Long-term effects of mHealth consultation services on postpartum depressive symptoms and the mediating role of loneliness: A follow-up study of a randomized controlled trial

Abstract

Background Although the short-term preventive effects of mHealth consultation intervention on postpartum depressive symptoms have been demonstrated, the long-term effects and role of alleviating loneliness on depressive symptoms remain unclear. Methods This follow-up study extended our previous trial, which ended at three months postpartum, by continuing observation to 12 months. Participants in the original trial were randomized to the mHealth group (n = 365) or the usual care group (n = 369). Women in the mHealth group had access to free, unlimited mHealth consultation services with healthcare professionals from enrollment through four months postpartum. The primary outcome of this study was the risk of elevated postpartum depressive symptoms at 12 months post-delivery (Edinburgh Postnatal Depression Scale score of ≥9). The mediation effect of alleviating loneliness on the primary outcome was also evaluated, using the UCLA loneliness scale at three months postpartum. Results A total of 515 women completed the follow-up questionnaires (mHealth group, 253/365; usual care group, 262/369; 70.2% of the original participants). Compared to the usual care group, the mHealth group had a lower risk of elevated postpartum depressive symptoms at 12 months post-delivery (36/253 [14.2%] vs. 55/262 [21.0%], risk ratio: 0.68 [95% confidence interval: 0.46–0.99]). Mediation analysis showed that reducing loneliness at three months postdelivery mediated approximately 20% of the total effect of the intervention on depressive symptoms 12 months post-delivery. Conclusions mHealth consultation services provided during the early perinatal period may help alleviate depressive symptoms at 12 months postpartum.