{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:35:03Z","timestamp":1760236503967,"version":"build-2065373602"},"reference-count":61,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2021,11,27]],"date-time":"2021-11-27T00:00:00Z","timestamp":1637971200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Depression is the most common psychological disorder during the perinatal period, and its negative effects extend to mothers, babies, their family and society. Scientific evidence points to the urgency of designing preventive interventions and concludes that the gestational period is the most appropriate time to implement these interventions. However, many pregnant women do not seek professional help due to a lack of knowledge about the importance of mental health, its impact, and the available intervention options, as well as a lack of time and financial resources. E-health interventions can be an efficient, cost-effective, and accessible resource for preventing postpartum depression that can circumvent the barriers that pregnant women face. This randomized clinical trial will examine the efficacy of Healthy Moms and Babies, an app aimed at preventing postpartum depressive symptomatology. The second objective of this study is to analyze the effectiveness of the tool in preventing anxious symptomatology. The primary outcome measure is the difference in the mean score between the intervention and control groups on the Patient Health Questionnaire-9 (PHQ-9) at the end of the intervention and at 3 and 6 months postpartum. The secondary outcome will be determined by using the Generalized Anxiety Disorder Screener (GAD-7) at the same time points. The research findings can be used to determine pregnant women\u2019s use of the e-health application for the prevention of postpartum depression, whether the Healthy Moms and Babies intervention app is an effective and useful resource, and what modifications will need to be made to the tool in future updates.<\/jats:p>","DOI":"10.3390\/ijerph182312485","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T04:48:37Z","timestamp":1638247717000},"page":"12485","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Healthy Moms and Babies Preventive Psychological Intervention Application: A Study Protocol"],"prefix":"10.3390","volume":"18","author":[{"given":"Natalia","family":"Ruiz-Segovia","sequence":"first","affiliation":[{"name":"Department of Psychology, Universidad Nacional de Educaci\u00f3n a Distancia (UNED), 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Fe","family":"Rodriguez-Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Department of Psychology, Universidad Nacional de Educaci\u00f3n a Distancia (UNED), 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Eugenia","family":"Olivares","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Instituto de Salud de la Mujer Jos\u00e9 Botella Llusi\u00e1, Hospital Cl\u00ednico San Carlos, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nuria","family":"Izquierdo","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Instituto de Salud de la Mujer Jos\u00e9 Botella Llusi\u00e1, Hospital Cl\u00ednico San Carlos, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0357-2015","authenticated-orcid":false,"given":"Pluvio","family":"Coronado","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Instituto de Salud de la Mujer Jos\u00e9 Botella Llusi\u00e1, Hospital Cl\u00ednico San Carlos, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huynh-Nhu","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Psychology, George Washington University, Washington, DC 20052, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1097\/01.AOG.0000183597.31630.db","article-title":"Perinatal depression: A systematic review of prevalence and incidence","volume":"106","author":"Gavin","year":"2015","journal-title":"Obstet. Gynecol."},{"key":"ref_2","first-page":"1","article-title":"PHQ-2 como primer instrumento de cribado de la depresi\u00f3n prenatal","volume":"91","year":"2017","journal-title":"Rev. Esp. Salud. P\u00fablica"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1038\/d41586-019-03226-8","article-title":"Prevent depression in pregnancy to boost all mental health","volume":"574","year":"2019","journal-title":"Nature"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.jad.2020.05.112","article-title":"Emerging issues and questions on peripartum depression prevention, diagnosis and treatment: A consensus report from the cost action riseup-PPD","volume":"274","author":"Fonseca","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"260","DOI":"10.3934\/publichealth.2018.3.260","article-title":"Review of the prevalence of postnatal depression across cultures","volume":"5","author":"Roshaidai","year":"2018","journal-title":"AIMS Public Health"},{"key":"ref_6","unstructured":"Pereira, P.K., Marcos, G., Abelha, L., Fortes, L., Ferdandes de Cintra Santos, J., Agadir, S., Lima, D., and Valencia, E. (2020, June 15). Depression during Pregnancy: Review of Epidemiological and Clinical Aspects in Developed and Developing Countries [Internet]. Available online: https:\/\/www.intechopen.com\/books\/psychiatric-disorders-trends-and-developments\/depression-during-pregnancy-review-of-epidemiological-and-clinical-aspects-in-developed-and-developi."