{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:49:41Z","timestamp":1791960581425,"version":"4.3.4"},"reference-count":52,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Pediatr Parent"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Postpartum psychological distress, ranging from transient mood and anxiety disturbances to full-syndrome postpartum depression, is prevalent. Many postpartum individuals lack access to evidence-based interventions due to stigma and insufficient provider availability. The treatment gap is particularly pronounced among historically marginalized groups, including Black, , and low-income mothers. Digital health interventions offer support to address this.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n We aimed to evaluate the feasibility, acceptability, and preliminary efficacy of Woebot for Postpartum Mood and Anxiety (W-PPMA), a smartphone-based relational agent delivering cognitive behavioral therapy\u2013informed psychoeducation to postpartum individuals.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This randomized controlled trial recruited participants from the PowerMom study, a digital platform for maternal health research. Eligible individuals (\u226516 y, <3 mo post partum) were randomized to W-PPMA or a waitlist control condition. W-PPMA, an investigational digital mental health intervention, features a relational agent delivering cognitive behavioral therapy\u2013based psychoeducation via text-based conversations. Primary outcomes included feasibility (Usage Rating Profile\u2013Intervention Revised, Feasibility Subscale), acceptability (Usage Rating Profile\u2013Intervention Revised, Acceptability Subscale), and satisfaction (Client Satisfaction Questionnaire\u20138) assessed at the 8-week end of intervention (EOI). The secondary outcome was change in depressive symptoms (Patient Health Questionnaire\u20138) among those with elevated baseline symptoms. Exploratory outcomes included anxiety (Generalized Anxiety Disorder\u20137 items), stress (Perceived Stress Scale), perinatal depression (Edinburgh Postnatal Depression Scale), Mother-to-Infant Bonding Scale, and therapeutic alliance (Working Alliance Inventory\u2013Short Revised). This study followed CONSORT (Consolidated Standards of Reporting Trials) guidelines and received Institutional Review Board approval.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 267 participants (W-PPMA=144, waitlist=123), mean age was 32.2 (SD 5.1) years; 12.7% (n=34) identified as , 8.6% (n=23) as Black, and 68.5% (n=183) as White. W-PPMA users engaged with the app a median of 9 (IQR 5\u201024) days across 4 active weeks (IQR 2\u20107). At EOI, W-PPMA participants reported high feasibility (Usage Rating Profile\u2013Intervention Revised, Feasibility Subscale median 31, IQR 28\u201034), acceptability (Usage Rating Profile\u2013Intervention Revised, Acceptability Subscale median 30, IQR 28\u201034), and satisfaction (Client Satisfaction Questionnaire\u20138 median 26, IQR 24\u201029). Among those with baseline depressive symptoms (n=97), Patient Health Questionnaire\u20138 scores improved modestly in the W-PPMA group compared to waitlist (mean change \u22120.7, SD 3.4, vs 0.0, SD 4.8; Cohen\n d<\/jats:italic>\n =\u22120.16). Exploratory analyses showed a statistically significant between-group difference in Perceived Stress Scale change at EOI (mean difference \u22121.59, 95% CI \u22122.4 to \u22120.73) and a nonsignificant between-group difference in Edinburgh Postnatal Depression Scale change (mean difference \u22120.51, 95% CI \u22121.36 to 0.34). Therapeutic alliance (Working Alliance Inventory\u2013Short Revised) was strongest at baseline among Black participants and those from socioeconomically disadvantaged neighborhoods (Area Deprivation Index \u226575). Participants with a high school or General Educational Development reported the highest satisfaction scores, underscoring accessibility across educational backgrounds.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n W-PPMA met primary study aims. Preliminary evidence and these findings support W-PPMA, warranting further evaluation in larger trials.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/74083","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T18:30:08Z","timestamp":1775586608000},"page":"e74083-e74083","source":"Crossref","is-referenced-by-count":1,"title":["Woebot for Postpartum Mood and Anxiety: Randomized Controlled Trial Evaluating Feasibility, Acceptability, and Preliminary Efficacy of a Mobile Cognitive Behavioral Therapy Intervention"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5739-4918","authenticated-orcid":false,"given":"Toluwalase","family":"Ajayi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6690-1552","authenticated-orcid":false,"given":"Jacqueline","family":"Kueper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4772-9635","authenticated-orcid":false,"given":"Jill","family":"Waalen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6005-8824","authenticated-orcid":false,"given":"Lauren","family":"Ariniello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1675-7094","authenticated-orcid":false,"given":"Edward","family":"Ramos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5540-2264","authenticated-orcid":false,"given":"Giulia","family":"Milan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9156-7111","authenticated-orcid":false,"given":"Katie","family":"Baca-Motes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6782-4165","authenticated-orcid":false,"given":"Andre","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7368-2618","authenticated-orcid":false,"given":"Lauren","family":"Bullard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1393-1563","authenticated-orcid":false,"given":"Athena","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"issue":"5","key":"R1","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1177\/1524838015584369","article-title":"Childhood maltreatment and perinatal mood and anxiety disorders: a systematic review","volume":"17","author":"Choi","journal-title":"Trauma Violence Abuse"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1007\/s00737-003-0004-x","article-title":"Mood disturbance in the early puerperium: a review","volume":"6 Suppl 2","author":"Henshaw","journal-title":"Arch Womens Ment Health"},{"issue":"9956","key":"R3","doi-asserted-by":"publisher","first-page":"1775","DOI":"10.1016\/S0140-6736(14)61276-9","article-title":"Non-psychotic mental disorders in the perinatal period","volume":"384","author":"Howard","journal-title":"Lancet"},{"key":"R4","unstructured":"Symptoms of depression among women. 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