Technology-Assisted, Entertaining CBT for Perinatal WIC Clients with Depression: Open Pilot Results

Background: Perinatal depression (PND) impacts between 10-15% of Americans during pregnancy and the postpartum period. When untreated, PND is associated with negative outcomes for birthers and their children. Perinatal people living in rural areas are more likely to experience depression, yet less likely to have access to PND treatment, compared to non-rural peers. It is critical to identify and test innovative approaches for increasing access to evidence-supported PND care. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offers a potential setting for identifying people with PND and offering treatment in an engaging, acceptable way. This pilot study examines the impact of a technology-assisted, entertaining, 8-session cognitive behavioral therapy for depression, Moms & Babies Feeling Better Together (MBFBT), among perinatal clients in one rural Michigan WIC clinic.

Methods: A one-group pre-/post- test design was used to assess participants’ change in depressive symptoms, anxiety, and parenting self-efficacy over time in MBFBT. Perinatal clients screening positive for depression during WIC appointments between March 2021 and September 2022 were given information about MBFBT and the pilot study, in addition to standard resource and referral options. Interested WIC clients provided informed consent, completed a baseline assessment, and were given access to the 8-session, technology-assisted MBFBT program. Research associates conducted brief (5-10 min.), weekly check-ins with participants during treatment to answer questions and provide homework support. Post-treatment and follow-up assessments were conducted immediately after treatment and three months later. Descriptive statistics, t-tests, and repeated measures analysis of variance (ANOVA) were used to assess outcomes.

Results: Twenty-four participants completed a baseline assessment; 19 started the MBFBT program (79.2%). On average, participants completed 5.79 (SD=3.03) of 8 sessions. Twelve participants completed all 8 sessions (63.2%).There was a statistically and clinically significant decrease in participants’ depressive symptoms between baseline and post-treatment assessments, as measured by the Edinburgh Postnatal Depression Scale (EPDS; BLM=14.8, SD=4.62; PTM=8.17, SD=5.86; t(11)=3.66; p=.004) and the Patient Health Questionnaire-9 (PHQ-9; BLM=13.2, SD=5.84; PTM=5.83, SD=5.44; t(11)=4.08; p=.002). Similar patterns were observed for anxiety measured by the Generalized Anxiety Scale-7 (GAD-7). Participants’ parenting self-efficacy, assessed via the Parenting Sense of Competence Scale (PCOS), significantly increased over time in MBFBT (t(11)=-2.70; p=.021). Repeated measures ANOVA demonstrated statistically significant patterns of difference in expected directions across baseline, post-treatment, and follow-up time points on EPDS (F(2)=12.9; p<.001), PHQ-9 (F(2)=12.7; p<.001), GAD-7 (F(2)=5.16; p=.017), and PCOS (F(2)=9.61; p=.017) scores.

Conclusion: Rural WIC clinics are promising settings for increasing treatment access among perinatal people with PND. Results suggest preliminary support for MBFBT as a treatment model that could be implemented in rural WIC clinics given the significant impact on participants’ symptoms as well as high levels of treatment engagement. Research in more sites and with larger samples is needed.