{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:45:43Z","timestamp":1785545143754,"version":"3.56.0"},"reference-count":22,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n There is increasing interest in the development of scalable digital mental health interventions for perinatal populations to increase accessibility. Mobile behavioral activation (BA) is efficacious for the treatment of perinatal depression; however, the effect of comorbid anxiety and depression (CAD) on symptom trajectories remains underexplored. This is important given that at least 10% of women in the perinatal period experience CAD.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n We assessed whether there were differences in symptom trajectories in pregnant participants with CAD as compared to those with depression only (ie, major depressive disorder [MDD]) during intervention with a BA mobile gaming app.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Pregnant adults with either CAD (n=10) or MDD (n=7) used a BA app for 10 weeks and completed biweekly symptom severity questionnaires for depression and anxiety. We assessed whether baseline diagnoses were associated with differential symptom trajectories across the study with mixed effects longitudinal models.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n When controlling for baseline symptoms, results revealed a significant interaction between baseline diagnosis and the quadratic component of study week on anxiety (\u03b2=.18, SE 0.07;\n t<\/jats:italic>\n 62<\/jats:sub>\n =2.61;\n P<\/jats:italic>\n =.01), revealing a tendency for anxiety in the CAD group to increase initially and then decrease at an accelerated rate, whereas MDD symptoms were relatively stable across time. There was a significant effect of linear time on depression (\u03b2=\u2212.39, SE 0.11;\n t<\/jats:italic>\n 68<\/jats:sub>\n =\u22123.51;\n P<\/jats:italic>\n =.001), showing that depression declined steadily across time for both groups. There was a significant effect of baseline diagnosis on depression (\u03b2=\u22128.53, SE 3.93;\n t<\/jats:italic>\n 13<\/jats:sub>\n =\u22122.17;\n P<\/jats:italic>\n =.05), suggesting that those with MDD had higher follow-up depression compared to those with CAD when holding other predictors constant.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The app was beneficial in reducing depression symptoms in perinatal individuals with different comorbidity profiles. With respect to anxiety symptom trajectories, however, there was more variability. The app may be especially effective for the treatment of anxiety symptoms among individuals with CAD, as it encourages in-the-moment ecologically relevant exposure to anxiety-provoking stimuli. Despite no significant group difference in baseline anxiety symptoms, the MDD group did not have a significant reduction in their anxiety symptoms across the study period, and some individuals had an increase in anxiety. Findings may point to opportunities for the augmentation of BA gaming apps for those with MDD to more effectively target anxiety symptoms. Overall, findings suggest there may be value in considering comorbidities and individual variations in participants when developing scalable mobile interventions for perinatal populations.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/59154","type":"journal-article","created":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T03:32:59Z","timestamp":1730777579000},"page":"e59154-e59154","source":"Crossref","is-referenced-by-count":2,"title":["Considering Comorbidities and Individual Differences in Testing a Gaming Behavioral Activation App for Perinatal Depression and Anxiety: Open Trial Pilot Intervention Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3764-2966","authenticated-orcid":false,"given":"Gabriella E","family":"Hamlett","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3822-4221","authenticated-orcid":false,"given":"Chloe","family":"Schrader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0053-024X","authenticated-orcid":false,"given":"Craig","family":"Ferguson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0035-0516","authenticated-orcid":false,"given":"Lauren A","family":"Kobylski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5661-0022","authenticated-orcid":false,"given":"Rosalind","family":"Picard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3439-1209","authenticated-orcid":false,"given":"Joseph J","family":"Locascio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5228-8777","authenticated-orcid":false,"given":"Richard J","family":"McNally","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6201-8150","authenticated-orcid":false,"given":"Lee S","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6997-7894","authenticated-orcid":false,"given":"Rachel","family":"Vanderkruik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,1,14]]},"reference":[{"issue":"5","key":"R1","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1192\/bjp.bp.116.187179","article-title":"Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis","volume":"210","author":"Dennis","journal-title":"Br J Psychiatry"},{"issue":"12","key":"R2","doi-asserted-by":"publisher","first-page":"2041","DOI":"10.1017\/S0033291717000617","article-title":"The prevalence of antenatal and postnatal co-morbid anxiety and depression: a meta-analysis","volume":"47","author":"Falah-Hassani","journal-title":"Psychol Med"},{"issue":"3","key":"R3","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1089\/jwh.2008.1352","article-title":"Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers","volume":"19","author":"Goodman","journal-title":"J Womens Health (Larchmt)"},{"issue":"3","key":"R4","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1080\/16506073.2023.2166578","article-title":"Psychological treatment of depression with other comorbid mental disorders: systematic review and meta-analysis","volume":"52","author":"Cuijpers","journal-title":"Cogn Behav Ther"},{"issue":"Suppl 1","key":"R5","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s40120-023-00469-6","article-title":"Anxiety symptoms in patients with major depressive disorder: commentary on prevalence and clinical implications","volume":"12","author":"Hopwood","journal-title":"Neurol Ther"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1037\/ccp0000151","article-title":"A pragmatic randomized clinical trial of behavioral activation for depressed pregnant women","volume":"85","author":"Dimidjian","journal-title":"J Consult Clin Psychol"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2024.102916","article-title":"Scaling up psychological interventions into the daily lives of patients with anxiety and related disorders","volume":"106","author":"Ebrahimi","journal-title":"J Anxiety Disord"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1007\/s10900-020-00852-6","article-title":"Routine healthcare utilization among reproductive-age women residing in a rural maternity care desert","volume":"46","author":"DiPietro Mager","journal-title":"J Community Health"},{"issue":"6","key":"R9","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1111\/jmwh.12669","article-title":"Women\u2019s experiences of seeking and receiving psychological and psychosocial interventions for postpartum depression: a systematic review and thematic synthesis of the qualitative literature","volume":"62","author":"Hadfield","journal-title":"J Midwife Womens Health"},{"issue":"4","key":"R10","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1007\/s00737-023-01327-y","article-title":"Effectiveness of digital psychological interventions in reducing perinatal depression: a systematic review of meta-analyses","volume":"26","author":"Chen","journal-title":"Arch Womens Ment Health"},{"issue":"2","key":"R11","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1007\/s10995-020-03028-9","article-title":"A systematic review of technology-based prevention and treatment interventions for perinatal depression and anxiety in Latina and African American women","volume":"25","author":"Lara-Cinisomo","journal-title":"Matern Child Health J"},{"issue":"1","key":"R12","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.ajog.2023.06.028","article-title":"The effect of digital health interventions on postpartum depression or anxiety: a systematic review and meta-analysis of randomized controlled trials","volume":"230","author":"Lewkowitz","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"R13","doi-asserted-by":"publisher","DOI":"10.2196\/56319","article-title":"Developing a guided web app for postpartum depression symptoms: user-centered design approach","volume":"8","author":"Franco","journal-title":"JMIR Form Res"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.2196\/44029","article-title":"Testing a behavioral activation gaming app for depression during pregnancy: multimethod pilot study","volume":"8","author":"Vanderkruik","journal-title":"JMIR Form Res"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.2196\/40937","article-title":"Digital behavioral activation interventions during the perinatal period: scoping review","volume":"6","author":"Mancinelli","journal-title":"JMIR Pediatr Parent"},{"key":"R16","unstructured":"Women's mental health across the life cycle. Massachusetts General Hospital Center for Women\u2019s Mental Health. URL: https:\/\/womensmentalhealth.org\/ [Accessed 01-10-2024]"},{"issue":"5","key":"R17","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1016\/S0924-9338(97)83296-8","article-title":"The MINI International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI","volume":"12","author":"Lecrubier","journal-title":"Eur psychiatr"},{"issue":"10","key":"R18","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","journal-title":"Arch Intern Med"},{"issue":"12","key":"R19","doi-asserted-by":"publisher","first-page":"1194","DOI":"10.1097\/00005650-200412000-00006","article-title":"Monitoring depression treatment outcomes with the patient health questionnaire-9","volume":"42","author":"L\u00f6we","journal-title":"Med Care"},{"issue":"9","key":"R20","doi-asserted-by":"publisher","first-page":"1491","DOI":"10.1017\/S0033291720000239","article-title":"Looking beyond depression: a meta-analysis of the effect of behavioral activation on depression, anxiety, and activation","volume":"51","author":"Stein","journal-title":"Psychol Med"},{"key":"R21","doi-asserted-by":"crossref","unstructured":"Hamlett GE Foa EB Brown LA . Exposure therapy and its mechanisms. In: Milad MR Norrholm SD , editors. Fear Extinction: From Basic Neuroscience to Clinical Implications. Springer International Publishing; 2023:273-288. [doi: 10.1007\/78542023428]","DOI":"10.1007\/7854_2023_428"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.2196\/49809","article-title":"Behavioral activation-based digital smoking cessation intervention for individuals with depressive symptoms: randomized clinical trial","volume":"25","author":"Dahne","journal-title":"J Med Internet Res"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e59154","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:32:37Z","timestamp":1785537157000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e59154"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,14]]},"references-count":22,"URL":"https:\/\/doi.org\/10.2196\/59154","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,14]]},"article-number":"v9i5e59154"}}