{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:32:56Z","timestamp":1791851576548,"version":"4.3.4"},"reference-count":42,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100023296","name":"Hewitt Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100023296","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004926","name":"Canadian Medical Association","doi-asserted-by":"publisher","award":["177935"],"award-info":[{"award-number":["177935"]}],"id":[{"id":"10.13039\/501100004926","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100022764","name":"Rossy Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022764","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["179899"],"award-info":[{"award-number":["179899"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"RBC Centre for Research on Children and Families"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,18]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the effectiveness of a web-based secondary prevention programme for postpartum depression, delivered with or without telephone support, compared with usual care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We first conducted a randomised controlled superiority trial to test whether the web-based Parents and Babies programme (Toi, Moi, B\u00e9b\u00e9; TMB) delivered with motivational telephone support (ie, coaching) was superior to the fully automated programme (ie, self-help). TMB incorporated classic and third-wave cognitive\u2013behavioural therapy components and psychoeducation. Then, we tested whether TMB (both treatment modalities combined) was superior to usual care. The usual care comparison group was drawn from the CONCEPTION prospective pan-Canadian perinatal cohort (N=592).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A remote study based at Sainte-Justine Hospital Centre, Quebec, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Web-based intervention programme participants were women aged \u226514 years at 12\u201325 weeks\u2019 gestation, with subclinical to moderate clinical Edinburgh Postnatal Depression Scale (EPDS) scores: 9\u201316. Exclusion criteria were psychosis and self-reported substance abuse. The usual care comparison group was pregnant women \u226518 years old. All participants were living in Canada at study inception.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was EPDS scores at 3 months post partum, accounting for baseline EPDS scores and depression events defined as EPDS \u226513 at 3 months post partum. The secondary outcomes were EPDS scores at 6 months post partum, depression events (EPDS\u226513) at 6 months post partum, anxiety symptoms (Generalised Anxiety Disorder 7-item Scale, GAD-7) at 3 and 6 months post partum, accounting for baseline scores for the continuous outcomes; as well as the number of completed intervention modules and well-being scores (WHO 5-Item Well-being Index) at 3 months post partum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We randomised 510 participants to TMB self-help (n=255) or TMB with coaching (n=255); 211 and 214 participants, respectively, were included in the complete-case intention-to-treat analyses. At baseline, 91% lived with a partner, 71% were university graduates and 42% self-reported GAD-7\u226510. Randomisation was successful. First, TMB with coaching was not superior to TMB self-help: at 3 months post partum, EPDS scores were TMB self-help (mean 8.0\u00b14.3) vs TMB with coaching (mean 8.6\u00b14.5); effect size was 0.01 (95% CI 0.00 to 0.03; p=0.16). Second, TMB (regardless of intervention arm) was superior to usual care: in adjusted regression models, EPDS scores were 6.2 units lower (per SD, 95%\u2009CI \u22128.2 to \u22124.3) in TMB (both treatment modalities combined) than in usual care; and proportions of depression events were 4.7 units lower (per SD on the logit scale, 95%\u2009CI \u22126.6 to \u22122.7) in TMB (combined) than in usual care. No other group differences were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings suggest that, in women with subclinical to moderate clinical antenatal depressive symptoms, receiving a web-based cognitive\u2013behavioural therapy-based programme in addition to usual care can reduce depression postnatally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05110456\">NCT05110456<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  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