Document text
Principal Investigator: Adam Korrick Lewkowitz
Organization: WOMEN AND INFANTS HOSPITAL-RHODE ISLAND
Fiscal Year: 2024
Award: $179,621
Funding agency: Eunice Kennedy Shriver National Institute of Child Health and Human Development
The prevalence of depression is high after childbirth: rates of postpartum depression (PPD) are as high as 25%
among women without prior PPD or depression but with personal or structural risk factors such as being low-
income or a women of color, among others. As such, the American College of Obstetricians and Gynecologists
recommends screening women for PPD. However, disparities in postpartum mental health care exist: <60% of
women attend post-partum visits where PPD screening occurs, and barriers such as lack of transportation or
childcare have been shown to not only reduce rates of postpartum visit attendance but to disproportionately
affect low-income women or women of color. In addition, the risk of PPD extends beyond 60 days post-partum,
when pregnancy-related federal health insurance often expires. Smartphone applications (apps) may increase
equity in postpartum mental health by providing long-term access to mental health treatment to most women.
Indeed, in the United States, 96% of those aged 18-29 own a smartphone, and medical apps have been shown
to improve obstetric outcomes and increase access to mental health services. Though in-person, cognitive
behavioral therapy given through the Mothers and Babies Program (MB) has been shown to reduce PPD by
53% among low-income women of color, the effect of app-provided group MB is unclear. The purpose of this
Mentored Patient-Oriented Career Development Award (K23) is to enable the candidate to develop a funded
research program to optimize postpartum mental health care for low-income women of color via an innovative
technology-based intervention that may decrease their rates of PPD. To achieve this goal, training and mentor-
ship are proposed in three key areas: 1) Advanced training in mixed methods research, perinatal psychology,
digital health, and biostatistics; 2) Mentorship from a multi-disciplinary team of established researchers; and 3)
Protected time to perform patient-oriented research on the feasibility of utilizing app-provided MB as a study
intervention for low-income women of color with risk factors for PPD. Two study phases are required. First,
focus groups and interviews will optimize the study intervention, which contains MB and parenting education
(PE). Those in the intervention group will access MB+PE while those in the control group will access PE to
encourage app engagement with both study groups. This is because women in both groups will receive
bimonthly Edinburgh Postnatal Depression Scales (EPDS) scores from birth to six months postpartum. The
primary outcome of the proposed randomized trial is demonstrated feasibility and acceptability of app-based
MB, defined via recruitment and app usage (feasibility), and scores on the System Usability Scale and Client
Satisfaction Questionnaire (acceptability). Secondary outcomes include EDPS scores. The proposed trial will
provide critical insight into a subsequent R01-supported randomized trial designed to examine the effect of
app-based MB on PPD among low-income, racially and ethnically diverse women. If effective, app-based MB
has great potential for scalability and could increase postpartum mental health equity for most women.
Terms: <0-11 years old><ACOG><Affect><American College of Obstetricians and Gynecologists><Android App><Android Application><Area><Behavior><Biometrics><Biometry><Biostatistics><Birth><Breast Feeding><Breast fed><Breastfed><Breastfeeding><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Career Development Awards><Career Development Awards and Programs><Career Development Programs K-Series><Cell Phone><Cell Phone Application><Cell phone App><Cellular Phone><Cellular Phone App><Cellular Phone Application><Cellular Telephone><Child><Child Care><Child Youth><Childbirth><Childhood><Children (0-21)><Client satisfaction><Cognition Therapy><Cognitive><Cognitive Psychotherapy><Cognitive Therapy><Cognitive treatment><Consent><Control Groups><Coping Skills><Curriculum><Data><Depression screen><Development><Diagnosis><Disparities><Disparity><Education><Educational Curriculum><Educational aspects><Educational process of instructing><Emotional Depression><Equity><Espanol><Evaluation><Feedback><Focus Groups><Funding><Gestation><Goals><Health Insurance><High Risk Woman><History><Impairment><Individual><Infant><Infant Care><Internet><Intervention><Intervention Strategies><Intervention Studies><Interview><Investigators><K-Awards><K-Series Research Career Programs><Low income><Measures><Medical><Mental Depression><Mental Health><Mental Health Services><Mental Hygiene><Mental Hygiene Services><Mental