Rural Americans experience higher rates of perinatal depression (PND) compared to non-rural Americans yet have decreased access to treatment. To address treatment access disparities, we must build capacity for care within non-mental health settings and leverage technology. This study uses a phenomenological approach, exploring treatment experiences of rural perinatal people with PND who participated in a technology-assisted cognitive behavioral-based treatment program. Participants who completed at least one program session were invited to participate in a qualitative interview about their experience. Four core themes emerged: (1) educational value, (2) factors impacting program engagement, (3) accessibility, and (4) suggested improvements. The program offers a treatment option for rural perinatal people and presents a model for increasing access to care in rural areas.
AnderssonG.CuijpersP. (2009). Internet-based and other computerized psychological treatments for adult depression: A meta-analysis. Cognitive Behaviour Therapy, 38(4), 196–205. https://doi.org/10.1080/16506070903318960
2.
AndrewsG.CuijpersP.CraskeM. G.McEvoyP.TitovN. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: A meta-analysis. PLOS ONE, 5(10), Article e13196. https://doi.org/10.1371/journal.pone.0013196
BalbierzA.Bodnar-DerenS.WangJ. J.HowellE. A. (2015). Maternal depressive symptoms and parenting practices 3-months postpartum. Maternal and Child Health Journal, 19(6), 1212–1219. https://doi.org/10.1007/s10995-014-1625-6
6.
BarreraM.CastroF. G.StryckerL. A.ToobertD. J. (2013). Cultural adaptations of behavioral health interventions: A progress report. Journal of Consulting and Clinical Psychology, 81(2), 196–205. https://doi.org/10.1037/a0027085
7.
BonariL.PintoN.AhnE.EinarsonA.SteinerM.KorenG. (2004). Perinatal risks of untreated depression during pregnancy. The Canadian Journal of Psychiatry, 49(11), 726–735. https://doi.org/10.1177/070674370404901103
8.
BraddockK.DillardJ. P. (2016). Meta-analytic evidence for the persuasive effect of narratives on beliefs, attitudes, intentions, and behaviors. Communication Monographs, 83(4), 446–467. https://doi.org/10.1080/03637751.2015.1128555
9.
ButlerA.ChapmanJ.FormanE.BeckA. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17–31. https://doi.org/10.1016/j.cpr.2005.07.003
CheesmondN. E.DaviesK.InderK. 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(1), 45–59. https://doi.org/10.1037/rmh0000109
CrumbL.MingoT. M.CroweA. (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. https://doi.org/10.1016/j.mhp.2019.01.010
14.
EtzelmuellerA.VisC.KaryotakiE.BaumeisterH.TitovN.BerkingM.CuijpersP.RiperH.EbertD. 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(8), e18100. https://doi.org/10.2196/18100
15.
FarvoldenP.DenisoffE.SelbyP.BagbyR. M.RudyL. (2005). Usage and longitudinal effectiveness of a web-based self-help cognitive behavioral therapy program for panic disorder. Journal of Medical Internet Research, 7(1), e7. https://doi.org/10.2196/jmir.7.1.e7
16.
FelsmanP.WeaverA.SegalJ.RubyanM. J.LandryÇ.CramptonK.Abdur-RahmanJ.DeKamA.Doss-SimmonsT.HimleJ. A. (2024). Doing better on dialysis: Open pilot outcomes of a technology-assisted, entertaining, CBT-based depression treatment for people with end-stage kidney disease at a dialysis clinic. Journal of Nephrology Social Work, 34, 100498.
17.
FongK. (2019). Concealment and constraint: Child protective services fears and poor mothers’ institutional engagement. Social Forces, 97(4), 1785–1810. https://doi.org/10.1093/sf/soy093
18.
GimbelL. A.WeingartenS. J.SmidM. C.HoffmanM. C. (2024). Maternal mental health as a major contributor to maternal mortality. Seminars in Perinatology, 48(6), 151943. https://doi.org/10.1016/j.semperi.2024.151943
GreenM. C.BrockT. C. (2000). The role of transportation in the persuasiveness of public narratives. Journal of Personality and Social Psychology, 79(5), 701–721. https://doi.org/10.1037/0022-3514.79.5.701
21.
HendersonR. C.WilliamsP.GabbidonJ.FarrellyS.SchaumanO.HatchS.ThornicroftG.BhugraD.ClementS. (2015). Mistrust of mental health services: Ethnicity, hospital admission and unfair treatment. Epidemiology and Psychiatric Sciences, 24(3), 258–265. https://doi.org/10.1017/S2045796014000158
22.
