PROJECT SUMMARY/ABSTRACT
An estimated 13% of pregnant individuals in the US experience depression perinatally (in pregnancy and/or up
to 1 year postpartum), making depression one of the largest contributors to maternal morbidity. Perinatal
depression is associated with adverse effects for both the perinatal person and their child. Risk of perinatal
depression is inequitably distributed, disproportionately impacting low-income, racial minority individuals and
those who have had adverse life experiences.
The US Preventive Services Task Force (USPSTF) recently endorsed counseling interventions as moderately
effective at preventing perinatal depression and recommended referral of all at-risk individuals to cognitive
behavioral therapy (CBT) or interpersonal therapy. However, there remain significant barriers to accessing
facility-based interventions for at-risk individuals, including lack of financial resources, time, transportation,
or social support to attend in-person services. These barriers may be especially heightened in those individuals
at highest risk of perinatal depression.
Some access barriers may be overcome by using mobile technology to deliver evidence-based interventions
remotely. We previously developed and pilot-tested a digital group adaptation of the evidence-based CBT
intervention, the Mothers and Babies course. This digital intervention, named IMAGINE, was developed
based on formative input from perinatal individuals and their healthcare providers. IMAGINE is a manualized 10-
to 12-week intervention delivered to groups of 6-10 individuals, using asynchronous, interactive, multimedia
messaging and an optional weekly synchronous group video call. IMAGINE’s strengths include its fidelity to an
evidence-based intervention and inclusion of facilitator guidance and peer support to maximize efficacy.
In this pilot effectiveness trial application, we propose to engage a broad range of stakeholders including perinatal
individuals at risk of perinatal depression as well as service providers, administrators and payers to complete
the following specific aims. In Aim 1 we will use a human-centered design approach to refine IMAGINE and
prepare for its delivery as part of routine perinatal mental health services. We will then conduct a pilot randomized
trial to (Aim 2) obtain preliminary data on IMAGINE’s engagement of CBT mechanistic targets and effectiveness
in preventing perinatal depression, and (Aim 3) obtain preliminary data on implementation outcomes
(acceptability, appropriateness, usability, feasibility) and their drivers.
This proposal addresses an urgent need to improve access to evidence-based interventions to prevent
perinatal depression among those at highest risk. Completion of these aims will generate preliminary data,
study tools, and a participatory group of stakeholder advisers to enable pragmatic evaluation of IMAGINE’s
impact on perinatal mental health in a future R01.