Moms & Babies Feeling Better Together: Outcomes of a Technology-Assisted,Entertaining,CBT-Based Depression Treatment for Low-Income Perinatal People Served by a Rural Michigan WIC Clinic

Abstract

Rural Americans experience higher rates of perinatal depression (PND) than urban peers yet are less likely to receive treatment. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a potential setting for offering PND treatment. This pilot study examines the impact of Moms & Babies Feeling Better Together (MBFBT), a technology-assisted depression treatment, on perinatal WIC clients’ depressive symptoms, anxiety, and parenting self-efficacy. A one-group pre-/post-test design assessed changes in outcomes over time. Paired-samples t-test results show statistically significant decreases in depression and anxiety and increases in parenting self-efficacy between baseline and post-treatment. Repeated measures analysis of variance demonstrates significant patterns of difference in expected directions across three timepoints for each outcome. Findings provide preliminary support for MBFBT’s effectiveness and its promise for delivery within rural WIC settings.

Keywords

perinatal depression (PND)technology-assisted cognitive behavioral therapy (T-CBT)rural mental health WIC mental health intervention research

Get full access to this article

View all access options for this article.

References

Andrews

Basu

Cuijpers

Craske

M. G.

McEvoy

English

C. L.

Newby

J. M.

(2018). Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. Journal of Anxiety Disorders, 55, 70–78.

Anvari

M. S.

Hampton

Tong

M. P.

Kahn

Triemstra

J. D.

Magidson

J. F.

Felton

J. W.

(2023). Behavioral activation disseminated by non-mental health professionals, paraprofessionals, and peers: A systematic review. Behavior Therapy, 54(3), 524–538.

Balbierz

Bodnar-Deren

Wang

J. J.

Howell

E. A.

(2015). Maternal depressive symptoms and parenting practices 3-months postpartum. Maternal and Child Health Journal, 19, 1212–1219.

Barrera

Jr Castro

F. G.

Strycker

L. A.

Toobert

D. J.

(2013). Cultural adaptations of behavioral health interventions: A progress report. Journal of Consulting and Clinical Psychology, 81, 196.

Bates

R. A.

Salsberry

P. J.

Justice

L. M.

Dynia

J. M.

Logan

J. A.

Gugiu

M. R.

Purtell

K. M.

(2020). Relations of maternal depression and parenting self-efficacy to the self-regulation of infants in low-income homes. Journal of Child and Family Studies, 29, 2330–2341.

Beck

A. T.

Rush

A. J.

Shaw

B. F.

Emery

(1987). Cognitive therapy of depression. Guildford Press.

Brand

S. R.

Brennan

P. A.

(2009). Impact of antenatal and postpartum maternal mental illness: How are the children? Clinical Obstetrics and Gynecology, 52, 441–455.

Cheesmond

N. E.

Davies

Inder

K. J.

(2019). Exploring the role of rurality and rural identity in mental health help-seeking behavior: A systematic qualitative review. Journal of Rural Mental Health, 43, 45.

Cooper

Hedges

L. V.

Valentine

J. C.

(Eds.) (2019). The handbook of research synthesis and meta-analysis. Russell Sage Foundation.

10.

Cox

Holden

(2003). Perinatal mental health: A guide to the Edinburgh postnatal depression scale (EPDS). Royal College of Psychiatrists.

11.

Crumb

Mingo

T. M.

Crowe

(2019). “Get over it and move on”: The impact of mental illness stigma in rural, low-income United States populations. Mental Health & Prevention, 13, 143–148.

12.

Dobson

K. S

. (2009). Evidence-based practice of cognitive-behavioral therapy. Guilford Press.

13.

Ellis

A. R.

Konrad

T. R.

Thomas

K. C.

Morrissey

J. P.

(2009). County-level estimates of mental health professional supply in the United States. Psychiatric Services, 60, 1315–1322.

14.

Etzelmueller

Vis

Karyotaki

Baumeister

Titov

Berking

Ebert

D. D.

(2020). Effects of internet-based cognitive behavioral therapy in routine care for adults in treatment for depression and anxiety: Systematic review and meta-analysis. Journal of Medical Internet Research, 22, Article e18100.