HimleJ. A.BybeeD.SteinbergerE.LavioletteW. T.WeaverA.VlnkaS.GolenbergZ.LevineD. S.HeimbergR. G.O’DonnellL. 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. https://doi.org/10.1016/j.brat.2014.10.005
23.
HofmannS. G.AsnaaniA.VonkI. J. J.SawyerA. T.FangA. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1
24.
HorowitzJ. A.GoodmanJ. H. (2005). Identifying and treating postpartum depression. Journal of Obstetric, Gynecologic & Neonatal Nursing, 34(2), 264–273. https://doi.org/10.1177/0884217505274583
25.
JahanN.WentT. R.SultanW.SapkotaA.KhurshidH.QureshiI. A.AlfonsoM. (2021). Untreated depression during pregnancy and its effect on pregnancy outcomes: A systematic review. Cureus. https://doi.org/10.7759/cureus.17251
26.
KingstonD.ToughS.WhitfieldH. (2012). Prenatal and postpartum maternal psychological distress and infant development: A systematic review. Child Psychiatry & Human Development, 43(5), 683–714. https://doi.org/10.1007/s10578-012-0291-4
27.
KrebsP.ProchaskaJ. O.RossiJ. S. (2010). A meta-analysis of computer-tailored interventions for health behavior change. Preventive Medicine, 51(3–4), 214–221. https://doi.org/10.1016/j.ypmed.2010.06.004
28.
LeeY.-L.TienY.BaiY.-S.LinC.-K.YinC.-S.ChungC.-H.SunC.-A.HuangS.-H.HuangY.-C.ChienW.-C.KangC.-Y.WuG.-J. (2022). Association of postpartum depression with maternal suicide: A nationwide population-based study. International Journal of Environmental Research and Public Health, 19(9), 5118. https://doi.org/10.3390/ijerph19095118
29.
LindahlV.PearsonJ. L.ColpeL. (2005). Prevalence of suicidality during pregnancy and the postpartum. Archives of Women’s Mental Health, 8(2), 77–87. https://doi.org/10.1007/s00737-005-0080-1
30.
MinkovitzC. S.StrobinoD.ScharfsteinD.HouW.MillerT.MistryK. B.SwartzK. (2005). Maternal depressive symptoms and children’s receipt of health care in the first 3 years of life. Pediatrics, 115(2), 306–314. https://doi.org/10.1542/peds.2004-0341
31.
MollardE.HudsonD. B.FordA.PullenC. (2016). An integrative review of postpartum depression in rural U.S. communities. Archives of Psychiatric Nursing, 30(3), 418–424. https://doi.org/10.1016/j.apnu.2015.12.003
32.
Moyer-GuséE. (2008). Toward a theory of entertainment persuasion: Explaining the persuasive effects of entertainment-education messages. Communication Theory, 18(3), 407–425. https://doi.org/10.1111/j.1468-2885.2008.00328.x
33.
MuzikM.BorovskaS. (2010). Perinatal depression: Implications for child mental health. Mental Health in Family Medicine, 7(4), 239–247.
34.
NoarS. M.BenacC. N.HarrisM. S. (2007). Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychological Bulletin, 133(4), 673–693. https://doi.org/10.1037/0033-2909.133.4.673
O’MahenH.FedockG.HenshawE.HimleJ. A.FormanJ.FlynnH. A. (2012). Modifying CBT for perinatal depression: What do women want?Cognitive and Behavioral Practice, 19(2), 359–371. https://doi.org/10.1016/j.cbpra.2011.05.005
37.
O’MahenH.HimleJ. A.FedockG.HenshawE.FlynnH. (2013). A pilot randomized controlled trial of cognitive behavioral therapy for perinatal depression adapted for women with low incomes. Depression and Anxiety, 30(7), 679–687. https://doi.org/10.1002/da.22050
38.
PoolerJ.PerryD. F.GhandourR. M. (2013). Prevalence and risk factors for postpartum depressive symptoms among women enrolled in WIC. Maternal and Child Health Journal, 17(10), 1969–1980. https://doi.org/10.1007/s10995-013-1224-y
39.
RichardsD.RichardsonT. (2012). Computer-based psychological treatments for depression: A systematic review and meta-analysis. Clinical Psychology Review, 32(4), 329–342. https://doi.org/10.1016/j.cpr.2012.02.004
SawyerD.GaleJ.LambertD. (2006). Rural and frontier mental and behavioral health care: Barriers, effective policy strategies, best practices. In PsycEXTRA Dataset. https://doi.org/10.1037/e546002013-001
42.
SlomianJ.HonvoG.EmontsP.ReginsterJ.-Y.BruyèreO. (2019). Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Women’s Health (London, England), 15, 1745506519844044. https://doi.org/10.1177/1745506519844044
43.