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.ejogrb.2017.06.009","article-title":"Feasibility of screening and prevalence of prenatal depression in an obstetric setting in Spain","volume":"215","year":"2017","journal-title":"Eur. J. Obstet. Gynecol. Reprod Biol."},{"key":"ref_8","first-page":"564","article-title":"The prevalence and risk factors for antenatal depression among pregnant immigrant and native women in Spain","volume":"31","year":"2019","journal-title":"J. Transcult. Nurs."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1192\/bjp.bp.107.045427","article-title":"Mood changes after delivery: Role of the serotonin transporter gene","volume":"193","author":"Sanjuan","year":"2008","journal-title":"Br. J. Psychiatry"},{"key":"ref_10","unstructured":"Ministerio de Sanidad y Pol\u00edticas Sociales (2010). Sistema Nacional de Salud, Ministerio de Sanidad y Pol\u00edticas Sociales."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.jad.2016.03.010","article-title":"Prevalence and risk factors for comorbid postpartum depressive symptomatology and anxiety","volume":"198","author":"Shiri","year":"2016","journal-title":"J. Affect. Disord"},{"key":"ref_12","first-page":"257","article-title":"Incidence, prevalence, and risk factors related to anxiety symptoms during pregnancy","volume":"30","year":"2018","journal-title":"Psicothema"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.eurpsy.2004.09.025","article-title":"Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: A prospective survey of the MATQUID cohort","volume":"19","author":"Verdoux","year":"2004","journal-title":"Eur. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.infbeh.2010.09.008","article-title":"Prenatal depression effectcs on early development: A review","volume":"34","author":"Field","year":"2011","journal-title":"Infant. Behav. Dev."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"\u015aliwerski, A., Kossakowska, K., Jarecka, K., \u015awitalska, J., and Bielawska-Batorowicz, E. (2020). The effect of maternal depression on infant attachment: A systematic review. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17082675"},{"key":"ref_16","first-page":"1745506519844044","article-title":"Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes","volume":"15","author":"Slomian","year":"2019","journal-title":"Women Health"},{"key":"ref_17","unstructured":"Fonagy, P., Target, M., Cottrell, D., Phillips, J., and Kurtz, Z. (2002). What Works for Whom? A Critical Review of Treatments for Children and Adolescents, Guilford."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.4088\/JCP.15r10174","article-title":"The Perinatal Depression Treatment Cascade: Baby Steps toward Improving Outcomes","volume":"77","author":"Cox","year":"2016","journal-title":"J. Clin. Psychiatry."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"US Preventive Services Task Force (2019). Interventions to Prevent Perinatal Depression. US Preventive ServicesTask Force Recommendation Statement. J. Am. Med. Assoc., 321, 580\u2013587.","DOI":"10.1001\/jama.2019.0007"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/s00787-014-0660-6","article-title":"The effects of psychological treatment of maternal depression on children and parental functioning: A meta-analysis","volume":"24","author":"Cuijpers","year":"2015","journal-title":"Eur. Child. Adolesc. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e022022","DOI":"10.1136\/bmjopen-2018-022022","article-title":"Cost-effectiveness of interventions for perinatal anxiety and\/or depression: A systematic review","volume":"8","author":"Camacho","year":"2018","journal-title":"BMJ Open"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"888","DOI":"10.2105\/AJPH.2020.305619","article-title":"Financial Toll of Untreated Perinatal Mood and Anxiety Disorders Among 2017 Births in the United States","volume":"110","author":"Luca","year":"2020","journal-title":"Am. J. Public Health"},{"key":"ref_23","unstructured":"Centre of Perinatal Excelence (2021, July 15). Mental Health the Consequences of Not Treating Perinatal Depression and Anxiety 2014. Available online: https:\/\/cope.org.au\/wp-content\/uploads\/2013\/12\/PWC-2013_Final3.pdf."