The Reproductive Mental health of Ontario Virtual Intervention Network (MOVIN): a pilot randomized controlled trial

Abstract

Background: The Reproductive Mental health of Ontario Virtual Intervention Network (MOVIN) aims to improve perinatal depression care across a large Canadian health jurisdiction. It involves a web-based platform, care coordinator for personalized treatment planning, and psychiatrist to liaise with primary care clinicians, and provide direct consultation as needed. This was a pilot randomized controlled trial (RCT) of MOVIN. Methods: Participants aged ≥18 years, pregnant or within 12 months postpartum and with Edinburgh Postnatal Depression Scale (EPDS) score >12 recruited from across Ontario, Canada, were randomized 1:1 to MOVIN for 24 weeks or a control condition. The primary outcome was feasibility, inclusive of recruitment, acceptability, and research protocol follow-up. Depression symptom remission was a main secondary outcome for the pilot trial. EPDS scores and remission (EPDS ≤ 12) were compared between groups. Results: Of 101 participants (n = 48 MOVIN; n = 53 control), 80% completed 24-week follow-up. Participant views of MOVIN were very positive (high acceptability) and multiple opportunities for protocol adjustment in a larger future study were identified. At 24 weeks post-randomization, EPDS scores were lower in MOVIN vs. controls, with a mean difference adjusted for baseline score of −2.32 (95% Confidence Interval, CI −4.23 to −0.42). At the same time point, 75.0% of the MOVIN group vs. 51.1% of controls were in remission (chi-square=4.83, p = 0.03). Conclusions: With high feasibility, including in recruitment, acceptability, and research protocol adherence, and preliminary suggestion of efficacy, the results of this study support proceeding to a large-scale RCT of MOVIN to definitively evaluate its efficacy at a larger scale.