StraussA. (1987). Qualitative analysis for social scientists. Cambridge University Press.
44.
StraussA.CorbinJ. (1990). Basics of qualitative research. Sage.
45.
StuhlmillerC.TolchardB. (2009). Computer-assisted for depression & anxiety: Increasing accessibility to evidence-based mental health treatment. Journal of Psychosocial Nursing and Mental Health Services, 47(7), 32–39. https://doi.org/10.3928/02793695-20090527-01
46.
ThomasK. C.EllisA. R.KonradT. R.HolzerC. E.MorrisseyJ. P. (2009). County-level estimates of mental health professional shortage in the United States. Psychiatric Services, 60(10), 1323–1328. https://doi.org/10.1176/ps.2009.60.10.1323
47.
van BallegooijenW.CuijpersP.van StratenA.KaryotakiE.AnderssonG.SmitJ. H.RiperH. (2014). Adherence to internet-based and face-to-face cognitive behavioural therapy for depression: A meta-analysis. PLOS ONE, 9(7), e100674. https://doi.org/10.1371/journal.pone.0100674
48.
van LaerT.de RuyterK.ViscontiL. M.WetzelsM. (2014). The extended transportation-imagery model: A meta-analysis of the antecedents and consequences of consumers’ narrative transportation. Journal of Consumer Research, 40(5), 797–817. https://doi.org/10.1086/673383
49.
VillegasL.McKayK.DennisC.-L.RossL. E. (2011). Postpartum depression among rural women from developed and developing countries: A systematic review. The Journal of Rural Health, 27(3), 278–288. https://doi.org/10.1111/j.1748-0361.2010.00339.x
50.
WardM.SchulzA. J.IsraelB. A.RiceK.MarteniesS. E.MarkarianE. (2018). A conceptual framework for evaluating health equity promotion within community-based participatory research partnerships. Evaluation and Program Planning, 70, 25–34. https://doi.org/10.1016/j.evalprogplan.2018.04.014
51.
WeaverA.LandryÇ.RubyanM. J.WhittedR.ZeaiterH.RossD.HallS.HolzworthJ.EgbuoguB.SmithF. N.ButterfieldA. (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. https://doi.org/10.1080/15332985.2023.2214653
52.
WeaverA.RubyanM. J.HolzworthJ.HallS. V.RossD. M.FelsmanP.LandryÇ.WhittedR.LongB.Al-ShamariT.ZhangA.HimleJ. A. (2024). Moms & babies feeling better together: Open pilot outcomes of a technology-assisted, entertaining, CBT-based depression treatment for low-income perinatal people served by a Rural Michigan WIC clinic. Families in Society. Advance online publication. https://doi.org/10.1177/10443894241281078
53.
WeaverA.ZhangA.LandryÇ.HahnJ.McQuownL.O’DonnellL. A.HarringtonM. M.BuysT.TuckerK. M.PfeifferP.KilbourneA. M.Grogan-KaylorA.HimleJ. A. (2022). Technology-assisted, group-based CBT for rural adults’ depression: Open pilot trial results. Research on Social Work Practice, 32(2), 131–145. https://doi.org/10.1177/10497315211044835
54.
WeaverA.ZhangA.XiangX.FelsmanP.FischerD. J.HimleJ. A. (2023). Entertain me well: An entertaining, tailorable, online platform delivering CBT for depression. Cognitive and Behavioral Practice, 30(1), 96–115. https://doi.org/10.1016/j.cbpra.2021.09.003
55.
WilsonC. J.CottoneR. R. (2013). Using cognitive behavior therapy in clinical work with African American children and adolescents: A review of the literature. Journal of Multicultural Counseling and Development, 41(3), 130–143. https://doi.org/10.1002/j.2161-1912.2013.00032.x
56.
WisnerK. L.ParryB. L.PiontekC. M. (2002). Postpartum depression. New England Journal of Medicine, 347(3), 194–199. https://doi.org/10.1056/NEJMcp011542
57.
WoukK.StuebeA. M.Meltzer-BrodyS. (2017). Postpartum mental health and breastfeeding practices: An analysis using the 2010–2011 pregnancy risk assessment monitoring system. Maternal and Child Health Journal, 21(3), 636–647. https://doi.org/10.1007/s10995-016-2150-6
58.
YuH.ShenQ.BrännE.YangY.ObergA. S.ValdimarsdóttirU. A.LuD. (2024). Perinatal depression and risk of suicidal behavior. JAMA Network Open, 7(1), Article e2350897. https://doi.org/10.1001/jamanetworkopen.2023.50897