15.

Field

(2017). Postpartum depression effects, risk factors and interventions: A review. Clinical Depression, 3, 2572–0791.

16.

Giron

Noe

Saiki

Kuchler

Rao

(2021). Implementation of postpartum depression screening for women participating in the WIC program. Journal of the American Psychiatric Nurses Association, 27(6), 443–449.

17.

Gjesfjeld

C. D.

Weaver

Schommer

(2015). Qualitative experiences of rural postpartum women and implications for rural social work. Contemporary Rural Social Work Journal, 7, 9.

18.

Goodman

S. H.

Simon

McCarthy

Ziegler

Ceballos

(2022). Testing models of associations between depression and parenting self-efficacy in mothers: A meta-analytic review. Clinical Child and Family Psychology Review, 25(3), 471–499.

19.

Himle

J. A.

Bybee

Steinberger

Laviolette

W. T.

Weaver

Vlnka

O’Donnell

L. A.

(2014). Work-related CBT versus vocational services as usual for unemployed persons with social anxiety disorder: A randomized controlled pilot trial. Behaviour Research and Therapy, 63, 169–176.

20.

Himle

J. A.

Weaver

Zhang

Xiang

(2022). Digital mental health interventions for depression. Cognitive and Behavioral Practice, 2(1), 50–59.

21.

IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. IBM Corp.

22.

Karyotaki

Efthimiou

Miguel

Bermpohl

G. F. M.

Furukawa

T. A.

Cuijpers

Forsell

(2021). Internet-based cognitive behavioral therapy for depression: A systematic review and individual patient data network meta-analysis. JAMA Psychiatry, 78(4), 361–371.

23.

Kessler

R. C.

Sampson

N. A.

Berglund

Gruber

M. J.

Al-Hamzawi

Andrade

… Wilcox

M. A

. (2015). Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys. Epidemiology and Psychiatric Sciences, 24, 210–226.

24.

Kim

H. J.

Kim

J. M.

(2015). Cognitive behavioral therapy for improving parenting efficacy of married immigrant women. Journal of Families and Better Life, 33(2), 135–148.

25.

Klawetter

Glaze

Sward

Frankel

K. A.

(2021). Warm connections: Integration of infant mental health services into WIC. Community Mental Health Journal, 57, 1130–1141.

26.

J. Y.

Rockhill

K. M.

Tong

V. T.

Morrow

Farr

S. L.

(2017). Trends in postpartum depressive symptoms—27 states, 2004, 2008, and 2012. Morbidity and Mortality Weekly Report, 66, 153.

27.

Kroenke

Spitzer

R. L.

Williams

J. B.

(2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.

28.

Löwe

Kroenke

Gräfe

(2005). Detecting and monitoring depression with a two-item questionnaire (PHQ-2). Journal of Psychosomatic Research, 58(2), 163–171.

29.

Luca

D. L.

Margiotta

Staatz

Garlow

Christensen

Zivin

(2020). Financial toll of untreated perinatal mood and anxiety disorders among 2017 births in the United States. American Journal of Public Health, 110(6), 888–896.

30.

Milgrom

Gemmill

A. W.

(2014). Screening for perinatal depression. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(1), 13–23.

31.

Mollard

Hudson

D. B.

Ford

Pullen

(2016). An integrative review of postpartum depression in rural US communities. Archives of Psychiatric Nursing, 30, 418–424.

32.

Mullens

C. L.

Hernandez

J. A.

Murthy

Hendren

Zahnd

W. E.

Ibrahim

A. M.

Scott

J. W.

(2024). Understanding the impacts of rural hospital closures: A scoping review. The Journal of Rural Health, 40(1), 227–237. https://doi.org/10.1111/jrh.12801

33.

Muzik

Borovska

(2010). Perinatal depression: Implications for child mental health. Mental Health in Family Medicine, 7, 239.

34.

Ngai

F. W.

Wong

P. W. C.

Chung

K. F.

Leung

K. Y.

Tarrant

(2019). Randomized controlled trial of telephone-based cognitive-behavioral therapy on parenting self-efficacy and satisfaction. Translational Behavioral Medicine, 9(6), 1163–1168.