disorders><Mental health disorders><Mentors><Mentorship><Mobile Phones><Mothers><NIH><National Institutes of Health><Outcome Study><Parenting Education><Parturition><Patient Satisfaction><Perinatal><Perinatal Care><Peripartum><Persons><Phase><Physiologic><Physiological><Post-Natal Depression><Post-Partum Depression><Post-partum Women><Postnatal Depression><Postpartum Depression><Postpartum Period><Postpartum Women><Pregnancy><Pregnant Women><Prevalence><Prevention><Preventive><Protocol><Protocols documentation><Psychiatric Disease><Psychiatric Disorder><Psychological Health><Psychology><Puericulture><Questionnaires><R-Series Research Projects><R01 Mechanism><R01 Program><Randomization trial><Randomized><Randomized, Controlled Trials><Recommendation><Recording of previous events><Reporting><Research><Research Career Program><Research Grants><Research Methodology><Research Methods><Research Personnel><Research Project Grants><Research Projects><Researchers><Risk><Risk Factors><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Smart Phone App><Smart Phone Application><Smartphone App><Social support><Spanish><Spanish/English><Symptoms><System><Teaching><Technology><Testing><Text Messaging><Therapeutic Intervention><Time><Training><Transportation><U.S. Preventative Services Task Force><U.S. Preventative Task Force><U.S. Preventive Services Task Force><U.S. Preventive Task Force><US Preventative Services Task Force><US Preventative Task Force><US Preventive Health Services Task Force><US Preventive Services Task Force><US Preventive Task Force><USPSTF><United States><United States National Institutes of Health><United States Preventative Services Task Force><United States Preventative Task Force><United States Preventive Services Task Force><United States Preventive Task Force><Unmarried><Visit><WWW><Woman><acceptability and feasibility><adaptive intervention><aged><antenatal><antepartum><at-risk females><at-risk women><baby care><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><barriers to implementation><base><bases><cell phone based app><child birth><cognitive behavior intervention><cognitive behavior modification><cognitive behavior therapy><cognitive behavioral intervention><cognitive behavioral modification><cognitive behavioral therapy><cognitive behavioral treatment><cognitive development><coping strategy><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><depression><depression screening><depression symptom><depressive><depressive symptoms><design><designing><developmental><diagnosis among females><diagnosis among women><diagnosis in females><diagnosis in women><diagnosis within females><diagnosis within women><digital health><effective intervention><efficacy testing><ethnic diversity><ethnically diverse><expectant mother><expecting mother><experience><falls><feasibility trial><female diagnosis><females at high risk><food insecurity><group intervention><health equity><health insurance plan><high risk><high risk females><histories><iOS app><iOS application><iPhone><iPhone App><iPhone Application><implementation barriers><implementation challenges><improved><improved outcome><infant health care><infant healthcare><innovate><innovation><innovative><innovative technologies><insight><intervention research><intervention therapy><interventional research><interventional strategy><interventional study><interventions research><kids><lesson plans><maternal morbidity><mental health care><mental healthcare><mental illness><mobile phone app><multidisciplinary><newborn care><novel><obstacle to care><obstacle to healthcare><obstetric outcomes><parenting education intervention><parenting education programs><parenting intervention><parenting program><parenting skill training><parenting training><patient centered><patient oriented><patient oriented research><patient oriented study><pediatric><perinatal mental health><pilot trial><post-partum><post-partum health><postpartum health><pregnant mothers><prevent><preventing><primary outcome><programs><prototype><psychiatric illness><psychological disorder><racial diversity><racially diverse><randomisation><randomization><randomized control trial><randomized trial><randomly assigned><recommended screening><recruit><research and methods><response><screening><screening guidelines><screening recommendations><screenings><secondary outcome><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><short message service><smart phone><smartphone><smartphone application><smartphone based app><smartphone based application><social support network><structural determinants><structural factors><technology intervention><technology-based interventions><technology-enabled interventions><technology-focused interventions><telehealth><texting><tool><trial design><usability><web><women at high risk><women of color><women's diagnosis><world wide web><youngster>