},{"key":"ref_24","unstructured":"Rodriguez-Mu\u00f1oz, M.F., Huynh-Nhu, L., Lara Cant\u00fa, M.A., and Jaffe, A. (2019). Depresi\u00f3n Perinatal. En Rodr\u00edguez-Mu\u00f1oz Coord, Psicolog\u00eda Perinatal: Teor\u00eda y Pr\u00e1ctica, Pir\u00e1mide."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/03630242.2017.1421286","article-title":"Factors associated with attitudes toward seeking mental health treatment postpartum","volume":"59","author":"Bina","year":"2018","journal-title":"Women Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1080\/07399330802089172","article-title":"Acceptance and experience of treatment for postnatal depression in a community mental health setting","volume":"29","author":"McCarthy","year":"2008","journal-title":"Health Care Women Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1111\/j.1523-536X.2008.00296.x","article-title":"Women\u2019s attitudes, preferences, and perceived barriers to treatment for perinatal depression","volume":"36","author":"Goodman","year":"2009","journal-title":"Birth"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1111\/j.1523-536X.2006.00130.x","article-title":"Postpartum depression help-seeking barriers and maternal treatment preferences: A qualitative systematic review","volume":"33","author":"Dennis","year":"2006","journal-title":"Birth"},{"key":"ref_29","unstructured":"Barrera, A.Z., Rosales, M., Ruiz-Segovia, N., and Rodr\u00edguez-Mu\u00f1oz, M.F. (2019). Sistemas e-Health en el Periodo Perinatal. En Rodr\u00edguez-Mu\u00f1oz Coord., Psicolog\u00eda Perinatal: Teor\u00eda y Pr\u00e1ctica, Pir\u00e1mide."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Lee, E.W., Denison, F.C., Kahyee, H., and Reynolds, R.M. (2016). Web-based interventions for prevention and treatment of perinatal mood disorders: A systematic review. BMC Pregnancy Childbirth, 16.","DOI":"10.1186\/s12884-016-0831-1"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.jad.2016.02.057","article-title":"Computer- or web-based interventions for perinatal mental health: A systematic review","volume":"197","author":"Ashford","year":"2016","journal-title":"J. Affect. Disord"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e2876","DOI":"10.2196\/jmir.2876","article-title":"MomMoodBooster Web-Based Intervention for Postpartum Depression: Feasibility Trial Results","volume":"15","author":"Danaher","year":"2013","journal-title":"J. Med. Internet Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.cbpra.2018.02.002","article-title":"Be a Mom: Formative evaluation of a Web-Based Psychological Intervention to Prevent Postpartum Depression","volume":"25","author":"Fonseca","year":"2018","journal-title":"Cogn. Behav. Pract."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"265","DOI":"10.3389\/fpsyg.2019.00265","article-title":"Be a Mom, a Web-Based Intervention to prevent postpartum depression: The enhancement of self-regulatory skills and its association with postpartum, depressive symptoms","volume":"10","author":"Fonseca","year":"2019","journal-title":"Front. Psychol."},{"key":"ref_35","first-page":"257","article-title":"Online prevention of postpartum depression for Spanish- and English-speaking pregnant women: A pilot randomized controlled trial","volume":"2","author":"Barrera","year":"2015","journal-title":"Int. Interv."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e10778","DOI":"10.2196\/10778","article-title":"A Group-Based Online Intervention to Prevent Postpartum Depression (Sunnyside): Feasibility Randomized Controlled Trial","volume":"6","author":"Duffecy","year":"2019","journal-title":"JMIR Ment. Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1089\/cyber.2015.0549","article-title":"Are pregnant and postpartum women interested in health-related apps? Implications for the prevention of perinatal depression","volume":"19","author":"Osma","year":"2016","journal-title":"Cyberpsychol. Behav. Soc. Netw."},{"key":"ref_38","first-page":"313","article-title":"The use of digital media by women using the maternity services in a developed country","volume":"107","author":"Murphy","year":"2014","journal-title":"Ir. Med. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.wombi.2016.01.008","article-title":"An Australian survey of women\u2019s use of pregnancy and parenting apps","volume":"29","author":"Lupton","year":"2016","journal-title":"Women Birth"},{"key":"ref_40","unstructured":"Uni\u00f3n Internacional de Telecomunicaciones (2015). Tendencias en las Reformas de Telecomunicaciones 2015, Uni\u00f3n Internacional de telecomunicaciones."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1080\/13698575.2015.1127333","article-title":"Threats and thrills: Pregnancy apps, risk, and consumption","volume":"17","author":"Thomas","year":"2015","journal-title":"Health Risk Soc."