A behavioral activation (BA) mobile app called The Guardians: Unite The Realms may be effective in reducing depression among pregnant women, according to a recent study published in JMIR Formative Research.
Takeaways
- The study suggests that The Guardians: Unite The Realms, a behavioral activation (BA) mobile app, shows promise in reducing depression among pregnant women, providing a potential alternative to traditional interventions.
- Perinatal depression affects 10% to 15% of pregnant women in high-income countries and is associated with adverse maternal and infant outcomes, highlighting the importance of effective interventions.
- Pregnant women, as per data, may prefer psychotherapeutic approaches like BA over antidepressant medications. The integration of BA into a mobile app aligns with this preference and can increase access to treatment.
- The Guardians app, designed as a gaming BA app, incorporates BA techniques into a mobile game context. Preliminary data indicate high user engagement, suggesting that gamification can enhance participation in behavioral activation.
- Participants in the study reported high satisfaction levels with The Guardians app. Engagement metrics correlated positively with satisfaction measures. Notably, completing various activities within the app was associated with mood improvements, indicating the potential effectiveness of the intervention.
Perinatal depression (PD) has been estimated in 10% to 15% of pregnant women in high-income countries, and it is associated with multiple adverse maternal and infant outcomes. The US Preventive Services Task Force recommends pregnant or postpartum individuals with increased PD risk receive counseling interventions.
Data has indicated pregnant women may prefer to be treated with psychotherapeutic approaches rather than antidepressant medications. This includes BA, which encourages engagement in activities to reduce depressive symptoms of avoidance and isolation.
Implementing BA into computer-based interventions would significantly increase access to the treatment. Data has indicated efficacy for mobile apps in providing BA.
The Guardians: Unite the Realms is a gaming BA app designed to increase engagement by incorporating BA techniques into the context of a mobile game. Preliminary data has indicated high levels of engagement among users of the app.
Investigators conducted a study to determine the efficacy of The Guardians in managing PD symptoms and receive participant feedback. Eligibility criteria included being aged over 18 years, pregnant, English speaking, having access to a smartphone, and having a Patient Health Questionnaire-9 score of 10 or more.
Patients with a bipolar or psychotic disorder, active mania, psychosis, substance abuse, or immediate risk of self-harm were excluded from the analysis. Postpartum women were also excluded.
Demographic characteristics, psychiatric history, and pregnancy characteristics were obtained during a baseline interview with a trained research assistant. The assistant helped participants download The Guardians app at the end of the interview.
Depressive and anxiety symptoms were evaluated over the following 10 weeks through bi-weekly surveys completed on Research Electronic Data Capture; Vanderbilt University. The final assessment occurred over mobile phone, during which participants completed a qualitative exit interview and received follow-up measures.
In The Guardians, players must collect pets to send on missions with a long-term goal of defeating enemies from 3 different realms. Missions are completed after 10 to 60 seconds in real time, and lead to pets receiving experience and other rewards that can be used to further progression. App analytics are collected through the game’s cloud save and gameplay recovery.
Players are made to select activities from 75 suggestions or by player choice, with categories being low, medium, or high effort. Categories included basics, arts and crafts, social, fitness, and fun. Rewards are not determined by effort or category, and players provide feedback about how they felt about the activity once it is completed.
A major depressive episode (MDE) was reported through the Mini International Neuropsychiatric Interview at baseline. MDE criteria included having a depressed mood most of the day or significantly reduced interest in activities for 2 weeks or longer, as well as presenting with at least 5 MDE symptoms.
