Background: Between 10 and 15 percent of all new mothers experience depressive symptoms of varying severity. For many, this is stigmatized and difficult to talk about, and many do not receive help. Previous studies have shown that web-based programs for mental health issues can be as effective as other psychological treatments when used in combination with guidance from healthcare professionals. Prompt assistance is crucial because untreated depression can negatively impact the interaction with the child. Mamma Mia is an internet program (app) designed to prevent perinatal depression. The program follows the pregnant woman from gestational week 21 until the child is six months old, providing support on the journey to motherhood. Six times during the program, women are asked about depressive symptoms and receive tailored feedback based on their responses. Additionally, they receive advice on where to seek further help. In a study of the Mamma Mia program, results showed that women using Mamma Mia had fewer depressive symptoms. The effect was most significant for those with the highest initial scores on depressive symptoms, although these women were also more likely to drop out of the study. Based on results from other studies, it is likely that the effectiveness of Mamma Mia will be greater if the program is combined with guidance from midwives or health nurses. It is also likely that fewer participants would drop out.
Purpose: In collaboration with an American research group, Mamma Mia will now be further developed and improved. The overall goal of the current project is to implement Mamma Mia at well-baby clinics stations and evaluate the effectiveness, as well as cost-effectiveness, of Mamma Mia with and without guidance from healthcare professionals.
Method: Approximately 1000 pregnant women will be recruited from health stations in municipalities where the training program "Tidlig inn" (Early In) is offered or the "Edinburgh method" is implemented. "Tidlig inn" is a training package for professionals working with pregnant women and parents of young children regarding substance abuse, mental health, and violence in close relationships. The program was initiated in 2010 by the Norwegian Directorate of Health and the Directorate for Children, Youth, and Family Affairs, and is offered in around 300 municipalities. Municipalities randomizedt to the intervention group that will provide Mamma Mia with guidance will receive training in the implementation and practical use of Mamma Mia. Recruitment of pregnant women will take place during prenatal care at the well-baby clinics before gestational week 25. Information on depressive symptoms, partner relationships, subjective well-being, breastfeeding, attachment, social support, and demographic factors will be collected using validated measurement instruments. Measurements will be taken at inclusion during gestational weeks 20-26, at 37 weeks, and one and a half, three, six, and 12 months after childbirth. Interviews with women will also be conducted, and user data from Mamma Mia will be collected. Focus groups with healthcare professionals will be conducted, and electronic questionnaires will be sent out at 3 and 15 months after training completion. The questionnaires and focus groups will largely revolve around the same themes, including feasibility, utility, expected results, organizational culture, implementation climate, and similar aspects. Information on guidance and implementation will also be collected.