},{"key":"ref_42","first-page":"475","article-title":"About the effectiveness of telehealth procedures in psychological treatment","volume":"12","year":"2012","journal-title":"Int. J. Clin. Health Psychol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1016\/j.jad.2013.03.005","article-title":"Internet-based behavioral activation treatment for postnatal depression Netmums : A randomized controlled trial","volume":"150","author":"Woodford","year":"2013","journal-title":"J. Affect. Disord."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1002\/wps.20673","article-title":"The efficacy of app-supported smartphone interventions for mental health problems: A meta-analysis of randomized controlled trials","volume":"18","author":"Linardon","year":"2019","journal-title":"World Psychiatry"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1016\/j.pec.2015.11.006","article-title":"Mobile application as a prenatal education and engagement tool: A randomized controlled pilot","volume":"99","author":"Ledford","year":"2016","journal-title":"Patient Educ. Couns"},{"key":"ref_46","unstructured":"INE (2021, May 15). Anuario de Estad\u00edstica 2019. Available online: https:\/\/www.ine.es\/prodyser\/pubweb\/anuario19\/anu19_completo.pdf."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_48","unstructured":"Pfizer (2021, June 15). Patient Health Questionnaire PHQ-9 2007. Available online: http:\/\/www.phqscreeners.com\/."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3928\/0048-5713-20020901-06","article-title":"The PHQ-9: A new depression diagnostic and severity measure","volume":"32","author":"Kroenke","year":"2002","journal-title":"Psychiatr. Ann."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.midw.2018.03.011","article-title":"The structure of the Patient Health Questionnaire-9 in pregnant women in Spain","volume":"62","year":"2018","journal-title":"Midwifery"},{"key":"ref_51","doi-asserted-by":"crossref","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","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_52","first-page":"164","article-title":"Validation of the Generalized Anxiety Disorder Screener (GAD-7) in Spanish Pregnant Women","volume":"33","author":"Le","year":"2021","journal-title":"Psicothema"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.cbpra.2006.04.021","article-title":"Prevention of postpartum depression in Low-Income Women development of the Mam\u00e1s y Beb\u00e9s\/Mothers and Babies Course","volume":"14","author":"Diaz","year":"2007","journal-title":"Cogn. Behav. Pract."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.jad.2021.05.010","article-title":"Effectiveness of psychological interventions in the treatment of perinatal depression: A systematic review of systematic reviews and meta-analyses","volume":"291","author":"Branquinho","year":"2021","journal-title":"J. Affect. Disord."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Huang, L., Zhao, Y., Qiang, C., and Fan, B. (2018). Is cognitive behavioral therapy a better choice for women with postnatal depression? A systematic review and meta-analysis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0205243"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta20370","article-title":"A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety, and acceptability of interventions to prevent postnatal depression","volume":"20. 20","author":"Morrell","year":"2016","journal-title":"Health Technol. Assess"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1053\/apnu.2003.1","article-title":"Shortages of rural mental health professionals","volume":"17","author":"Merwin","year":"2003","journal-title":"Arch. Psychiatr. Nurs."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1111\/j.1748-0361.2002.tb00922.x","article-title":"Depression treatment in rural California: Preliminary survey of nonpsychiatric physicians","volume":"18","author":"Ng","year":"2002","journal-title":"J. Rural. Health"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.2196\/resprot.2329","article-title":"Web-Based Intervention for Postpartum Depression: Formative Research and Design of the MomMoodBooster Program","volume":"1","author":"Danaher","year":"2012","journal-title":"JMIR Res. Protoc."},{"key":"ref_60","first-page":"37","article-title":"Digital tools for prevention and treatment of depression: Lessons from the institute for international internet interventions for health","volume":"32","author":"Pineda","year":"2021","journal-title":"Clin. Salud."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e009967","DOI":"10.1136\/bmjopen-2015-009967","article-title":"Usage, adherence and attrition: How new mothers engage with nurse-moderated web-based intervention to support maternal and infantl health. 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