatal depression (PND), few women seek help. The internet may increase timely access to treatment. We report a randomized controlled trial of a minimal intervention internet Behavioral Activation (iBA) treatment modified to address postnatal specific concerns (Postnatal-iBA).
  
  
  METHODS
  Women (n=910) recruited via a popular UK parenting site, Netmums.com, scoring above 12 on the Edinburgh Postnatal Depression Scale (EPDS) were randomly assigned to receive either Postnatal-iBA delivered or treatment-as-usual (TAU). We investigated the feasibility (recruitment, trial and treatment adherence) and effectiveness (depression status EPDS >12) of the intervention.
  
  
  RESULTS
  Recruitment was excellent; 1261 women, 961 of whom met inclusion criteria, signed up to the trial within two 2-week recruitment periods. Thirty-eight percent (343/910) of women completed the 15-week outcome assessment. Of those who completed 15-week assessment, fewer exceeded the depression cutoff in the Postnatal-iBA group (n=66/181) compared to TAU (n=91/162). Assuming all non-respondents remained depressed, the Postnatal-iBA effect was reduced.
  
  
  CONCLUSIONS
  The study suffered from high attrition and future trials need to consider strategies for improving outcome completion. Some women reported struggles "keeping up" with the treatment.
  
  
  CONCLUSIONS
  A minimal support, widely accessible internet Behavioral Activation program for PND is feasible to deliver to community populations when embedded within popular parenting sites. For women who provide outcome data, postnatal-iBA offers promise as an effective treatment for PND. The addition of support may reduce women's struggles to keep pace with the treatment.
authors.affiliation: University of Exeter, Mood Disorders Centre, Washington Singer Building, Exeter EX4 4QG, UK. ho215@ex.ac.uk
authors.forename: Heather A
authors.initials: HA
authors.lastname: O'Mahen
authors.forename: Joanne
authors.initials: J
authors.lastname: Woodford
authors.forename: Julia
authors.initials: J
authors.lastname: McGinley
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Warren
authors.forename: David A
authors.initials: DA
authors.lastname: Richards
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Lynch
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D019052:Depression, Postpartum / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D016896:Treatment Outcome
keywords: Behavioral activation; Cognitive behavioral therapy; Depression; Online cbt; Postnatal depression; Randomized controlled trial