Treating postpartum depression in rural veterans using internet delivered CBT: program evaluation of MomMoodBooster
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Treating postpartum depression in rural veterans using internet delivered CBT: program evaluation of MomMoodBooster Cara L. Solness1,2 · Emily B. Kroska1,3 · Paul J. Holdefer1,3 · Michael W. O’Hara1,3
Received: 2 June 2020 / Accepted: 30 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Depression in the postpartum period impacts approximately 13–26% of the general population. This number can be much higher for rural veteran women who face additional barriers to accessing specialized mental health services due to isolation and cultural factors. This study reports on a program evaluation of MomMoodBooster, a coach-supported internet-delivered CBT program for the treatment of maternal depression in veteran women. Repeated measures ANOVA, run with this sample of 326 women, demonstrated an overall positive effect size across outcome measures and engagement with no differences found between rural women and their urban counterparts. Some differences between urban and rural participants were found in total and average time spent with coaches as well as ratings of coach helpfulness, possibly indicating some cultural differences between coaches and rural women that need to be addressed. These results and the results of earlier trials suggest that MomMoodBooster can be a valid and efficacious option for reaching under-served veteran populations with specialized postpartum mental health support and is as effective with rural women as with urban women Keywords Postpartum · Depression · Rural · Veteran · Telehealth * Michael W. O’Hara mike‑[email protected] 1
The U.S. Department of Veterans Affairs (VA) Office of Rural Health’s Veterans Rural Health Resource Center in Iowa City, Iowa City, USA
2
Department of Psychological and Quantitative Foundations, The University of Iowa, Iowa City, IA, USA
3
Department of Psychological and Brain Sciences, The University of Iowa, 340 Iowa Ave., Iowa City, IA 52242, USA
Introduction In the general population, 10–15% of women will develop depression in the perinatal period (Ashford et al., 2016; Thomas et al., 2018). Among active duty and veteran women, the prevalence may be higher. For example, Klaman and Turner (2016) found that 16–32% of veteran women in the antenatal period and 19% in the postpartum period experience depression. Moreover, Appolomio and Fingerhut (2008) reported that 19.5% active duty, exposed to combat, first-time mothers experience postpartum depression. Finally, Schachman and Lindsey (2013) found that 50.7% of mothers (enlisted and civilian sample) with deployed partners experience postpartum depression. In the general population, risk factors for developing postpartum depression are well known. Military mothers face additional stressors such as the increased isolation of living on base, separation from deployed spouses, comorbid diagnoses of post-traumatic stress disorder (PTSD) (Nguyen et al., 2013), frequent relocations, working longer into pregnancy, less reported support (Klaman & Turner, 2016), and incre
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