Development of a spouse-inclusive framework for digital self-management of perinatal depression and anxiety [EMBARGOED]

Abstract

Introduction: Spouse-inclusive intervention has been found effective to improve perinatal mental health; however, it is commonly delivered face-to-face and requires high commitment from spouses and healthcare providers, thus deemed unsustainable. While several digital applications demonstrate modest success in reducing the symptoms of depression and anxiety, spouses’ participation in such approach remains limited. Therefore, this study aimed to develop a spouse-inclusive framework for the digital self-management of perinatal depression and anxiety based on the viewpoints of women, spouses, and field experts. Materials and method: Phase I involved the use of a generic qualitative research design whereby in-depth interviews were conducted with 20 perinatal women (with symptoms of depression and anxiety) and 15 men (spouses). The participants were recruited from the obstetrics and gynaecology clinics at Sultan Ahmad Shah Medical Centre and Hospital Canselor Tuanku Muhriz using the following criteria: Edinburgh Postnatal Depression Scale (EPDS) score of ?12 or Depression Anxiety Stress Scale (DASS) score of ?8 for depression and ?7 for anxiety. The interview data was analysed using framework analysis. In Phase II, the existing literature review and self-care elements from WHO were integrated with the findings in Phase I to design a spouse-inclusive framework. Results: In Phase I, three main themes were identified from the interview, namely: i) adjusting to a new period of life, ii) dealing with perinatal distress, and iii) mobilising needs and support. While spouse support was perceived by the perinatal women as one of the contributing factors to depression and anxiety, financial constraint was seen by the men (spouses) as the major factor leading to depression and anxiety. Both women and spouses preferred to have a user-friendly online intervention to obtain knowledge on maternal mental health. They expressed their informational needs on communication skills, depression and anxiety cues, self-screening, childcare management, perinatal care, and coping mechanisms. In Phase II, the spouse-inclusive framework was designed to increase the perception and awareness on depression and anxiety during pregnancy until one year after childbirth among perinatal women (with depression and anxiety) and their spouses. The framework was found to have good content validation (mean CVI = 0.88). Conclusion: Both perinatal women (with depression and anxiety) and their spouses acknowledged that the spouse-inclusive framework (which will later be digitalised into an application) can alleviate perinatal depression and anxiety. Subsequent validation indicates that the spouse-inclusive framework has high validity and serves as a suitable educational tool for further research. Keywords: Perinatal, Spouse Support, Depression, Anxiety, Digital, Intervention ?