title: Internet Cognitive Behavioral Therapy for Women With Postnatal Depression: A Randomized Controlled Trial of MumMoodBooster.
abstract: BACKGROUND
  There are few published controlled trials examining the efficacy of Internet-based treatment for postnatal depression (PND) and none that assess diagnostic status (clinical remission) as the primary outcome. This is despite the need to improve treatment uptake and accessibility because fewer than 50% of postnatally depressed women seek help, even when identified as depressed.
  
  
  OBJECTIVE
  In a randomized controlled trial (RCT), we aimed to test the efficacy of a 6-session Internet intervention (the MumMoodBooster program, previously evaluated in a feasibility trial) in a sample of postnatal women with a clinical diagnosis of depression. The MumMoodBooster program is a cognitive behavioral therapy (CBT) intervention, is highly interactive, includes a partner website, and was supported by low-intensity telephone coaching.
  
  
  METHODS
  This was a parallel 2-group RCT (N=43) comparing the Internet CBT treatment (n=21) to treatment as usual (n=22). At baseline and at 12 weeks after enrollment, women's diagnostic status was assessed by telephone with the Standardized Clinical Interview for DSM-IV (SCID-IV) and symptom severity with the Beck Depression Inventory (BDI-II). Depression symptoms were measured repeatedly throughout the study period with the Patient Health Questionnaire (PHQ-9).
  
  
  RESULTS
  At the end of the study, 79% (15/19) of women who received the Internet CBT treatment no longer met diagnostic criteria for depression on the SCID-IV (these outcome data were missing for 2 intervention participants). This contrasted with only 18% (4/22) remission in the treatment as usual condition. Depression scores on the BDI-II showed a large effect favoring the intervention group (d=.83, 95% CI 0.20-1.45). Small to medium effects were found on the PHQ-9 and on measures of anxiety and stress. Adherence to the program was very good with 86% (18/21) of users completing all sessions; satisfaction with the program was rated 3.1 out of 4 on average.
  
  
  CONCLUSIONS
  Our results suggest that our Internet CBT program, MumMoodBooster, is an effective treatment option for women clinically diagnosed with PND. This is one of only two controlled evaluations of specialized online psychological treatment among women clinically diagnosed with PND. MumMoodBooster appears to be a feasible, effective treatment option, which is potentially accessible to large numbers of women in metropolitan, rural, and remote areas. Future work might be focused profitably on establishing comparability with face-to-face treatments and purely self-guided delivery. We have commenced a larger RCT comparing MumMoodBooster with face-to-face CBT.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000113752; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363561 (Archived by WebCite® at http://www.webcitation.org/6f64kuyLf).
authors.affiliation: Parent-Infant Research Institute, Melbourne, Australia.
authors.forename: Jeannette
authors.identifier: http://orcid.org/0000-0002-4082-4595
authors.initials: J
authors.lastname: Milgrom
authors.forename: Brian G
authors.identifier: http://orcid.org/0000-0001-8234-0479
authors.initials: BG
authors.lastname: Danaher
authors.forename: Alan W
authors.identifier: http://orcid.org/0000-0002-7753-4110
authors.initials: AW
authors.lastname: Gemmill
authors.forename: Charlene
authors.identifier: http://orcid.org/0000-0003-2477-6375
authors.initials: C
authors.lastname: Holt
authors.forename: Christopher J
authors.identifier: http://orcid.org/0000-0001-6296-3759
authors.initials: CJ
authors.lastname: Holt
authors.forename: John R
authors.identifier: http://orcid.org/0000-0002-5320-7510
authors.initials: JR
authors.lastname: Seeley
authors.forename: Milagra S
authors.identifier: http://orcid.org/0000-0003-3207-6248
authors.initials: MS
authors.lastname: Tyler
authors.forename: Jessica
authors.identifier: http://orcid.org/0000-0003-4612-9195
authors.initials: J
authors.lastname: Ross
authors.forename: Jennifer
authors.identifier: http://orcid.org/0000-0001-8359-0103
authors.initials: J
authors.lastname: Ericksen
mesh_terms: D000328:Adult; D001007:Anxiety / Q000628:therapy; D001315:Australia; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D019052:Depression, Postpartum / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D011569:Psychiatric Status Rating Scales; D012424:Rural Population; D017216:Telemedicine; D013689:Telephone; D016896:Treatment Outcome
keywords: Internet-based intervention; cognitive behavioral therapy; postnatal depression; postpartum depression; randomized controlled trial