35.

Nidey

Tabb

K. M.

Carter

K. D.

Bao

Strathearn

Rohlman

D. S.

Ryckman

(2020). Rurality and risk of perinatal depression among women in the United States. The Journal of Rural Health, 36(1), 9–16.

36.

O’hara

M. W.

McCabe

J. E.

(2013). Postpartum depression: Current status and future directions. Annual Review of Clinical Psychology, 9, 379–407.

37.

Ohan

J. L.

Leung

D. W.

Johnston

(2000). The parenting sense of competence scale: Evidence of a stable factor structure and validity. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 32, 251.

38.

Pooler

Perry

D. F.

Ghandour

R. M.

(2013). Prevalence and risk factors for postpartum depressive symptoms among women enrolled in WIC. Maternal and Child Health Journal, 17, 1969–1980.

39.

Proctor

B. D.

Semega

J. L.

Kollar

M. A.

(2016). Income and poverty in the United States: 2015. US Census Bureau, Current Population Reports, 14, 1–63.

40.

Rayburn

(2017). Who will deliver the babies? Identifying and addressing barriers. The Journal of the American Board of Family Medicine, 30, 402–404.

41.

Richards

Richardson

(2012). Computer-based psychological treatments for depression: A systematic review and meta-analysis. Clinical Psychology Review, 32, 329–342.

42.

Sawyer

Gale

J. A.

Lambert

(2006). Rural and frontier mental and behavioral health care: Barriers, effective policy strategies, best practices. National Association of Rural Mental Health.

43.

Sheehan

D. V

. (2016). Mini International Neuropsychiatric Interview English version 7.0. Medical Outcomes Systems.

44.

Slomian

Honvo

Emonts

Reginster

J. Y.

Bruyère

(2019). Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Women’s Health, 15, 1745506519844044.

45.

Spitzer

R. L.

Kroenke

Williams

J. B.

Löwe

(2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092–1097.

46.

Tickamyer

A. R.

(2020). Rural poverty: Research and policy for US families. Rural Families and Communities in the United States: Facing Challenges and Leveraging Opportunities, 10, 3–26.

47.

Underwood

Waldie

D’Souza

Peterson

E. R.

Morton

(2016). A review of longitudinal studies on antenatal and postnatal depression. Archives of Women’s Mental Health, 19, 711–720.

48.

United States Department of Agriculture Food and Nutrition Service. (2023, July 31). Special supplemental nutrition program for Women, Infants, and Children (WIC). https://www.fns.usda.gov/wic

49.

Villegas

McKay

Dennis

C. L.

Ross

L. E.

(2011). Postpartum depression among rural women from developed and developing countries: A systematic review. The Journal of Rural Health, 27, 278–288.

50.

Weaver

Himle

Steketee

Murnoff

. (2014). Cognitive Behavioral Therapy. Encyclopedia of Social Work. National Association of Social Workers Press and Oxford University Press.

51.

Weaver

Landry

Jacobson

Whitted

Zeaiter

Ross

Butterfield

(2023). Initiating perinatal depression screening in rural WIC clinics: WIC provider perceptions of barriers and facilitators. Social Work in Mental Health, 21(6), 701–735.

52.

Weaver

Zhang

Landry

Hahn

McQuown

O’Donnell

L. A.

Himle

J. A.

(2022). Technology-assisted, group-based CBT for rural adults’ depression: Open pilot trial results. Research on Social Work Practice, 32, 131–145.

53.

Weaver

Zhang

Xiang

Felsman

Fischer

D. J.

Himle

J. A.

(2021). Entertain me well: An entertaining, tailorable, online platform delivering CBT for depression. Cognitive and Behavioral Practice, 30, 96–115.

54.

Zajicek-Farber

M. L.

(2009). Postnatal depression and infant health practices among high-risk women. Journal of Child and Family Studies, 18, 236.

55.

Zhang

Bornheimer

L. A.

Weaver

Franklin

Hai

A. H.

Guz

Shen

(2019). Cognitive behavioral therapy for primary care depression and anxiety: A secondary meta-analytic review using robust variance estimation in meta-regression. Journal of Behavioral Medicine, 42, 1117–1141.