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2014 Emerging Knowledge Podium Presentation Abstract| Volume 28, ISSUE 6, e49, November 2014

Text Messaging as an Adjunct Treatment for Urban Mothers with Postpartum Depression

      Purpose

      To evaluate the feasibility of receiving scheduled text messages from pediatric providers as an adjunct treatment for postpartum depression (PPD) in urban mothers identified in a high-volume, academic, primary care clinic.

      Background

      Rates of perinatal depression among postpartum women range from 5-25%; however among low-income mothers and parenting teens, rates may approach 40-60% (Earls, 2010). For pediatric health care providers, it is important to take a holistic approach in caring for patients and families (Connelly, et al, 2007). Studies have found that low-income mothers are more likely to experience PPD, but are less likely than those of higher income, to seek treatment (Abrams, 2009). Mobile-phone-based text messaging is a widely available and relatively inexpensive tool that can be used for health behavior change (Cole-Lewis and Kershaw, 2010). Texting has the benefit of reaching all mobile phones, regardless of model or service provider (Aguilera, 2011), even when barriers are present.

      Research Hypotheses

      When used as an adjunct treatment, text messaging is a feasible option for urban mothers who experience barriers to receiving treatment for postpartum depression.

      Methods

      Prospective study. Inclusion criteria: mothers scoring ≥ 10 on the Edinburgh Postnatal Depression Scale (EPDS) between 1 week to 6 months post-delivery, were English speaking, and lived within St. Louis City. Exclusion criteria: non-English speaking and residence outside of St. Louis City. Thirty mothers received text messages from the research team, either 1, 2, or 4 times per week. Message content varied between routine infant care and basic information on PPD. Additional messages provided support, encouragement, and motivation. Some messages included an option to receive a call back from a team member within 24 hours. Mothers also received cognitive behavioral therapy during the intervention. Descriptive statistics were used for the preliminary analyses.

      Discussion questions

      What is the likelihood and feasibility of using text messages as a form of supportive treatment for mothers with PPD in your practice?

      Results

      In 6 months, 1362 text messages were sent to 30 mothers. Only 6.3% (n=86) of these messages were noted to have message failure. Of messages with ‘Yes/No’ option to request a phone call from the team, 4.6% (n=63) of messages were answered ‘Yes.’ Nearly 75% of all contacts between the research team and enrolled mothers occurred via text message (additional contacts were via phone or appointments). Among all participants, 69% (n=20) had smart phones. Regarding maternal texting use, 31% (n=9) of mothers texted between 0-10 times daily, however 41% (n=12) texted at least ≥51 times daily, and 7% (n=2) reported texting ≥300 times daily.

      Discussion/Conclusion

      Sending mothers informational and motivational text messages is a feasible and viable method of communication and support for use as an adjunct therapy for postpartum depression. Text messaging overcomes common obstacles, namely access to care and transportation, faced by urban mothers in obtaining treatment. Texting is a practical and inexpensive alternative for pediatric providers to communicate with and support families who struggle with postpartum depression.